Safety of Chorionic Villus Sampling in the Presence of Asymptomatic Subchorionic Hematoma

Abstract

Objective: According to our knowledge the safety of chorionic villus sampling (CVS) has not been studied in the presence of subchorionic hematoma (SCH). Our study aimed to evaluate the effects of CVS on the procedure-related fetal loss rate in patients with SCH. Method: Fifty-six patients with asymptomatic SCH (cases) and 986 controls in whom there was no hematoma underwent elective CVS for a prenatal diagnosis of β-thalassemia and were entered into a prospective study. Mean gestational age (±SD) at diagnosis for the case and control groups were 11.07 weeks (±0.95, range 10–13 weeks) and 11.51 weeks (±1.04, range 10–13 weeks), respectively. Procedural fetal loss rates were evaluated in these groups after follow-up until 28 weeks of gestation. Results: The average hematoma volume (±SD) was 1.83 ml (±1.57, range 0.3–10.0 ml). Post-CVS early fetal loss was seen in 3.57% (2/56) of patients in the case group and 1.62% (16/986) of patients in the control group. Late fetal loss (up to the 28th week) in the case and control groups was 8.16% (4/49) and 3.76% (29/771), respectively. Post-CVS early fetal loss was seen in 2.44% (1/41) of patients with small-sized SCH (<20% of gestational sac circumference) and in 6.67% (1/15) of patients with medium-sized SCH (20–50% of gestational sac circumference). Comparison of procedure-related early and late fetal loss in the case and control groups using Fisher’s exact test demonstrated no statistically significant difference (p value = 0.252, p value = 0.128). Difference in CVS-related early fetal loss in small- and medium-sized hematoma groups (6.67 vs. 2.44%) was not significant either (p value = 0.468). Conclusion: We were unable to detect any statistically significant difference in fetal loss rate after performing CVS in patients with SCH in comparison to the control group. However, it seems that fetal loss rate may be higher in the presence of medium-sized (20–50% of gestational sac circumference) SCH and further cases are necessary to evaluate the safety of doing CVS in this group.

Do First-Trimester Subchorionic Hematomas Affect Pregnancy Outcomes?

“…There are many studies in the literature investigating the rela tionship between SHC and abortion. Although some of them re ported that they increased the abortion rate [4,[10][11][12], the num ber of studies reporting that they did not increase the abortion rate is also substantial [5,6]. Zhou et al reported that the rate of low birth weight increased but the rate of abortion did not increase in pregnant women with SCH in their study evaluating 1,097 preg nant women [6].…”

“…The most feared situation in a patient with a SCH is pregnancy loss. Although a large systematic review showed that SCH was correlated with a twofold increase in spontaneous abortion 4 , other studies found no association between SCH and pregnancy loss 5 6 . The aim of this study is to investigate the relationship between first trimester SCH and pregnancy loss in women with singleton pregnancies.…”

Outcomes of subchorionic hematoma‐affected pregnancies in the infertile population

“…The impact of SCH on early pregnancies has been disputed; prior studies in the fertile population have shown increased rates of pregnancy loss, 4 , 5 , 6 while recent studies demonstrate no increased risk. 1 , 7 Few studies have evaluated SCH among the infertile population, and these have focused primarily on pregnancies conceived by in vitro fertilization (IVF). Additionally, the majority of these studies have focused on identifying risk factors for SCH and not on evaluating the impact of SCH on pregnancy outcomes such as first trimester loss or live birth rate.…”

“…The impact of SCH on early pregnancies has been disputed; prior studies in the fertile population have shown increased rates of pregnancy loss, 4–6 while recent studies demonstrate no increased risk 1,7 . Few studies have evaluated SCH among the infertile population, and these have focused primarily on pregnancies conceived by in vitro fertilization (IVF).…”

The effects of first-trimester subchorionic hematoma on pregnancy outcomes: a retrospective cohort study

“…The clinical signi cance of SCH in early pregnancy remains controversial, and whether it increases the risk of adverse pregnancy outcomes is still uncertain. Some studies reported that SCH increased the risk of miscarriage [5,6], while others reported null associations [7,8]. Increased risks of fetal growth restriction and preterm delivery associated with SCH were also reported in some but not all studies [9,10].…”