Threatened abortion in women with retrohorial hematomas in the first trimester

Abstract

The objective: to study the features of the clinical course of the first trimester of pregnancy, complicated by the threat of abortion with the formation of retrochorial hematoma (RCH). Materials and methods. 100 pregnant women aged 18–44 years (average age 28.08±3.5 years) in 6–13 weeks of gestation were examined. The main group consisted of 70 patients and was divided into two subgroups: subgroup A (n=40) – 40 primigravida women with the threat of abortion and RCH; subgroup B (n=30) – 30 multigravida women with the threat of abortion and RCH and a complicated obstetric and gynecological history. Control group (n=30) – primi- and multigravida women with physiological course of the current and previous pregnancies. All women had a complete clinical and laboratory examination, ultrasound examination of the uterus and fetus with Doppler, determination of the infectious profile (bacterioscopy).Results. The majority of the patients in all groups had a complicated somatic history, while in half of the cases there was a combination of two or more somatic diseases – in 45.7% of pregnant women in the main group and 33.3% – control group. 32.9% of women in the main group had a genetically determined form of thrombophilia. A complicated obstetrical and gynecological history was established in 22.5% of patients in subgroup A, 30% – subgroup B and 16.6% of pregnant women in the control group. Mostly, inflammatory diseases of the pelvic organs were detected in the main group – 15–21.4% (in both subgroups) and previous surgery on the pelvic organs (11.4% in total). A high incidence of spontaneous miscarriages was found in patients of subgroup B (13–43.3%). Every fourth pregnant woman in the main group had a 3–4 degree of purity of vaginal smears. For the first time, the hematoma was diagnosed before 6 weeks of gestation in 8% of pregnant women of subgroup A (2.5% of these patients had a spontaneous abortion at 9–10 weeks) and in 30% of women in subgroup B (23.3% of them had an interruption of pregnancy at 7–12 weeks). The corporal location of RCH was found in 28.6% of patients in the main group (15.7% and 12.9% in subgroups, respectively), supracervical – 71.4% (almost the same in both subgroups), while hematomas of more than 25 cm3 were detected in 8 patients of the main group (25% and 75% in subgroups, respectively), all of such RCH were located corporally. In 70% of supracervical RCH, a small and medium volume of hematoma was diagnosed, which was in 1.5 times more often detected in pregnant women of subgroup A. Hematomas of a larger size were found in 3 times more often in women of subgroup B. The main clinical symptoms of threatened abortion with the formation of RCH were bleeding from the genital tract (53–75.7%), pain syndrome (48–68.5%), uterine hypertonus or a combination of these symptoms (39–55.7%).Conclusions. The presence of chronic extragenital pathology, chronic urogenital infection, surgical interventions on the pelvic organs, a high frequency of artificial and spontaneous abortions, recurrent miscarriage, a history of missed pregnancy in combination with a large volume of RCH, the corporal location of PCH, the term of gestation in which a hematoma is found, as well as ultrasound signs of uterine hypertonus are unfavorable predictors of early miscarriage and reproductive losses.