Ultrasound-Detected Subchorionic Hemorrhage and the Obstetric Implications
ABSTRACT To estimate the association between the ultrasonographic diagnosis of subchorionic hemorrhage and adverse pregnancy outcomes.
This was a retrospective cohort study of all consecutive women undergoing routine ultrasonography before 22 weeks with a singleton gestation at one institution from 1994 to 2008. Presence or absence of subchorionic hemorrhage defined the two study groups. The primary outcomes were abruption, intrauterine growth restriction defined as birth weight less than the 10th percentile, and nonanomalous intrauterine fetal demise after 20 weeks. Secondary outcomes included preeclampsia, preterm premature rupture of membranes, and preterm delivery before 37 weeks and before 34 weeks of gestation. Univariable, bivariate, and multiple logistic regression analyses were performed.
Of the 63,966 women in the patient population, 1,081 had subchorionic hemorrhage (1.7%). Women with a subchorionic hemorrhage were at increased risk of abruption (n=432, 3.6% compared with 0.6%, adjusted odds ratio 2.6, 95% confidence interval 1.8-3.7) and of preterm delivery (n=6,601, 15.5% compared with 10.5%, adjusted odds ratio 1.3, 95% confidence interval 1.1-1.5), even after adjusting for bleeding during pregnancy, chronic hypertension, body mass index, race, diabetes mellitus, tobacco use, and previous preterm delivery.
Women with ultrasound-detected subchorionic hemorrhage before 22 weeks of gestation are at increased risk of placental abruption and preterm delivery but are not at increased risk of other adverse pregnancy outcomes.
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Article: Placental Abruption[Show abstract] [Hide abstract]
ABSTRACT: Placental abruption complicates about 1% of pregnancies and is a leading cause of vaginal bleeding in the latter half of pregnancy. It is also an important cause of perinatal mortality and morbidity. The maternal effect of abruption depends primarily on its severity, whereas its effect on the fetus is determined both by its severity and the gestational age at which it occurs. Risk factors for abruption include prior abruption, smoking, trauma, cocaine use, multifetal gestation, hypertension, preeclampsia, thrombophilias, advanced maternal age, preterm premature rupture of the membranes, intrauterine infections, and hydramnios. Abruption involving more than 50% of the placenta is frequently associated with fetal death. The diagnosis of abruption is a clinical one, and ultrasonography and the Kleihauer-Betke test are of limited value. The management of abruption should be individualized on a case-by-case basis depending on the severity of the abruption and the gestational age at which it occurs. In cases where fetal demise has occurred, vaginal delivery is preferable. Disseminated intravascular coagulopathy should be managed aggressively. When abruption occurs at or near term and maternal and fetal status are reassuring, conservative management with the goal of vaginal delivery may be reasonable. However, in the presence of fetal or maternal compromise, prompt delivery by cesarean is often indicated. Similarly, abruption at extremely preterm gestations may be managed conservatively in selected stable cases, with close monitoring and rapid delivery should deterioration occur. Most cases of placental abruption cannot be predicted or prevented. However, in some cases, maternal and infant outcomes can be optimized through attention to the risks and benefits of conservative management, ongoing evaluation of fetal and maternal well-being, and through expeditious delivery where appropriate.Obstetrics and Gynecology 11/2006; 108(4):1005-16. DOI:10.1097/01.AOG.0000239439.04364.9a · 4.37 Impact Factor
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ABSTRACT: Vaginal bleeding during gestation is an ominous sign indicating an adverse pregnancy outcome. Bleeding can occur during all stages of gestation. It complicates up to 20% of pregnancies during the first trimester and is regarded as a sign of threatened abortion. During the second and third trimesters, vaginal bleeding was found to be a risk factor for adverse maternal and neonatal outcomes including preterm labor (PTL), preterm prelabor rupture of membranes (PROM), placental abruption, placenta previa, and stillbirth.12/2010: pages 99-118;
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ABSTRACT: Vaginal bleeding is a common event during pregnancy. The incidence varies, ranging from 1 to 22% [1–3]. The source of bleeding is mostly maternal. The significance, initial diagnosis, and clinical approach to vaginal bleeding depend on the gestational age and the bleeding characteristics. Vaginal bleeding during early pregnancy is associated with a 1.6-fold increased risk of many adverse outcomes, including preterm labor (PTL) and preterm premature rupture of membranes (PPROM) . As bleeding persists or recurs later in pregnancy, the risk of associated morbidities grows . Although 50% of the women who suffer from vaginal bleeding during early pregnancy go on to have a normal pregnancy , vaginal bleeding in the second half of pregnancy is linked to perinatal mortality, disorders of the amniotic fluid, premature rupture of membranes (PROM), preterm deliveries, low birth weight, and low neonatal Apgar scores .12/2010: pages 3-21;