Pregnancy Outcome of Primigravida with Threatened Miscarriage and Subchorionic Hematoma

Abstract

ABSTRACT:BACKGROUND: : Threatened Miscarriage is vaginal bleeding occurring any time between implantation and 20 weeks gestation , with or without uterine contraction, without dilatation of cervix , and without expulsion of the products of conception Threatened miscarriage tends to be associated with a high likelihood of adverse subsequent pregnancy outcome.Subchorionic Hematoma is described as the collections with circular or crescent-shaped ecogenity localised between the chorionic membrane and the uterine wall and it has been reported to occur with a varying incidence of 4- 48 %in pregnancies, which experienced vaginal bleeding in early stage.OBJECTIVE:To evaluate the association between threatened miscarriage in the presence of subchorionic hematoma in first and second trimester and adverse pregnancy outcome with regard to maternal and neonatal outcome.PATIENTS AND METHODS:prospective case control study(follow –up study) done at the Department of obstetrics and gynecology, Baghdad Teaching Hospital, Medical City complex, Baghdad. 60 primigravida women with threatened miscarriage in their first and second trimester were included in the study . . Thirty women had Subchorionic hematoma (SCH) (study group) were matched with thirty women without Subchorionic hematoma (control group). The demographic feature, course of pregnancy, obstetric outcome and neonatal outcome were analyzed.RESULTS: Analysis of data show that there is statistically significant difference between both groups regarding maternal and neonatal outcome. There is increasing rate of miscarriage (50%),(p=0.032) and preterm labour in study group ((93.3%), (p=0.046 ), when compared to control group . Regarding neonatal outcome there is increasing rate of very LBW <1.5 kg(26.7%), and LBW <2.5kg (40.0%) (p=0.029) and poor Apgar score in one minute (86.7%) (p=0.015) and five minutes in study group(53.3%)( p=0.002) when compared with control group. Also the study show that there is no statistically significant difference regarding the gestational age. at presentation as threatened miscarriage ,placental site, volume of hematoma, method of delivery and sex of the fetus. CONCLUSION:Women with threatened miscarriage who had Subchorionic hematoma are at increased risk for adverse maternal and neonatal outcome.