Perinatal Outcomes in Women With Subchorionic Hematoma
A Systematic Review and Meta-Analysis
Methodius G. Tuuli, MD, MPH, Shayna M. Norman, MD, Anthony O. Odibo, George A. Macones, MD, MSCE, and Alison G. Cahill, MD, MSCI
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 forgestational age. Pooled odds ratios (ORs) were calculated from random effects models. TABULATION, INTEGRATION, RESULTS: 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 (from0.9% 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 riskof 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%
From the Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri. Corresponding author: Methodius Tuuli, MD, MPH, Department of Obstetrics and Gynecology, Washington University School of Medicine, Department of Obstetrics andGynecology, Washington University in St. Louis, Campus Box 8064, St Louis, MO 63110; e-mail: email@example.com. Financial Disclosure The authors did not report any potential conflicts of interest. © 2011 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins. ISSN: 0029-7844/11
CI 1.18 –1.68), and preterm premature rupture ofmembranes (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 latepregnancy loss, abruption, and preterm premature rupture of membranes.
(Obstet Gynecol 2011;117:1205–12) DOI: 10.1097/AOG.0b013e31821568de
ubchorionic hematoma is a frequent finding on routine obstetric ultrasonography. It appears as a hypoechoic or anechoic crescent-shape area behind the gestational sac in the first trimester and behind the fetal membranes in the second trimester. Although theexact etiology is uncertain, it is believed to result from partial detachment of the chorionic membranes from the uterine wall.1 The reported incidence of subchorionic hematoma varies widely, from as low as 0.5% to as high as 22%.2,3 This disparity is most likely attributable to differences in definition, gestational age of diagnosis, populations studied, and the route and resolution ofultrasonography used. First described by Mantoni and Pedersen in 1981,4 the clinical significance of subchorionic hematoma has been controversial, with results of studies conflicting.5 It is hypothesized that subchorionic hemorrhage signifies an underlying placental dysfunction that subsequently results in pregnancy complications, including abruption, preterm premature rupture of membranes, preterm...