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Prognosis of Very Large First-Trimester Hematomas

Inner Vision Women’s Ultrasound, Nashville, Tennessee USA (J.L., P.R., P.J.); and Department of Obstetrics and Gynecology, University of Foggia, Foggia, Italy (A.C.R.).

Address correspondence to Juliana Leite, MD, c/o Philippe Jeanty, Inner Vision Women’s Ultrasound, 2201 Murphy Ave, Suite 203, Nashville, TN 37203-1926 USA. E-mail: juliana.mbl{at}gmail.com

Objective. The aim of this study was to evaluate the outcome of pregnancies complicated by very large hematomas in the first trimester. Methods. Between January 2001 and January 2006, 8085 patients between 5 and 14 weeks’ gestation underwent routine first-trimester ultrasonographic examinations at our practice. Of these, 30 patients had a "very large" (>50% of the gestational sac) intrauterine hematoma. These 30 patients were further classified according to pregnancy outcome (normal or adverse), maternal age, vaginal bleeding, crown-rump length, gestational age at diagnosis of the hematoma, and position and location of the hematoma. P < .05 was considered statistically significant. Results. Six patients were excluded (4 were still pregnant, and 2 were lost to follow-up), leaving 24 patients eligible for analysis, of which 11 (46%) had adverse outcomes and 13 (54%) had normal outcomes. The group with adverse outcomes had a significantly lower gestational age at diagnosis than the second group (7 weeks [range, 5.7–8.4 weeks] versus 8.4 weeks [range, 6.2–14 weeks]; P = .0227), but crown-rump length, vaginal bleeding, and position and location of the hematoma were similar. Conclusions. Very large hematomas were associated with adverse outcome in 46% of the pregnancies. Vaginal bleeding was not associated with a poor prognosis. Neither position nor location of the placental hematoma was related to the outcome; however, when the hematoma was diagnosed at an early gestational age, the outcomes were worse.

Key Words: intrauterine hematoma • ultrasonography • vaginal bleeding