Predictors of adverse outcomes in pregnant women with intrauterine hematoma

Abstract

Objective: To investigate the relationship between clinical features evaluated at presentation and the presence of adverse maternal or perinatal outcomes in pregnant women with intrauterine hematoma (IUH). Methods: Pregnant women aged 18 years and over who were diagnosed with IUH and had a single live fetus of six to 12 weeks at that time were retrospectively reviewed for the period from January 1, 2019 to July 30, 2021. The patients were divided into two groups according to the presence or absence of adverse pregnancy outcomes after IUH. The clinical features of the patients were evaluated. The effect of clinical factors on adverse pregnancy outcomes was determined using the logistic regression analysis. Results: We found adverse pregnancy outcomes in 31.6% (n=42) of 133 patients included in the study. According to the multiple logistic regression analysis, age≥35 years [odds ratio (OR): 2.62, 95% confidence interval (CI): 1.16-4.37, p<0.001], presence of vaginal bleeding (OR: 2.53, 95% CI: 1.34-3.89, p=0.001), hematoma size≥4 cm (OR: 2.38, 95% CI: 1.08-4.15, p=0.023) and presence of retroplacental hematoma (OR: 2.44, 95% CI: 1.68-3.56, p<0.001) were risk factors for adverse pregnancy outcomes. Conclusion: In the presence of IUH, pregnant women aged ≥35 years and those with vaginal bleeding, hematoma size of ≥4 cm, and retroplacental hematoma are at risk of adverse pregnancy outcomes. These factors can help identify pregnant women who require close monitoring.

Keywords

• adverse outcome
• Intrauterine hematoma
• pregnancy
• predictors

References

1. 1. Ott J, Pecnik P, Promberger R, Pils S, Binder J, Chalubinski KM. Intra- versus retroplacental hematomas: a retrospective case-control study on pregnancy outcomes. BMC Pregnancy Childbirth 2017;17(1):366.
2. 2. Peixoto AB, Caldas TMRDC, Petrini CG, Romero ACP, Júnior LEB, Martins WP, et al. The impact of first-trimester intrauterine hematoma on adverse perinatal outcomes. Ultrasonography 2018;37(4):330-336.
3. 3. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. William’s obstetrics, Vol 6. 24th ed. New York: McGraw-Hill Medical; 2014. p. 116.
4. 4. Van Oppenraaij RH, Jauniaux E, Christiansen OB, Horcajadas JA, Farquharson RG, Exalto N; ESHRE Special Interest Group for Early Pregnancy (SIGEP). Predicting adverse obstetric outcome after early pregnancy events and complications: a review. Hum Reprod Update 2009;15(4):409-21.
5. 5. Tuuli MG, Norman SM, Odibo AO, Macones GA, Cahill AG. Perinatal outcomes in women with subchorionic hematoma: a systematic review and meta-analysis. Obstet Gynecol 2011;117(5):1205-1212.
6. 6. Şükür YE, Göç G, Köse O, Açmaz G, Özmen B, Atabekoğlu CS, et al. The effects of subchorionic hematoma on pregnancy outcome in patients with threatened abortion. J Turk Ger Gynecol Assoc 2014;15(4):239-42.
7. 7. Tower CL, Regan L. Intrauterine haematomas in a recurrent miscarriage population. Hum Reprod 2001;16(9):2005-7.
8. 8. Al-Memar M, Vaulet T, Fourie H, Bobdiwala S, Farren J, Saso S, et al. First-trimester intrauterine hematoma and pregnancy complications. Ultrasound Obstet Gynecol 2020;55(4):536-545.

9. 9. 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(6):422-4.
10. 10. Nagy S, Bush M, Stone J, Lapinski RH, Gardó S. Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy. Obstet Gynecol 2003;102(1):94-100.
11. 11. Ozkaya E, Altay M, Gelisen O. Significance of subchorionic haemorrhage and pregnancy outcome in threatened miscarriage to predict miscarriage, preterm labour and intrauterine growth restriction. J Obstet Gynaecol 2011;31(3):210-2.
12. 12. Dongol A, Mool S, Tiwari P. Outcome of pregnancy complicated by threatened abortion. Kathmandu Univ Med J (KUMJ) 2011;9(33):41-4.
13. 13. Hashem A, Sarsam SD. The Impact of Incidental Ultrasound Finding of Subchorionic and Retroplacental Hematoma in Early Pregnancy. J Obstet Gynaecol India 2019;69(1):43-49.
14. 14. 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(2):339-44.
15. 15. Xiang L, Wei Z, Cao Y. Symptoms of an intrauterine hematoma associated with pregnancy complications: a systematic review. PLoS One 2014;9(11):e111676.
16. 16. Tower CL, Regan L. Intrauterine haematomas in a recurrent miscarriage population. Hum Reprod 2001;16(9):2005-7.
17. 17. Jauniaux E, Van Oppenraaij RH, Burton GJ. Obstetric outcome after early placental complications. Curr Opin Obstet Gynecol 2010;22(6):452-7.
18. 18. Biesiada L, Krekora M, Krasomski G. Subchorionic hematoma as a risk factor of pregnancy and delivery in women with threatening abortion. Ginekol Pol 2010;81(12):902-6.
19. 19. Ji W, Hou B, Li W, Guo F, He P, Zheng J. Associations between first-trimester intrauterine hematoma and twin pregnancy outcomes: a retrospective cohort study. BMC Pregnancy Childbirth 2021;21(1):46.