Symptoms of an intrauterine hematoma associated with pregnancy complications: a systematic review

Abstract

Objective: To evaluate the predictive value of the symptoms of an intrauterine hematoma (IUH) for adverse pregnancy outcomes.

Methods: A 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.

Results: It 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.

Conclusions: Both 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.

Figure 1. A resolving subchorionic hematoma (H), detected at 13 menstrual weeks, extending beneath the margin (arrow) of the placenta (P) .

Figure 2. A large retroplacental hematoma (H) detected at 25 menstrual weeks, detaching more than 50%of the placenta (P).

Retroplacental venous complex (arrows) separated the hematoma and placenta (a); 1 week later, a resolving hematoma (H) contained (arrows) posterior to the placenta (P) (b) .

Figure 3. A preplacental hematoma (H), detected at 18 menstrual weeks, located between the placenta (P) and the fetus (F) .

Figure 4. Flow diagram of studies in the review.

Figure 5. An 8-week fetus associated with a small (less than one-third of the chorionic sac circumference) subchorionic hematoma (arrows) .

Figure 6. A 10-week fetal head adjacent to a moderate-size (one-third to one-half of the chorionic sac circumference) subchorionic hematorna (arrows) .

Figure 7. An 8-week fetus associated with a large (at least two-thirds of the chorionic sac circumference) subchorionic hematoma (arrows) .