Prenatal diagnosis, clinical outcomes, and associated pathology in pregnancies complicated by massive subchorionic thrombohematoma (Breus' mole)

Alanjari, Abdulmohsen; Wright, E. James; Keating, Sarah; Ryan, Greg; Kingdom, John

doi:10.1002/pd.4176

Cited by 38 publications

(44 citation statements)

References 34 publications

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“…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.…”

Section: Methodsmentioning

confidence: 99%

Symptoms of an Intrauterine Hematoma Associated with Pregnancy Complications: A Systematic Review

2014

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ObjectiveTo evaluate the predictive value of the symptoms of an intrauterine hematoma (IUH) for adverse pregnancy outcomes.MethodsA 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.ResultsIt 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.ConclusionsBoth 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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Section: Methodsmentioning

confidence: 99%

Symptoms of an Intrauterine Hematoma Associated with Pregnancy Complications: A Systematic Review

2014

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“…Secondly, the ultrasound findings of MSH are highly variable, and the pregnancy outcome is poor. Table shows the results of a literature review performed by searching MEDLINE for “massive subchorionic hematoma” and/or “Breus’ mole” published in English after 2000 . There were 43 cases, including the case outlined here.…”

Section: Discussionmentioning

confidence: 99%

“…FGR occurs due to utero‐placental insufficiency, and when a hematoma occurs near the umbilical cord attachment, the umbilical vessels can be compressed; it has been suggested that perinatal outcomes in these cases are considerably worse . Alanjari et al reported that the perinatal outcome depends on gestational age at delivery and the degree of FGR, and that normal umbilical artery Doppler at presentation is a favorable prognostic sign. A total of 90.7% (39/43) of cases were identified antenatally.…”

Section: Discussionmentioning

confidence: 99%

“…Massive subchorionic hematoma (MSH) is a large maternal blood clot with a thickness of at least 1 cm, that separates the chorionic plate from the villous chorion . Especially when presenting preplacentally, MSH is commonly termed “Breus’ Mole” and has been linked with poor pregnancy outcomes such as fetal growth restriction (FGR) and intrauterine fetal death (IUFD) . The estimated incidence of this condition is low (1/3000 pregnancies) .…”

Section: Introductionmentioning

confidence: 99%

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Massive subchorionic hematoma (Breus’ mole) presents a variety of ultrasonic appearances: A case report and literature review

Yanagisawa

Aoki

Odagami

et al. 2019

Clinical Case Reports

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“…Las causas de mortalidad se han relacionado con la prematuridad extrema y con el RCIU con Doppler anormal de la arteria umbilical (AU) (3).…”

Section: Discussionunclassified

Diagnóstico prenatal de trombohematoma subcoriónico masivo (mola de Breus)

et al. 2016

Rev. chil. obstet. ginecol.

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RESUMENEl trombohematoma subcoriónico masivo o Mola de Breus, por ser éste el autor que lo describió por primera vez en abortos, es un hematoma subcorial de al menos 1 cm de grosor que ocupa al menos, el 50% de la superficie fetal. Suele asociar una alta morbimortalidad fetal y perinatal, en forma de abortos, retraso del crecimiento intrauterino, muerte intrauterina, desprendimiento de placenta normalmente inserta y recién nacidos de bajo peso, generalmente pretérminos. Esta entidad debe diferenciarse de otros procesos que pueden asentar bajo la placa corial, hacia la superficie fetal como: corioangioma, depósitos de fibrina y trombosis del espacio intervelloso. Se han intentado postular mecanismos que pudieran causar dicha circunstancia, sin que por el momento podamos definir factores de riesgo médicos que claramente predispongan a padecer esta entidad. El objetivo de describir estos dos casos clínicos diagnosticados en 2013 es resaltar que, gracias a la sospecha ecográfica de un trombohematoma subcoriónico masivo, podemos estudiar la pieza de placenta y membranas tras la finalización de la gestación, con lo que obtendríamos así la confirmación anátomo-patológica, de otra manera esta información podría perderse.PALABRAS CLAVE: Trombohematoma subcoriónico masivo, mola de Breus, aborto tardío, retraso del crecimiento intrauterino, diagnóstico prenatal SUMMARYThe massive subchorionictrombo hematoma or Breus´s Mola, this was the author who first described it in miscarriages, is a subchorionic hematoma at least 1 cm in thickness which occupies at least 50% of the fetal surface. Usually associated with high fetal and perinatal morbidity and mortality, as miscarriages, intrauterine growth retardation, stillbirth, placental abruption and low birth weight, preterm generally. This entity should be distinguished from other processes that can seat under the chorionic plate to the fetal surface as chorioangioma, fibrin deposition and thrombosis intervillous space. They have tried to apply mechanisms that could cause such a circumstance, but for now we don't define medical risk factors that predispose clearly suffer from this entity. In order to describe these two cases diagnosed in 2013 is to emphasize that thanks to the sonographic suspicion of a massive subchorionic trombohematoma, can study the piece of placenta and membranes after the end of pregnancy, so it would provide pathologic confirmation, otherwise this information could be lost.

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Prenatal diagnosis, clinical outcomes, and associated pathology in pregnancies complicated by massive subchorionic thrombohematoma (Breus' mole)

Abstract: Massive subchorionic thrombohematoma/Breus' mole may be diagnosed in the second trimester by ultrasound assessment of the placenta. Normal fetal growth and UA Doppler waveforms are associated with perinatal survival.

Cited by 38 publications

References 34 publications

Symptoms of an Intrauterine Hematoma Associated with Pregnancy Complications: A Systematic Review

Symptoms of an Intrauterine Hematoma Associated with Pregnancy Complications: A Systematic Review

Massive subchorionic hematoma (Breus’ mole) presents a variety of ultrasonic appearances: A case report and literature review

Diagnóstico prenatal de trombohematoma subcoriónico masivo (mola de Breus)

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