Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.
Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.
Arch Gynecol Obstet. 2022 Dec;306(6):2167-2175. doi: 10.1007/s00404-022-06775-y. Epub 2022 Sep 16.
This study aimed to investigate the association between first-trimester subchorionic hematoma (SCH) detected at 6-8 weeks of gestation after fresh embryo transfers and adverse pregnancy outcomes.
We performed a retrospective cohort involving 3074 patients. All of them acquired singleton pregnancies after fresh embryo transfers in the first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. According to first-trimester ultrasound examinations at 6-8 weeks of gestation, we divided patients into SCH and non-SCH groups and compared their perinatal outcomes. Symptomatic patients with vaginal bleeding and asymptomatic patients were analyzed separately, and propensity score matching (PSM) and multivariable regression were adopted to control potential confounding factors.
The incidence of SCH was 17.1% in 3074 women, and vaginal bleeding occurred in 92 SCH patients and 215 control patients. In the asymptomatic cohort, 415 women with SCH and 807 women without SCH were finally included after PSM. No significant differences were observed in livebirth rate (91.3% vs 92.9%, P = 0.314), miscarriage rate (8.4% vs 6.7%, P = 0.267), and preterm birth rate (4.8% vs 5.7%, P = 0.519) between two groups. Secondary outcomes including gestational hypertension or preeclampsia, gestational diabetes mellitus (GDM), gestational age (GA) at delivery, mode of delivery, sex of newborns and birthweight of newborns were comparable. For symptomatic patients, both univariable and multivariable regression analysis showed no significant association between SCH and pregnancy outcomes. A subgroup analysis including patients with SCH illustrated the symptom of vaginal bleeding rather than hematoma size was associated with livebirth.
First-trimester SCH detected at 6-8 weeks of gestation was not associated with adverse pregnancy outcomes in singleton pregnancies after fresh embryo transfers. Vaginal bleeding was the risk factor of pregnancy loss for patients with SCH.
本研究旨在探讨新鲜胚胎移植后 6-8 周妊娠时发现的早孕期绒毛膜下血肿（SCH）与不良妊娠结局之间的关系。
我们进行了一项回顾性队列研究，纳入了 3074 名患者。他们均在首次体外受精/胞浆内单精子注射（IVF/ICSI）周期中接受新鲜胚胎移植后获得单胎妊娠。根据 6-8 周的早孕期超声检查，我们将患者分为 SCH 组和非 SCH 组，并比较其围产结局。对有阴道出血症状的患者和无症状的患者分别进行分析，并采用倾向评分匹配（PSM）和多变量回归来控制潜在的混杂因素。
3074 名女性中 SCH 的发生率为 17.1%，92 名 SCH 患者和 215 名对照患者出现阴道出血。在无症状队列中，经过 PSM 后，最终纳入 415 名 SCH 患者和 807 名非 SCH 患者。两组间活产率（91.3% vs 92.9%，P=0.314）、流产率（8.4% vs 6.7%，P=0.267）和早产率（4.8% vs 5.7%，P=0.519）均无显著差异。次要结局包括妊娠期高血压或子痫前期、妊娠期糖尿病（GDM）、分娩时的孕龄、分娩方式、新生儿性别和新生儿体重也相似。对于有症状的患者，单变量和多变量回归分析均显示 SCH 与妊娠结局之间无显著关联。包括 SCH 患者的亚组分析表明，阴道出血的症状而不是血肿大小与活产有关。
新鲜胚胎移植后 6-8 周妊娠时发现的早孕期 SCH 与单胎妊娠的不良妊娠结局无关。SCH 患者的阴道出血是妊娠丢失的危险因素。
