Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Vienna, Austria.
Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Vienna, Austria.
BMC Pregnancy Childbirth. 2017 Oct 26;17(1):366. doi: 10.1186/s12884-017-1539-6.
Intrauterine hematomas are a common pregnancy complication. The literature lacks studies about outcomes based on hematoma localization. Thus, we aimed to compare pregnancies complicated by an intraplacental hematoma to cases with a retroplacental hematoma and to a control group.
In a retrospective case-control study, 32 women with an intraplacental hematoma, 199 women with a retroplacental hematoma, and a control group consisting of 113 age-matched women with no signs of placental abnormalities were included. Main outcome measures were pregnancy complications.
Second-trimester miscarriage was most common in the intraplacental hematoma group (9.4%), followed by women with a retroplacental hematoma (4.2%), and controls (0%; p = 0.007). The intraplacental hematoma group revealed the highest rates for placental insufficiency, intrauterine growth retardation, premature preterm rupture of membranes, preterm labor, preterm delivery <37 weeks, and early preterm delivery <34 weeks (p < 0.05), followed by the retroplacental hematoma group. When tested in multivariate models, intraplacental hematomas were independent predictors for placental insufficiency (ß = 4.19, p < 0.001) and intrauterine growth restriction (ß = 1.44, p = 0.035). Intrauterine fetal deaths occurred only in women with a retroplacental hematoma (p = 0.042).
Intra- and retroplacental hematomas have different risk profiles for the affected pregnancy and act as independent risk factors.
子宫内血肿是一种常见的妊娠并发症。文献中缺乏基于血肿定位的结局研究。因此，我们旨在比较胎盘内血肿、胎盘后血肿与对照组妊娠的结局。
在一项回顾性病例对照研究中，纳入了 32 例胎盘内血肿、199 例胎盘后血肿和 113 例无胎盘异常迹象的年龄匹配对照组妇女。主要结局指标为妊娠并发症。
胎盘内血肿组（9.4%）妊娠中期流产最常见，其次是胎盘后血肿组（4.2%）和对照组（0%；p=0.007）。胎盘内血肿组胎盘功能不全、宫内生长受限、胎膜早破早产、早产<37 周和早产<34 周的发生率最高（p<0.05），其次是胎盘后血肿组。多变量模型检验显示，胎盘内血肿是胎盘功能不全（β=4.19，p<0.001）和宫内生长受限（β=1.44，p=0.035）的独立预测因素。只有胎盘后血肿组发生宫内胎儿死亡（p=0.042）。
胎盘内和胎盘后血肿对受影响的妊娠有不同的风险特征，且为独立的危险因素。
