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Symptoms of an intrauterine hematoma associated with pregnancy complications: a systematic review.

Xiang L, Wei Z, Cao Y - PLoS ONE (2014)

Bottom Line: We just focused on the pregnancy outcomes associated with different symptoms of an IUH.It is generally agreed that a retroplacental, posterior or subchorionic in the fundus of uterus, and/or persistent IUH is associated with adverse outcomes in the ongoing pregnancy.Some researchers argue that a large IUH is associated with an increased risk of adverse events during pregnancy while others refuted.

View Article: PubMed Central - PubMed

Affiliation: Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei, China.

ABSTRACT

Objective: To evaluate the predictive value of the symptoms of an intrauterine hematoma (IUH) for adverse pregnancy outcomes.

Methods: A literature review was performed with the search terms, including intrauterine/subchorionic/retroplacental/subplacental hematoma/hemorrhage/bleeding/collection/fluid, covering the period from January, 1981 to January, 2014. We just focused on the pregnancy outcomes associated with different symptoms of an IUH.

Results: It is generally agreed that a retroplacental, posterior or subchorionic in the fundus of uterus, and/or persistent IUH is associated with adverse outcomes in the ongoing pregnancy. However, the prognosis value of both volume and gestational age at diagnosis of IUH still remains controversial. Some researchers argue that a large IUH is associated with an increased risk of adverse events during pregnancy while others refuted. It is believed by some that the earlier an IUH was detected, the higher the risk for adverse outcomes would be, while no or weak association were reported by other studies. The prognostic value of the simultaneous presence of vaginal bleeding on pregnancy outcome is also controversial.

Conclusions: Both the position relative to the placenta or uterus and duration of IUH have strong predictive value on the prognosis in the ongoing pregnancy. However, the prognostic values of the IUH volume, gestational age at diagnosis and the simultaneous presence of vaginal bleeding remain controversial up to now. Moreover, most of previous reports are small, uncontrolled studies with incomplete information. Prospective, large sample, cohorts studies which take all detailed symptoms of an IUH into consideration are needed when we evaluate its clinical significance in the prognosis of pregnancy.

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Related in: MedlinePlus

A large retroplacental hematoma (H) detected at 25 menstrual weeks, detaching more than 50%of the placenta (P).Retroplacental venous complex (arrows) separated the hematoma and placenta (a); 1 week later, a resolving hematoma (H) contained (arrows) posterior to the placenta (P) (b) [8].
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pone-0111676-g002: A large retroplacental hematoma (H) detected at 25 menstrual weeks, detaching more than 50%of the placenta (P).Retroplacental venous complex (arrows) separated the hematoma and placenta (a); 1 week later, a resolving hematoma (H) contained (arrows) posterior to the placenta (P) (b) [8].

Mentions: IUH was divided into three types according to their locations [8], [10]: subchorionic (SCH, between the myometrium and the placental membranes and/or at the margin of the placenta, 81%, Figure 1), retroplacental (between the placenta and the myometrium, 16%, Figure 2), and preplacental (between the placenta and the amniotic fluid/placental membranes, 4%, namely called subamniotic hematoma later [11], Figure 3) Because of the low incidence of preplacental type, and most discussions focused on the first two types in published literatures, we reviewed subchorionic and retroplacental hematomas in this article. In addition, massive subchorionic hematoma/thrombohematoma (the so-called ‘Breus’ mole’, a hematoma placed beneath the chorionic plate separating it from the underlying intervillous space and must be more than 1 cm thick), different from those two hematomas [11]–[13], was also excluded in our review. Search term combination for bibliographic databases was text words, including the following variations of search terms combing with pregnancy outcome: intrauterine/subchorionic/retroplacental/subplacental hematoma/hemorrhage/bleeding/collection/fluid. In view of the heterogeneity of the data, we did not apply a formal meta-analysis in this review.


Symptoms of an intrauterine hematoma associated with pregnancy complications: a systematic review.

Xiang L, Wei Z, Cao Y - PLoS ONE (2014)

A large retroplacental hematoma (H) detected at 25 menstrual weeks, detaching more than 50%of the placenta (P).Retroplacental venous complex (arrows) separated the hematoma and placenta (a); 1 week later, a resolving hematoma (H) contained (arrows) posterior to the placenta (P) (b) [8].
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4219764&req=5

pone-0111676-g002: A large retroplacental hematoma (H) detected at 25 menstrual weeks, detaching more than 50%of the placenta (P).Retroplacental venous complex (arrows) separated the hematoma and placenta (a); 1 week later, a resolving hematoma (H) contained (arrows) posterior to the placenta (P) (b) [8].
Mentions: IUH was divided into three types according to their locations [8], [10]: subchorionic (SCH, between the myometrium and the placental membranes and/or at the margin of the placenta, 81%, Figure 1), retroplacental (between the placenta and the myometrium, 16%, Figure 2), and preplacental (between the placenta and the amniotic fluid/placental membranes, 4%, namely called subamniotic hematoma later [11], Figure 3) Because of the low incidence of preplacental type, and most discussions focused on the first two types in published literatures, we reviewed subchorionic and retroplacental hematomas in this article. In addition, massive subchorionic hematoma/thrombohematoma (the so-called ‘Breus’ mole’, a hematoma placed beneath the chorionic plate separating it from the underlying intervillous space and must be more than 1 cm thick), different from those two hematomas [11]–[13], was also excluded in our review. Search term combination for bibliographic databases was text words, including the following variations of search terms combing with pregnancy outcome: intrauterine/subchorionic/retroplacental/subplacental hematoma/hemorrhage/bleeding/collection/fluid. In view of the heterogeneity of the data, we did not apply a formal meta-analysis in this review.

Bottom Line: We just focused on the pregnancy outcomes associated with different symptoms of an IUH.It is generally agreed that a retroplacental, posterior or subchorionic in the fundus of uterus, and/or persistent IUH is associated with adverse outcomes in the ongoing pregnancy.Some researchers argue that a large IUH is associated with an increased risk of adverse events during pregnancy while others refuted.

View Article: PubMed Central - PubMed

Affiliation: Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei, China.

ABSTRACT

Objective: To evaluate the predictive value of the symptoms of an intrauterine hematoma (IUH) for adverse pregnancy outcomes.

Methods: A literature review was performed with the search terms, including intrauterine/subchorionic/retroplacental/subplacental hematoma/hemorrhage/bleeding/collection/fluid, covering the period from January, 1981 to January, 2014. We just focused on the pregnancy outcomes associated with different symptoms of an IUH.

Results: It is generally agreed that a retroplacental, posterior or subchorionic in the fundus of uterus, and/or persistent IUH is associated with adverse outcomes in the ongoing pregnancy. However, the prognosis value of both volume and gestational age at diagnosis of IUH still remains controversial. Some researchers argue that a large IUH is associated with an increased risk of adverse events during pregnancy while others refuted. It is believed by some that the earlier an IUH was detected, the higher the risk for adverse outcomes would be, while no or weak association were reported by other studies. The prognostic value of the simultaneous presence of vaginal bleeding on pregnancy outcome is also controversial.

Conclusions: Both the position relative to the placenta or uterus and duration of IUH have strong predictive value on the prognosis in the ongoing pregnancy. However, the prognostic values of the IUH volume, gestational age at diagnosis and the simultaneous presence of vaginal bleeding remain controversial up to now. Moreover, most of previous reports are small, uncontrolled studies with incomplete information. Prospective, large sample, cohorts studies which take all detailed symptoms of an IUH into consideration are needed when we evaluate its clinical significance in the prognosis of pregnancy.

Show MeSH
Related in: MedlinePlus