The relationship between hematoma sizes and hematological parameters whit  miscarriage in singleton pregnancies with first trimester subchorionic hematoma: Subchorionic hematoma and hematological parameters

Kemal Dinç; Özlem  Serol Deveci

doi:10.5281/zenodo.7740199

Authors

Kemal Dinç Erzincan Binali Yıldırım University Faculty of Medicine, Department of Obstetrics and Gynecology, Erzincan, Turkey https://orcid.org/0000-0003-4955-455X
Özlem Serol Deveci Manisa Şehzadeler District Health Directorate, Manisa, Turkey https://orcid.org/0000-0001-9084-8950

DOI:

https://doi.org/10.5281/zenodo.7740199

Keywords:

Abortion, subchorionic hematoma, immune inflammatory index

Abstract

Objective: The aim of our study is to compare the size of hematoma in pregnant women diagnosed with subchorionic hematoma (SCH) between pregnant women with SCH who had abortion and those who did not, and to investigate the role of miscarriage risk.

Methods: Between January 2018 and December 2022, this is a retrospective observational cohort study of women with intrauterine singleton pregnancies between 6 0/7 and 13 6/7 weeks of pregnancy at Mengücek Gazi Training and Research Hospital. Serial ultrasounds were performed on pregnant women in their first trimester to assess the presence, location, and size of any SCH. Clinical symptoms, including pelvic pain and vaginal bleeding, were recorded at each visit. Hospital records were used to obtain antenatal, birth, and neonatal outcomes.

Results: There was no discernible difference between the groups in terms of demographic or obstetric characteristics. Hb, leukocyte, neutrophil, lymphocyte, and platelet counts did not differ statistically between groups (p=0.89, 0.26, 0.16, 0.66, and 0.53 respectively). Neutrophil/lymphocyte (NLR), platelet/lymphocyte (PLR), and systemic immune inflammatory index (SII) hematological indices did not differ significantly (p=0.30, p=0.80, p=0.35). There was no discernible difference when the SCH area and volume of the two groups were compared (p=0.25; p=0.20).

Conclusion: In our study results, we showed that the hematological indices NLR, PLR, and SII are not effective in detecting the possibility of miscarriage in pregnant women with SCH. In addition, no significant correlation was found between the size of the hematoma and the probability of miscarriage. Prospective studies with larger populations, however, are required to better understand the relationship between subchorionic hematoma and miscarriage.

References

Bondick CP, M Das J, Fertel H. Subchorionic Hemorrhage. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 3, 2022.

Khan RI, Taimoor A, Nazir A, Zaman U, Azmat S, Nawaz F. Association Of Subchorionic Hematoma With Preterm Labour In Patients With Threatened Abortion. J Ayub Med Coll Abbottabad. 2021;33(3):451-5.

Jianjun Z, Wu M, Bin W, Xiaoni H, Junxia W, Hua C, et al. The effect of first trimester subchorionic hematoma on pregnancy outcomes in patients underwent IVF/ICSI treatment. The Journal of Maternal-Fetal & Neonatal Medicine. 2017; 30(4): 406–10.

Xiang L, Wei Z, Cao Y. Symptoms of an intrauterine hematoma associated with pregnancy complications: a systematic review. PLoS One. 2014;9(11):e111676.

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.

Sonaglioni A, Esposito V, Caruso C, Nicolosi GL, Bianchi S, Lombardo M, et al. Association between neutrophil to lymphocyte ratio and carotid artery wall thickness in healthy pregnant women. Eur J Obstet Gynecol Reprod Biol. 2020;255:98-104.

Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O'Reilly DS, et al. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer. 2011;47(17):2633-41.

Huang H, Liu Q, Zhu L, Zhang Y, Lu X, Wu Y, et al. Prognostic Value of Preoperative Systemic Immune-Inflammation Index in Patients with Cervical Cancer. Scientific reports. 2019;9(1), 3284.

Turgut E, Yildirim M, Sakcak B, Ayhan SG, Tekin OM, Sahin D. Predicting miscarriage using systemic immune-inflammation index. J Obstet Gynaecol Res. 2022;48(3):587–92.

Methods for estimating the due date. Committee Opinion No. 700. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;129:e150–4.

Johns J, Hyett J, Jauniaux E. Obstetric outcome after threatened miscarriage with and without a hematoma on ultrasound. Obstet Gynecol 2003;102:483–7.

Kars A, Sahin A, Kılıc K, Sakat MS, Bilen A. Systemic immune inflammation index in differentiated thyroid cancers. Acta Otorhinolaryngol Ital. 2022;42(2):150-4.

Sonaglioni A, Esposito V, Caruso C, Nicolosi GL, Bianchi S, Lombardo M, et al. Association between neutrophil to lymphocyte ratio and carotid artery wall thickness in healthy pregnant women. Eur J Obstet Gynecol Reprod Biol. 2020;255:98-04.

Kiremitli T, Kiremitli S, Erel O, Oguz E, Dinc K, Nayki U, et al. Dynamic thiol/disulphide homeostasis and ischemic modified albumin levels in isolated oligohydramnios. Taiwan J Obstet Gynecol. 2021;60(6):1038-42.

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.

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: 863- 8

Ball RH, Ade CM, Schoenborn JA, Crane JP. The clinical significance of ultrasonographically detected subchorionic hemorrhages. Am J Obstet Gynecol. 1996; 174: 996-1002.

Şükür YE, Göç G, Köse O, Açmaz G, Özmen B, Atabekoğlu CS, et al. The effects of subchorionic hematoma on pregnancy outcome in patients with threatened abortion. J Turk Ger Gynecol Assoc. 2014; 15: 239-242

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)

Christoforaki V, Zafeiriou Z, Daskalakis G, Katasos T, Siristatidis, C. First trimester neutrophil to lymphocyte ratio (NLR) and pregnancy outcome. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 2020;40(1), 59–64.

Liu D, Huang X, Xu Z, Chen M, Wu M. Predictive value of NLR and PLR in missed miscarriage. J Clin Lab Anal. 2022;36(3):e24250.

Swellam M, Samy N, Abdl Wahab S, Ibrahim MS. Emerging role of endothelial and inflammatory markers in preeclampsia. Dis Markers. 2009;26(3):127–33.

Yuan M, Jordan F, McInnes IB, Harnett MM, Norman JE. Leukocytes are primed in peripheral blood for activation during term and preterm labour. Mol Hum Reprod. 2009;15(11):713–24.

Kalagiri RR, Carder T, Choudhury S, Vora N, Ballard AR, Govande V, et al. Inflammation in complicated pregnancy and its outcome. Am J Perinatol. 2016;33(14):1337–56.