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Effect of First Trimester Subchorionic Haemorrhage on Pregnancy

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Effect of First Trimester Subchorionic Haemorrhage on Pregnancy 02 Dec 16 - 09:08 Date of Search: 02/12/2016 Sources Searched: Medline, Embase, DynaMed See full search strategy Perinatal outcomes in women with subchorionic hematoma: A systematic review and meta- analysis Author(s): Tuuli M.G.; Norman S.M.; Odibo A.O.; MacOnes G.A.; Cahill A.G. Source: Obstetrics and Gynecology; May 2011; vol. 117 (no. 5); p. 1205-1212 Publication Date: May 2011 Available in print at Patricia Bowen Library and Knowledge Service West Middlesex university Hospital - from Obstetrics and Gynecology Available in full text at Obstetrics and Gynecology - from Ovid Abstract:Objective: To estimate the association between subchorionic hematoma and adverse perinatal outcomes. Data sources: MEDLINE, EMBASE, and the Cochrane Library. Methods of study selection: We searched English language publications from January 1981 to August 2010 for cohort and case-control studies evaluating subchorionic hematoma and perinatal outcomes. The primary outcome was pregnancy loss (spontaneous abortion and stillbirth). Secondary outcomes were abruption, preterm premature rupture of membranes, preterm delivery, pre-eclampsia, and small for gestational age. Pooled odds ratios (ORs) were calculated from random effects models. TABULATION, INTEGRATION, Rssults: Seven studies including 1,735 women with subchorionic hematoma and 70,703 controls met inclusion criteria. Subchorionic hematoma was associated with an increased risk of spontaneous abortion (from 8.9% to 17.6%; pooled OR 2.18, 95% confidence interval [CI] 1.29-3.68) and stillbirth (from 0.9% to 1.9%, pooled OR 2.09, 95% CI 1.20-3.67). The number needed to harm was 11 for spontaneous abortion and 103 for stillbirth, meaning one extra spontaneous abortion is estimated to occur for every 11 women with subchorionic hematoma diagnosed and one extra stillbirth occurs for every 103 women with subchorionic hematoma diagnosed. Women with subchorionic hematoma were also at increased risk of abruption (from 0.7% to 3.6%, pooled OR 5.71, 95% CI 3.91-8.33), preterm delivery (from 10.1% to 13.6%, pooled OR 1.40, 95% CI 1.18-1.68), and preterm premature rupture of membranes (from 2.3% to 3.8%, pooled OR 1.64, 95% CI 1.22-2.21), but not small for gestational age (OR 1.69, 95% CI 0.89-3.19) or pre- eclampsia (OR 1.47, 95% CI 0.37-5.89). The numbers needed to harm were 34, 28, and 69 for abruption, preterm delivery, and preterm premature rupture of membranes, respectively. Conclusion: Subchorionic hematoma is associated with an increased risk of early and late pregnancy loss, abruption, and preterm premature rupture of membranes. © 2011 The American College of Obstetricians and Gynecologists. Database: EMBASE Subchorionic hematoma (SCH) and adverse perinatal outcomes: Systematic review and meta- analysis Author(s): Tuuli M.; Norman S.; Odibo A.; Macones G.; Cahill A. Source: American Journal of Obstetrics and Gynecology; Jan 2011; vol. 204 (no. 1) Publication Date: Jan 2011 Abstract:OBJECTIVE: The relationship between SCH and adverse perinatal outcomes is unclear. We performed a systematic review and meta-analysis evaluating the association between SCH and adverse perinatal outcomes. STUDY DESIGN: Medline, Embase and the Cochrane Library were searched without language restrictions from January 1981 (year of the first reports of intra-uterine hematoma on ultrasound) to June 2010 for cohort and case-control studies evaluating the relationship between subchorionic hematoma and adverse perinatal outcomes. The primary outcome was pregnancy loss (spontaneous abortion [SAB] and stillbirth). Secondary outcomes were placental abruption, premature rupture of membranes (PPROM), preterm delivery (PTD), preeclampsia and small for gestational age (SGA) at birth. Pooled odds ratios were calculated from a random effects model. Heterogeneity was assessed using I2 for heterogeneity and I2. Publication bias was evaluated using funnel plots with Egger's tests. RESULTS: Seven studies, including 1,735 women with SCH and 70,703 controls, met inclusion criteria. SCH was associated with a significantly increased risk of SAB (OR 2.18, 95 % CI 1.29 - 3.68) and stillbirth (OR 2.09, 95%CI 1.20 - 3.67) (Figure 1). There was evidence of statistical heterogeneity among studies for SAB (X2 p=0.045, I2=58.8 %) but not for stillbirth (X2 p=0.311, I2 =16.1%). There was no evidence of publication bias for either outcome (Egger's test p-0.607 and 0.334). Women with SCH were also at a significantly increased risk of abruption (5.71,95 % CI 3.91 - 8.33), PPROM (1.64, 95% CI 1.22 - 2.21) and PTD (1.40, 95% CI 1.18 - 1.68), but not SGA (1.69, 95% CI 0.89 - 3.19) or preeclampsia (1.47, 95% CI 0.37 - 5.89). CONCLUSIONS: SCH is associated with an increased risk of pregnancy loss, abruption, PPROM and PTD.(Figure presented). Database: EMBASE Early subchorionic bleed (SCB) in assisted reproductive technology (ART) pregnancies does not influence birth weight Author(s): Nervi L.; Bergh P.A.; Molinaro T.A. Source: Fertility and Sterility; Sep 2016; vol. 106 Publication Date: Sep 2016 Abstract:OBJECTIVE: Determine the impact of SCB in the first trimester on birth weight in ART pregnancies DESIGN: Retrospective cohort study MATERIALS AND METHODS: Records from 8,636 patients treated between January 2000 and April 2015 in a single IVF center were analyzed. All patients underwent in vitro fertilization (IVF) with blastocyst transfer, conceived, and were discharged at approximately 8 weeks of pregnancy. Pregnant patients who reported vaginal bleeding or who had a SCB visualized with transvaginal ultrasound were included as the study group with low birth weight as the primary outcome. Baseline demographics were compared between groups using chi square and t-tests. Logistic regression was performed to control for confounders. This study was powered to detect a 3% difference between groups. RESULTS: 31.4% (2,715) of 8,636 patients had a SCB. The mean oocyte age for those with SCB was significantly lower than for those without SCB (33.1 vs 33.3, p=0.02). The mean number of embryos replaced and number of fetuses was significantly higher for those with SCB. These differences were not clinically significant. In fresh cycles, those with SCB had a significantly higher peak estradiol and progesterone than those without SCB. Transfer type (fresh vs. frozen), preimplantation genetic screening (PGS), and high body mass index (BMI) (BMI > 30) were shown to have no significant effect on rates of SCB. SCB significantly increased the risk of having a child of low birth weight (LBW) (22.6% vs 19.7%, p<0.001). However, when analyzing only those pregnant with a singleton, SCB trended towards but did not have a significant impact on LBW (p=0.06). SCB did not significantly increase the risk of LBW in pregnancies with multiple gestation (p=0.9), but the incidence of SCB was higher in twin pregnancies (29.1% vs 34.8%, p<0.0001). Interestingly, patients who had fresh transfers had a significantly higher rate of delivering a child with LBW than those who had frozen transfers (26.0% vs 15.4%, p<0.001). There was no significant association between SCB and LBW after controlling for possible confounders with logistic regression. CONCLUSIONS: These data suggest that first trimester SCB in ART patients has little to no effect on the incidence of LBW. Twin pregnancies may be at a higher risk for SCB. While more studies are warranted, the results of this study may be used to reassure patients regarding the clinical significance of first-trimester SCB on pregnancy outcome after IVF. Database: EMBASE First-trimester bleeding and twin pregnancy outcomes after in vitro fertilization Author(s): Eaton J.L.; Zhang X.; Kazer R.R. Source: Fertility and Sterility; Jul 2016; vol. 106 (no. 1); p. 140-143 Publication Date: Jul 2016 Abstract:Objective To examine the association between first-trimester bleeding and live-birth rates in twin pregnancies conceived with in vitro fertilization (IVF). Design Retrospective cohort study. Setting Academic infertility practice. Patient(s) Women with two gestational sacs on first-trimester ultrasound after transfer of fresh embryos derived from autologous oocytes between January 1, 1999, and December 31, 2010. Intervention(s) None. Main Outcome Measure(s) Live-birth rate. Result(s) Sixty-five women reported vaginal bleeding, and 288 did not. The baseline characteristics were similar between the two groups, except for an increased prevalence of subchorionic hematoma in women with first-trimester vaginal bleeding (26.2% vs. 1.7%). Live-birth rates were similar between women with bleeding and those with no bleeding (87.7% vs. 91.7%, adjusted odds ratio [OR] 0.73; 95% confidence interval [CI], 0.31-1.73). Two hundred eighty-eight women gave birth to live twins. Among the women who delivered twins, those with first-trimester bleeding had an increased risk of low birth weight of at least one twin (75.0% vs. 59.7%). The association between bleeding and low birth weight persisted after controlling for possible confounders with logistic regression (adjusted OR 2.33, 95% CI, 1.14-4.74). Conclusion(s) Live-birth rates are high in IVF twin gestations, regardless of the presence of first-trimester bleeding. Among women giving birth to IVF twins, however, first-trimester bleeding is associated with increased odds of low birth weight. Copyright © 2016 American Society for Reproductive Medicine Database: EMBASE Subchorionic hematomas are increased in early pregnancy in women taking low-dose aspirin Author(s): Truong A.; Sayago M.M.; Kutteh W.H.; Ke R.W. Source: Fertility and Sterility; May 2016; vol. 105 (no. 5); p. 1241-1246 Publication Date: May 2016 Abstract:Objective To determine the frequency of subchorionic hematomas (SCH) in first-trimester ultrasound examinations of patients with infertility and recurrent pregnancy loss (RPL) and in patients from a general obstetric population.
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