Factors associated with subchorionic hematoma formation in pregnancies achieved via assisted reproductive technologies

Abstract

Purpose To determine if certain clinical and/or embryologic factors are independently associated with the increased prevalence of subchorionic hematoma (SCH) among pregnancies achieved via in vitro fertilization (IVF) with fresh embryo transfer (ET). Design Retrospective chart review. Methods In this retrospective study, data were abstracted from 210 autologous oocyte IVF clinical pregnancies that resulted from fresh ET at a single fertility center from January 2012 through December 2016. Clinical and embryology laboratory variables were analyzed as possible factors associated with the presence or absence of SCH in IVF pregnancies via bivariate associations and multivariable logistic regression analyses. Independent variables included prior uterine surgery versus no uterine surgery, peak estradiol, and progesterone levels, day 3 (n = 92) versus day 5 (n = 118) ET, and assisted hatching versus no assisted hatching. Among the day 5 ET subgroup of 118 patients, 117 had data for the variables inner cell mass (ICM) grading and trophectoderm (TE) because one day 5 ET was at the morula stage. Results We found a significant bivariate association between TE grading and SCH, where cases with TE grade "A" were significantly less likely to have SCH compared with cases with grades "B" or "C." This significant difference remained when adjusting for the other factors considered in a multivariable logistic regression model for the probability of SCH. Conclusions The data analyzed here suggest that a less-advanced trophectoderm grade may be a potential factor that is associated with the presence of SCH in pregnancies achieved via IVF.

Outcomes of subchorionic hematoma‐affected pregnancies in the infertile population

“…While a prior meta‐analysis demonstrated increased risk of miscarriage in the fertile population with SCH, 5 a 2019 study demonstrated no increased risk 1 . Similarly, in other studies examining only the infertile population, there was no association between SCH and first trimester pregnancy loss 3,13,18 . Notably, these studies did not assess for the presence of symptoms and whether they impacted risk of miscarriage.…”

“… 1 Similarly, in other studies examining only the infertile population, there was no association between SCH and first trimester pregnancy loss. 3 , 13 , 18 Notably, these studies did not assess for the presence of symptoms and whether they impacted risk of miscarriage.…”

Subchorionic hematoma: Research status and pathogenesis (Review)

“…It has been found that the incidence of SCH in pregnant women with assisted reproduction is higher than that in women with natural pregnancy, and frozen embryo transfer and blastocyst transfer increase the risk of SCH ( 17 ). A previous study demonstrated that the transfer of poor blastocyst trophoblast cells can notably increase the risk of SCH, which may be related to the long-term in vitro culture of blastocysts and abnormal placental development ( 18 ). So et al ( 19 ) assumed that uterine cavity surgeries, such as endometrial polyp removal and hysteroscopy prior to embryo transfer, would damage the endometrium and affect the normal development of the placenta.…”

Association of volume of first trimester subchorionic hemorrhage with pregnancy outcome

“…Subchorionic hemorrhage, blood clot or collection of blood between the uterine lining and the gestational sac, is a relatively common condition during early pregnancy and can cause varying degrees of concern for expectant mothers. 2 It may result from the separation of the chorion. 3 Majority of cases resolve spontaneously without causing harm to the pregnancy.…”