Evaluation of obstetric complications and results of pregnancy with subchorionic hematoma in the first tri̇mester

Aim: In this study, it was aimed to evaluate the obstetric complications and outcomes of pregnant women with subchorionic hematoma on ultrasonography in the 1st trimester. Materials and Method: Our study was conducted at Erzincan Binali Yıldırım University Mengücek Gazi Training and Research Hospital obstetrics outpatient clinic between January 2019 and November 2021 and patients under the 14th gestational week who had a single pregnancy, who did not have a cervical opening and whose bleeding area was monitored on ultrasonography were included in the study. Patients whose bleeding area was detected ultrasonographically were grouped according to vaginal bleeding, pelvic pain, localization of bleeding areas, according to hematoma area calculation and CRL (crown-rump length) and hematoma size ratio in their follow-up and past patient file records were examined to investigate the pregnancy prognosis of each group separately. Patients who were at risk for complications of abortion, preterm labor, intrauterine growth retardation (IUGR), early membrane rupture, malpresentation, gestational hypertension, gestational diabetes mellitus (GDM), preterm premature rupture of membranes (PPROM) (multiple pregnancy, uterine anomalies, history of recurrent abortion) and who did not continue their pregnancy follow-up in our hospital and did not perform abortion/delivery in our hospital were excluded from the study. Within the scope of the research, 1819 patients with hematoma were screened for the first time and 334 patients with bleeding area were detected on ultrasonography. Patients who did not continue their follow-up, whose pregnancy did not end in our hospital and who had the specified risk factors were excluded and 215 patients were included in the study. All data were analyzed statistically. Results: The complication rate of the patients was 60.9%. Complications most commonly involved abortus at 43.7%, followed by preterm birth at 9.3% When the factors affecting abortions are investigated; When the CRL size is calculated according to the ratio of the horizontal length of the hematoma, it increases the probability of continuation of pregnancy by 2,923 times and is statistically significant compared to those who are less than 1/2 in those who are more than 1/2. There was no significant difference between the localization and area of the hematoma in terms of abortion. At the same time, there was no significant difference between the localization and area of the hematoma area in terms of PPROM, abortion, early rupture of membranes, GDM, preeclampsia, IUGR, polyhydramniosis, malpresentation, preterm birth, miad delivery, primary cesarean delivery 4 (C/S), old/duplicate C/S, normal spontaneous birth. When the factors affecting the complication in pregnant women with subchorionic hematoma are investigated; It was found that the ratio of CRL size and horizontal length of the hematoma more than 1/2 increased the likelihood of healthy pregnancy by 2,325 times compared to being less than 1/2, that the ratio of CRL and hematoma to depth (longitudunal) size increased the rate of healthy pregnancy by 3,439 times compared to less than 1 and that being more than 4 increased the healthy pregnancy rate by 3,439 times and was statistically significant. Conclusion: As a result of the study, a significant difference was found between the groups in terms of poor obstetric outcome. It has been shown to be statistically significant in predicting abortion and complication outcomes in patient groups where CRL size is proportional to hematoma size. However, we believe that prospective studies with larger patient groups are needed to better determine the rates of abortion and complication in patients with subchorionic hematoma. Key Words: Subchorionic hematoma, abortus , poor obstetric outcomes