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Preterm delivery risk among pregnancies with history of first trimester vaginal bleeding and intrauterin hematoma

Year 2006, Volume: 37 Issue: 3, 47 - 51, 01.04.2006

Abstract

Aim:Vaginal bleeding during the first trimester is considered as threatened abortion. Vaginal bleeding can be associated by sonographic demonstration of subchorionic hematoma. This study evaluates the risk of preterm delivery among pregnancies with a history of intrauterin hematoma with vaginal bleeding during the first trimester. Materials and Methods: The files of singleton pregnancies followed up at our center between 2001 and 2003 were retrospectively evaluated. Gestations with vaginal bleeding and intrauterine hematoma during the first trimester were allocated for the study. This group was compared to control gestations beyond 20 weeks according to preterm delivery rate and low birth weight infant. Results: During the assesed period, 58 (6.6%) pregnant had vaginal bleeding and intrauterine hematom among 876 pregnant. Mean maternal age in study group was 30.8 ±4.1, while 31.2 ±4.6 in control group (p>0.05). Mean delivery gestational age was 35.7 ±3.9 weeks and 37.2 ±3.5 weeks in control which was significantly different. Mean infant birth weight was 2805.2 ±671.2 gr and 3045.3 ±601.5 gr in control group ( p-0.01). Eleven pregnant (18.9%) in control group and 59 (7.2%) pregnant in control group delivered at or before 33 weeks of gestation (p=0.0002, OR: 3.3, %95CI: 1.6-6.6). Conclusion: History of vaginal bleeding with intrauterine hematoma significantly increases preterm delivery and low birth weight infant compared to asymptomatic pregnant. Keeping in mind that assessed pregnancies were beyond 20 weeks of gestation, regardless of size of hematoma, adverse obstetric outcome can be associated in women with threatened abortion symptoms.

References

  • Seki H, Kuromaki K, Takeda S, Kinoshita K. Persistent subchorionic hematoma with clinical symptoms until delivery. Int J Gynaecol Obstet. 1998 ;63:123-8
  • Borlum KG, Thorns en A, Clausen I, Eriksen G. Long-term prognosis of pregnancies in women with intrauterine hematomas. Obstet Gynecol. 1989 ;74:231-3 Pearlstone MM, Baxi LV. Subchorionic hematoma: a review. Obstet Gynecol Surv 1993:48: 65-8 Bennett GL,Bromley B, Lieberman E, Benacerraf BR. Subchorionic hemorrhage in first-trimester pregnancies: prediction of pregnancy outcome with sonography
  • Radiology. 1996 ;200:803-6
  • Mandruzzato GP, D'Ottavio G, Rustico MA, Fontana A, Bogatti P. The intrauterine hematoma: diagnostic and clinical aspects. J Clin Ultrasound. 1989 ;17:503-10
  • Strobino BA, Pantel-Silverman J. First trimester vaginal bleeding and the loss of chromosomally normal and abnormal conceptions. Am J Obstet Gynecol. 1987 ;157:1150-4
  • Pedersen JF, Mantoni M. Prevalence and significance of subchorionic hemorrhage in threatened abortion: a sonographic study. AJR Am J Roentgenol. 1990 ;154:535-7
  • Kaufman AJ, Fleischer AC, Thieme GA, Shah DM, James AE Jr. Separated chorioamnion and elevated chorion: sono graphic features and clinical significance
  • J Ultrasound Med. 1985 ;4:119-25 Tower CL, Regan L. Intrauterine haematomas in a recurrent miscarriage population. Hum Reprod. 2001; 16:2005-7
  • Maso G, D'Ottavio G, De Seta F, Sartore A, Piccoli M, Mandruzzato G. First-trimester intrauterine hematoma and outcome of pregnancy. Obstet Gynecol. 2005 ;105:339-44 Nagy S, Bush M, Stone J, Lapinski RH, Gardo S. Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy. Obstet Gynecol. 2003 ;102:94-100 Ben-Haroush A, Yogev Y, Mashiach R, Meizner I Pregnancy outcome of threatened abortion with subchorionic hematoma: possible benefit of bed-rest? Isr Med Assoc J. 2003;5:422-4 Pedersen JF, Mantoni M. Large intrauterine haematomata in threatened miscarriage. Frequency and clinical consequences. Br J Obstet Gynaecol. 1990;97:75-7 Stabile I, Campbell S, Grudzinskas JGThreatened miscarriage and intrauterine hematomas. Sonographic and biochemical studies. J Ultrasound Med. 1989;8:289-92 Kurjak A, Schulman H, Zudenigo D, Kupesic S, Kos M, Goldenberg M. Subchorionic hematomas in early pregnancy: clinical outcome and blood flow patterns. J Matem Fetal Med. 1996;5:41-4
  • Sharma G, Kalish RB, Chasen ST Prognostic factors associated with antenatal subchorionic echolucencies. Am J Obstet Gynecol. 2003; 189:994-6
  • Poulose T, Richardson R, Ewings P, Fox R
  • Probability of early pregnancy loss in women with vaginal bleeding and a singleton live fetus at ultrasound scan. J Obstet Gynaecol. 2006 ;26:782-4 Leite J, Ross P, Rossi AC, Jeanty P. Prognosis of very large first-trimester hematomas. J Ultrasound Med. 2006,-25:1441-5

Birinci trimesterde vaginal kanama ve intrauterin hematom görünen gebelerde preterm doğum riski

Year 2006, Volume: 37 Issue: 3, 47 - 51, 01.04.2006

Abstract

Amaç: Birinci trimesterde vaginal kanama görülebilmekte ve düşük tehdidi olarak algılanmaktadır. Vaginal kanama ile birlikte sonografik olarak intrauterin subkoryonik hematom görüntüsü de izlenebilmektedir. Bu çalışmamızda viabilite sınırını aşmış gebeliklerde ilk trimesterde saptanan hematoma bağlı vaginal kanamanın obstetrik açıdan erken doğum için risk faktörü olup olmadığı araştırılmıştır. Materyal ve Metod: Merkezimizde 2001 ile 2003 yılları arasında takip edilen tekiz gebeliklerin dosyalan retrospektif olarak değerlendirilmiştir. Gebeliğin ilk 12 haftasında vaginal kanama şikayeti olan ve transvaginal sonografide hematom izlenmiş hastalar çalışma grubu olarak seçilmiştir. Aynı dönemde takip edilen ve 20. haftayı aşmış vaginal kanama öyküsü olmayan gebeler kontrol grubu olarak kullanılmıştır. Bulgular: İncelenen dönem içersinde 876 gebenin 58'nde (%6.6) vaginal kanama ve hematom tespit edilmiştir. Çalışma grubunda ortalama maternal yaş 30.8 ±4.1, kontrol grubunda 31.2 ±4.6 olarak hesaplanmış ve fark bulunamamıştır. Çalışma grubunda ortalama doğum haftası 35.7 ±3.9 iken kontrol grubunda 37.2 ±3.5 olarak bulunmuş ve istatistiksel olarak anlamlıdır (p=0.002). Bu bağlamda ortalama doğum ağırlığı değerlendirildiğinde çalışma grubunda bebek ağırlığı anlamlı olarak daha az saptanmıştır (2805.2 ±671.2 gr ve 3045.3 ±601.5 gr, p=0.01). Çalışma grubunda 11 (%18.9)gebe 33. hafta ve öncesinde doğum yaparken, kontrol grubunda 59 (%7.2) gebe doğum yapmıştır (p=0.0002, OR: 3.3, %95CI: 1.6-6.6). Sonuç: Çalışmamızın sonuçları gebeliğin erken döneminde izlenen vaginal kanamayla devam eden intrauterin hematomların viabilite sınırını aşmış gebeliklerde erken doğum ve düşük doğum ağırlıklı bebek risklerini arttırdığını göstermiştir. İncelenen gebeliklerin 20. haftayı geçtikleri göz önüne alınacak olursa, kötü obstetrik sonuç açısından hematomun boyutu ne olursa olsun önemli bir etken olduğu düşünülmelidir.

References

  • Seki H, Kuromaki K, Takeda S, Kinoshita K. Persistent subchorionic hematoma with clinical symptoms until delivery. Int J Gynaecol Obstet. 1998 ;63:123-8
  • Borlum KG, Thorns en A, Clausen I, Eriksen G. Long-term prognosis of pregnancies in women with intrauterine hematomas. Obstet Gynecol. 1989 ;74:231-3 Pearlstone MM, Baxi LV. Subchorionic hematoma: a review. Obstet Gynecol Surv 1993:48: 65-8 Bennett GL,Bromley B, Lieberman E, Benacerraf BR. Subchorionic hemorrhage in first-trimester pregnancies: prediction of pregnancy outcome with sonography
  • Radiology. 1996 ;200:803-6
  • Mandruzzato GP, D'Ottavio G, Rustico MA, Fontana A, Bogatti P. The intrauterine hematoma: diagnostic and clinical aspects. J Clin Ultrasound. 1989 ;17:503-10
  • Strobino BA, Pantel-Silverman J. First trimester vaginal bleeding and the loss of chromosomally normal and abnormal conceptions. Am J Obstet Gynecol. 1987 ;157:1150-4
  • Pedersen JF, Mantoni M. Prevalence and significance of subchorionic hemorrhage in threatened abortion: a sonographic study. AJR Am J Roentgenol. 1990 ;154:535-7
  • Kaufman AJ, Fleischer AC, Thieme GA, Shah DM, James AE Jr. Separated chorioamnion and elevated chorion: sono graphic features and clinical significance
  • J Ultrasound Med. 1985 ;4:119-25 Tower CL, Regan L. Intrauterine haematomas in a recurrent miscarriage population. Hum Reprod. 2001; 16:2005-7
  • Maso G, D'Ottavio G, De Seta F, Sartore A, Piccoli M, Mandruzzato G. First-trimester intrauterine hematoma and outcome of pregnancy. Obstet Gynecol. 2005 ;105:339-44 Nagy S, Bush M, Stone J, Lapinski RH, Gardo S. Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy. Obstet Gynecol. 2003 ;102:94-100 Ben-Haroush A, Yogev Y, Mashiach R, Meizner I Pregnancy outcome of threatened abortion with subchorionic hematoma: possible benefit of bed-rest? Isr Med Assoc J. 2003;5:422-4 Pedersen JF, Mantoni M. Large intrauterine haematomata in threatened miscarriage. Frequency and clinical consequences. Br J Obstet Gynaecol. 1990;97:75-7 Stabile I, Campbell S, Grudzinskas JGThreatened miscarriage and intrauterine hematomas. Sonographic and biochemical studies. J Ultrasound Med. 1989;8:289-92 Kurjak A, Schulman H, Zudenigo D, Kupesic S, Kos M, Goldenberg M. Subchorionic hematomas in early pregnancy: clinical outcome and blood flow patterns. J Matem Fetal Med. 1996;5:41-4
  • Sharma G, Kalish RB, Chasen ST Prognostic factors associated with antenatal subchorionic echolucencies. Am J Obstet Gynecol. 2003; 189:994-6
  • Poulose T, Richardson R, Ewings P, Fox R
  • Probability of early pregnancy loss in women with vaginal bleeding and a singleton live fetus at ultrasound scan. J Obstet Gynaecol. 2006 ;26:782-4 Leite J, Ross P, Rossi AC, Jeanty P. Prognosis of very large first-trimester hematomas. J Ultrasound Med. 2006,-25:1441-5
There are 12 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Ulun Uluğ This is me

Esra Aksoy Jozwıak This is me

Süleyman Tosun This is me

Mustafa Bahçeci This is me

Publication Date April 1, 2006
Published in Issue Year 2006 Volume: 37 Issue: 3

Cite

APA Uluğ, U., Jozwıak, E. A., Tosun, S., Bahçeci, M. (2006). Birinci trimesterde vaginal kanama ve intrauterin hematom görünen gebelerde preterm doğum riski. Zeynep Kamil Tıp Bülteni, 37(3), 47-51. https://doi.org/10.16948/zktb.14202
AMA Uluğ U, Jozwıak EA, Tosun S, Bahçeci M. Birinci trimesterde vaginal kanama ve intrauterin hematom görünen gebelerde preterm doğum riski. Zeynep Kamil Tıp Bülteni. April 2006;37(3):47-51. doi:10.16948/zktb.14202
Chicago Uluğ, Ulun, Esra Aksoy Jozwıak, Süleyman Tosun, and Mustafa Bahçeci. “Birinci Trimesterde Vaginal Kanama Ve Intrauterin Hematom görünen Gebelerde Preterm doğum Riski”. Zeynep Kamil Tıp Bülteni 37, no. 3 (April 2006): 47-51. https://doi.org/10.16948/zktb.14202.
EndNote Uluğ U, Jozwıak EA, Tosun S, Bahçeci M (April 1, 2006) Birinci trimesterde vaginal kanama ve intrauterin hematom görünen gebelerde preterm doğum riski. Zeynep Kamil Tıp Bülteni 37 3 47–51.
IEEE U. Uluğ, E. A. Jozwıak, S. Tosun, and M. Bahçeci, “Birinci trimesterde vaginal kanama ve intrauterin hematom görünen gebelerde preterm doğum riski”, Zeynep Kamil Tıp Bülteni, vol. 37, no. 3, pp. 47–51, 2006, doi: 10.16948/zktb.14202.
ISNAD Uluğ, Ulun et al. “Birinci Trimesterde Vaginal Kanama Ve Intrauterin Hematom görünen Gebelerde Preterm doğum Riski”. Zeynep Kamil Tıp Bülteni 37/3 (April 2006), 47-51. https://doi.org/10.16948/zktb.14202.
JAMA Uluğ U, Jozwıak EA, Tosun S, Bahçeci M. Birinci trimesterde vaginal kanama ve intrauterin hematom görünen gebelerde preterm doğum riski. Zeynep Kamil Tıp Bülteni. 2006;37:47–51.
MLA Uluğ, Ulun et al. “Birinci Trimesterde Vaginal Kanama Ve Intrauterin Hematom görünen Gebelerde Preterm doğum Riski”. Zeynep Kamil Tıp Bülteni, vol. 37, no. 3, 2006, pp. 47-51, doi:10.16948/zktb.14202.
Vancouver Uluğ U, Jozwıak EA, Tosun S, Bahçeci M. Birinci trimesterde vaginal kanama ve intrauterin hematom görünen gebelerde preterm doğum riski. Zeynep Kamil Tıp Bülteni. 2006;37(3):47-51.