Perinatal Delivery in Women with Retrochorial Hematomas in the First Trimester

Abstract

The objective: an analysis of the peculiarities of childbirth and the condition of newborns in women with retrochorial hematoma (RCH) in the I trimester of pregnancy. Materials and methods. At the beginning of the study, 100 pregnant women 18–44 years old (mean age 28.08±3.5 years) were examined – 70 women included in the main group and 30 – control one. In 10 cases out of 70, the pregnancy was interrupted in the I trimester on the background of RCH. Sixty patients of the main group, in whom the pregnancy progressed, were divided into two subgroups: subgroup A (n=39) – primigravida pregnant women with the threat of abortion due to RCH; subgroup B (n=21) – multigravida women with complicated obstetrical and gynecological history and RCH. The control group (n=30) included primi- and multigravida women with physiological course of the current and previous pregnancies. All women had a complete clinical and laboratory examination. The patients with a risk of abortion and RCH received pathogenetical therapy for pregnancy preservation (sedative, anti stress therapy, spasmolytics, hormonal support (progestogens), fibrinolysis inhibitors, anticoagulants and antiplatelet agents, tocolytics). The condition of newborns in the first minutes of life was assessed by the Apgar scale, if necessary, rehabilitation measures were applied. Results. The majority of patients in all groups had complicated obstetrical and gynecological history: 22.5% of patients in subgroup A, 30% – subgroup B, 16.6% – control group, and half of them were diagnosed two or more somatic diseases. Every third patient of the main group (7 (17.9%) women in subgroup A and 5 (23.8%) in subgroup B) delivered by cesarean section, in the control group – 5 (16.6%) persons. Spontaneous vaginal childbirth in the main group had 71.7% of the women, in the control group – 80%, premature birth – 2 (5.1%) women in subgroup A, 4 (19%) – subgroup B and 1 (3,3%) case – control group. The average duration of pregnancy in the main group was 37.3±2.4 weeks, in the control group – 39.4±0.3 weeks. In the main group 54 (90%) full-term newborns were born, in the control group – 29 (96.7%); premature infants – 2 (5.1%) in subgroup A, 4 (19%) – subgroup B, 1 (3.3%) – control group. In the main group the frequency of infants birth with hypoxia, who needed resuscitation and intensive care, was more than 2 times higher compared to the control group (5 (8.3%) and 2 (6.7%) infants, respectively). Newborns of subgroups A and B, due to intrauterine hypoxia, had pathological conditions such as morphological and functional immaturity, neurological disorders, signs of intrauterine infection, but not a single child needed to be transferred to a specialized department for the second stage of care. Conclusions. Preservation of pregnancy in the patients with a risk of abortion and RCH in the I trimester is possible in 85.7% of cases. Pregnant women with complicated obstetrical and gynecological history are at risk for preterm birth. The infants born in women with the threat of abortion and the formation of RCH in the I trimester belong to the risk group of intrauterine hypoxia and infectious complications. Comprehensive pathogenetical therapy helps to prolong pregnancy, reduce the incidence of early reproductive losses, improve perinatal outcomes and reduce the incidence of perinatal morbidity.