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BMC Pregnancy and Childbirth

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Open Access 01-12-2024 | Hematoma | Research

The impact of first-trimester subchorionic hematomas on pregnancy outcomes after euploid embryo transfer: a retrospective cohort study

Authors: Weilin Wang, Qing Zhao, Yingbo Liu, Ling Guo, Wei Zhou, Qian Zhang, Junhao Yan, Tianxiang Ni

Published in: BMC Pregnancy and Childbirth | Issue 1/2024

Abstract

Background

The aim of the retrospective cohort study was to investigate the prognostic effect of subchorionic hematomas (SCH) in the first trimester on pregnancy outcomes after euploid embryo transfer.

Methods

We retrospectively analyzed women achieving singleton pregnancy by PGT-A or PGT-SR from January 2017 to January 2022. Patients were enrolled in the study if they had a viable intrauterine pregnancy at ultrasound between 6 0/7 and 8 0/7 weeks of gestation. Pregnancy outcomes as well as the incidence of maternal complications were compared between patients with and without SCH. Logistic regression was used for adjusting for potential confounding factors.

Results

A total of 1539 women were included, of which 298 with SCH and 1241 with non-SCH. The early miscarriage rate in SCH group was significantly higher than that in the non-SCH group (10.1% vs. 5.6%, adjusted odds ratio [aOR] 1.99, 95% confidence interval [CI] 1.25–3.16, P = 0.003). The live birth rate in SCH group was significantly lower than that in the non-SCH group. (85.6% vs. 91.2%, aOR 0.57, 95% CI 0.39–0.84, P = 0.005). In addition, SCH group had an increased risk of hypertensive disorder of pregnancy (HDP) (8.9% vs. 5.2%, P = 0.022), especially in hematoma with bleeding (19.3% vs. 6.0%, P = 0.002). The incidence of gestational diabetes mellitus (GDM), major congenital abnormalities rate, normal birth weight rate and low birth weight rate were similar between the two groups.

Conclusions

The presence of SCH in the first trimester was associated with worse pregnancy outcomes after euploid embryo transfer, including an increased risk of early miscarriage and hypertensive disorder of pregnancy, along with a reduced live birth rate.

Anderson KL, Jimenez PT, Omurtag KR, Jungheim ES. Outcomes of in vitro fertilization pregnancies complicated by subchorionic hematoma detected on first-trimester ultrasound. F S Rep. 2020;1(2):149–53. https://doi.org/10.1016/j.xfre.2020.05.008.

Seki H, Kuromaki K, Takeda S, Kinoshita K. Persistent subchorionic hematoma with clinical symptoms until delivery. Int J Gynaecol Obstet. 1998;63(2):123–8. https://doi.org/10.1016/s0020-7292(98)00153-2.

Johns J, Hyett J, Jauniaux E. Obstetric outcome after threatened miscarriage with and without a hematoma on ultrasound. Obstet Gynecol. 2003;102(3):483–7. https://doi.org/10.1016/s0029-7844(03)00580-5.

Xiang L, Wei Z, Cao Y. Symptoms of an intrauterine hematoma associated with pregnancy complications: a systematic review. PLoS ONE. 2014;9(11):e. https://doi.org/10.1371/journal.pone.0111676.

Asato K, Mekaru K, Heshiki C, Sugiyama H, Kinjyo T, Masamoto H, et al. Subchorionic hematoma occurs more frequently in in vitro fertilization pregnancy. Eur J Obstet Gynecol Reprod Biol. 2014;181:41–4. https://doi.org/10.1016/j.ejogrb.2014.07.014.

Yan X, Xu H, Li J, Xu Z, Niu Y, Wang Y. Subchorionic hematoma and risk of preterm delivery: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2023;5(1):100791. https://doi.org/10.1016/j.ajogmf.2022.100791.

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):1205–12. https://doi.org/10.1097/AOG.0b013e31821568de.

Zhou J, Wu M, Wang B, Hou X, Wang J, Chen H, et al. The effect of first trimester subchorionic hematoma on pregnancy outcomes in patients underwent IVF/ICSI treatment. J Matern Fetal Neonatal Med. 2017;30(4):406–10. https://doi.org/10.1080/14767058.2016.1174682.

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. https://doi.org/10.1016/s0029-7844(03)00403-4.

10.

Naert MN, Khadraoui H, Muniz Rodriguez A, Naqvi M, Fox NS. Association between First-Trimester Subchorionic hematomas and pregnancy loss in Singleton Pregnancies. Obstet Gynecol. 2019;134(2):276–81. https://doi.org/10.1097/aog.0000000000003360.

11.

Naert MN, Muniz Rodriguez A, Khadraoui H, Naqvi M, Fox NS. Association between First-Trimester Subchorionic hematomas and adverse pregnancy outcomes after 20 weeks of Gestation in Singleton Pregnancies. Obstet Gynecol. 2019;134(4):863–8. https://doi.org/10.1097/aog.0000000000003487.

12.

Heller HT, Asch EA, Durfee SM, Goldenson RP, Peters HE, Ginsburg ES, et al. Subchorionic Hematoma: correlation of Grading techniques with first-trimester pregnancy outcome. J Ultrasound Med. 2018;37(7):1725–32. https://doi.org/10.1002/jum.14524.CrossRefPubMed

13.

Fesahat F, Montazeri F, Hoseini SM. Preimplantation genetic testing in assisted reproduction technology. J Gynecol Obstet Hum Reprod. 2020;49(5). https://doi.org/10.1016/j.jogoh.2020.101723.

14.

Fadl SA, Linnau KF, Dighe MK. Placental abruption and hemorrhage—review of imaging appearance. Emerg Radiol. 2018;26(1):87–97. https://doi.org/10.1007/s10140-018-1638-3.CrossRefPubMed

15.

Kalra SK, Ratcliffe SJ, Dokras A. Is the fertile window extended in women with polycystic ovary syndrome? Utilizing the Society for Assisted Reproductive Technology registry to assess the impact of reproductive aging on live-birth rate. Fertil Steril. 2013;100(1):208–13. https://doi.org/10.1016/j.fertnstert.2013.02.055.CrossRefPubMed

16.

Polat M, Bozdag G, Yarali H. Best protocol for controlled ovarian hyperstimulation in assisted reproductive technologies: fact or opinion? Semin Reprod Med. 2014;32(4):262–71. https://doi.org/10.1055/s-0034-1375178.CrossRefPubMed

17.

Medicine ASIR, Embryology ESIG. Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Reprod Biomed Online. 2011;22(6):632–46. https://doi.org/10.1016/j.rbmo.2011.02.001.CrossRef

18.

Shi Y, Sun Y, Hao C, Zhang H, Wei D, Zhang Y, et al. Transfer of fresh versus frozen embryos in ovulatory women. N Engl J Med. 2018;378(2):126–36. https://doi.org/10.1056/NEJMoa1705334.CrossRefPubMed

19.

Zhang WY, von Versen-Hoynck F, Kapphahn KI, Fleischmann RR, Zhao Q, Baker VL. Maternal and neonatal outcomes associated with trophectoderm biopsy. Fertil Steril. 2019;112(2):283–90. https://doi.org/10.1016/j.fertnstert.2019.03.033.CrossRefPubMedPubMedCentral

20.

Chen S, Sun FZ, Huang X, Wang X, Tang N, Zhu B, et al. Assisted reproduction causes placental maldevelopment and dysfunction linked to reduced fetal weight in mice. Sci Rep. 2015;5:10596. https://doi.org/10.1038/srep10596.ADSCrossRefPubMedPubMedCentral

21.

Riesche L, Bartolomei MS. Assisted Reproductive technologies and the Placenta: clinical, morphological, and Molecular outcomes. Semin Reprod Med. 2018;36(3–04):240–8. https://doi.org/10.1055/s-0038-1676640.CrossRefPubMed

22.

Inman ER, Miranian DC, Stevenson MJ, Kobernik EK, Moravek MB, Schon SB. Outcomes of subchorionic hematoma-affected pregnancies in the infertile population. Int J Gynaecol Obstet. 2022;159(3):743–50. https://doi.org/10.1002/ijgo.14162.CrossRefPubMedPubMedCentral

23.

Jauniaux E, Watson AL, Hempstock J, Bao YP, Skepper JN, Burton GJ. Onset of maternal arterial blood flow and placental oxidative stress. A possible factor in human early pregnancy failure. Am J Pathol. 2000;157(6):2111–22. https://doi.org/10.1016/s0002-9440(10)64849-3.CrossRefPubMedPubMedCentral

24.

Xiang L, Wei Z, Wu J, Zhou P, Xiang H, Cao Y. Clinical significance of first-trimester intrauterine haematomas detected in pregnancies achieved by IVF-embryo transfer. Reprod Biomed Online. 2014;29(4):445–51. https://doi.org/10.1016/j.rbmo.2014.06.015.CrossRefPubMed

25.

Khalil A, Maiz N, Garcia-Mandujano R, Penco JM, Nicolaides KH. Longitudinal changes in maternal serum placental growth factor and soluble fms-like tyrosine kinase-1 in women at increased risk of pre-eclampsia. Ultrasound Obstet Gynecol. 2016;47(3):324–31. https://doi.org/10.1002/uog.15750.

26.

27.

Elmas B, Özgü BS, Zorlu U, Koç BL, Ozdemir EU, Akkaya SK et al. Do First-Trimester Subchorionic Hematomas Affect Pregnancy. Outcomes? Zeitschrift für Geburtshilfe und Neonatologie., 2022. 227(01): p. 31–35. https://doi.org/10.1055/a-1929-9500.

Title: The impact of first-trimester subchorionic hematomas on pregnancy outcomes after euploid embryo transfer: a retrospective cohort study
Authors: Weilin Wang
Qing Zhao
Yingbo Liu
Ling Guo
Wei Zhou
Qian Zhang
Junhao Yan
Tianxiang Ni
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Hematoma
Miscarriage
Hypertensive Disorder of Pregnancy
Preimplantation Genetic Diagnostics
Published in: BMC Pregnancy and Childbirth / Issue 1/2024
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-024-06359-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The impact of first-trimester subchorionic hematomas on pregnancy outcomes after euploid embryo transfer: a retrospective cohort study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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