Sonographic Findings and Clinical Outcomes in Women With Massive Subchorionic Hematoma Detected in the Second Trimester

Windrim, Catherine; Athaide, Greg; Gerster, Tracy; Kingdom, John

doi:10.1016/s1701-2163(16)34881-2

Cited by 14 publications

(17 citation statements)

References 6 publications

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“…Rarely, hemorrhage may be seen where large portions of the membranes detach from the uterine wall. 72 The perinatal risk from this range of placental lesions depends upon the amount of residual normally functioning placental tissue, combined with knowledge of the uterine and umbilical arterial Doppler waveforms. A good example of this concept is in the diagnosis and evaluation of prognosis in Breus' mole, a condition associated with severe FGR, where layers of hemorrhage accumulate directly under the chorionic plate, underlying at least 50% of the chorionic plate surface 73 (Figure 7 and Supplementary Video 8).…”

Section: Expert Reviews Ajogorgmentioning

confidence: 99%

A placenta clinic approach to the diagnosis and management of fetal growth restriction

Kingdom

Audette

Hobson

et al. 2018

American Journal of Obstetrics and Gynecology

128

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Effective detection and management of fetal growth restriction is relevant to all obstetric care providers. Models of best practice to care for these patients and their families continue to evolve. Since much of the disease burden in fetal growth restriction originates in the placenta, the concept of a multidisciplinary placenta clinic program, managed primarily within a maternal-fetal medicine division, has gained popularity. In this context, fetal growth restriction is merely one of many placenta-related disorders that can benefit from an interdisciplinary approach, incorporating expertise from specialist perinatal ultrasound and magnetic resonance imaging, reproductive genetics, neonatal pediatrics, internal medicine subspecialties, perinatal pathology, and nursing. The accurate diagnosis and prognosis for women with fetal growth restriction is established by comprehensive clinical review and detailed sonographic evaluation of the fetus, combined with uterine artery Doppler and morphologic assessment of the placenta. Diagnostic accuracy for placenta-mediated fetal growth restriction may be enhanced by quantification of maternal serum biomarkers including placenta growth factor alone or combined with soluble fms-like tyrosine kinase-1. Uterine artery Doppler is typically abnormal in most instances of early-onset fetal growth restriction and is associated with coexistent preeclampsia and underlying maternal vascular malperfusion pathology of the placenta. By contrast, rare but potentially more serious underlying placental diagnoses, such as massive perivillous fibrinoid deposition, chronic histiocytic intervillositis, or fetal thrombotic vasculopathy, may be associated with normal uterine artery Doppler waveforms. Despite minor variations in placental size, shape, and cord insertion, placental function remains, largely normal in the general population. Consequently, morphologic assessment of the placenta is not currently incorporated into current screening programs for placental complications. However, placental ultrasound can be diagnostic in the context of fetal growth restriction, for example in Breus' mole and triploidy, which in turn may enhance diagnosis and management. Several examples are illustrated in our figures and supplementary videos. Recent advances in the ability of multiparameter screening and intervention programs to reduce the risk of severe preeclampsia will likely increase efforts to deliver similar improvements for women at risk of fetal growth restriction. Placental pathology is important because the underlying pathologies associated with fetal growth restriction have a wide range of recurrence risks. Rare conditions such as massive perivillous fibrinoid deposition or chronic histolytic intervillositis may recur in >50% of subsequent pregnancies. Postpartum care in a placenta-focused program can provide effective counseling for modifiable maternal risk factors, and can assist in planning future pregnancy care based on the pathologic basis of fetal growth restriction.

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Section: Expert Reviews Ajogorgmentioning

confidence: 99%

A placenta clinic approach to the diagnosis and management of fetal growth restriction

Kingdom

Audette

Hobson

et al. 2018

American Journal of Obstetrics and Gynecology

128

View full text Add to dashboard Cite

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“…By contrast hemorrhage at the edge of the placenta or behind an isolated area of the fetal membrane, blood may track externally to cause vaginal bleeding. 1 Later in the first trimester and early second trimester, the subchorionic hematoma partially strips the developing placenta away from its attachment site. Therefore prognosis of patients with type of hematoma in second trimester is worse than the prognosis of patients with hematoma early in first trimester.…”

Section: Introductionmentioning

confidence: 99%

Massive subchorionic haemorrhage: a rare case report associated with secondary PPH due to uterine artery pseudoaneurysm

Arumaikannu¹,

Rani²,

Thasleem³

2017

Int J Reprod Contracept Obstet Gynecol

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Massive subchorionic hemorrhage is a rare but serious condition in pregnancy in which a large amount of blood, mainly maternal collects between the uterine wall and the chorionic membrane and may leak through the cervical canal. Although many associations have been reported, an underlying etiology has not been elucidated. Association of massive subchorionic hemorrhage with thrombophilias have been reported in few articles. We are reporting a case of massive subchorionic hemorrhage presented at 13 weeks of gestation associated with secondary post-partum hemorrhage due to uterine artery pseudoaneurysm.

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“…First, despite the wide differential diagnosis of a thick placenta and the varied location of hemorrhage, our suspicion of MTH on ultrasound was confirmed following delivery in all cases.…”

Section: Discussionmentioning

confidence: 89%

“…Hemorrhage may occur in several sites in the placenta and membranes including the retroplacental space causing abruption, beneath the fetal membranes, on the surface of the chorionic plate (subamniotic), and beneath the chorionic plate. Large areas of subchorionic hemorrhage, originally described in the context of missed abortion, are commonly referred to as Breus' mole, after the original description .…”

Section: Introductionmentioning

confidence: 99%

“…These include uteroplacental vascular insufficiency, 1 chorion regression syndrome with low maternal serum pregnancy-associated plasma protein-A (PAPP-A), 2 chronic fetal anemia, 3 placental chorioangioma, 4 placenta previa increta, 5 and a spectrum of pathologies characterized by hemorrhage within the placenta. 6 Hemorrhage may occur in several sites in the placenta and membranes 7 including the retroplacental space causing abruption, 8 beneath the fetal membranes, 9 on the surface of the chorionic plate (subamniotic), 6,10 and beneath the chorionic plate. Large areas of subchorionic hemorrhage, originally described in the context of missed abortion, are commonly referred to as Breus' mole, after the original description.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2013

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Sonographic Findings and Clinical Outcomes in Women With Massive Subchorionic Hematoma Detected in the Second Trimester

Cited by 14 publications

References 6 publications

A placenta clinic approach to the diagnosis and management of fetal growth restriction

A placenta clinic approach to the diagnosis and management of fetal growth restriction

Massive subchorionic haemorrhage: a rare case report associated with secondary PPH due to uterine artery pseudoaneurysm

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

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