Prevention of obstetric complications against the background of retrochoric hematoma in the i trimester of pregnancy

Authors

DOI:

https://doi.org/10.18370/2309-4117.2018.42.60-66

Keywords:

retrochorial hematoma, miscarriage, micronized progesterone, large obstetrical syndromes, Utrozhestan

Abstract

In modern obstetrical and gynecological practice, the problem of miscarriage, one of the manifestations of which is the retrochoric hematoma, does not lose its relevance. Despite numerous studies of the etiology and pathogenesis of this problem, there are still many questions that need answers.

The purpose of this systematic review was to highlight the problem of retrochoric hematomas, the etiological features of their occurrence and the importance of treatment in order to avoid the development of further complications, the preservation and prolongation of pregnancy. The features of diagnostics and subsequent therapy with the main pathogenetically grounded drug, micronized progesterone, are considered, which provides early support for pregnancy and a reduction in the frequency of obstetric and perinatal complications that combine into large obstetrical syndromes.

Analyzed data from modern world studies suggest that it is progestins (micronized progesterone) that should be the drug of choice in the treatment of miscarriage, which occurs against the background of retrochorial hematoma. The conclusion of the expert group of ESHRE on special issues of early pregnancy is: in women with bleeding in early pregnancy and the formation of retrochoric and retrocopental hematomas the risk of premature birth, the development of fetal growth retardation syndrome, placental abruption in the 2nd and 3rd trimesters is increased. In order to prevent preterm delivery experts recommend prolongation of therapy with micronized progesterone (200 mg per day intravaginally from early pregnancy).

In the diagnostics of retrochoric hematoma the tactics of management should be based on the therapy of preserving pregnancy and preventing its further complications. The high efficacy of micronized progesterone Utrozhestan and haemostatic therapy in the treatment of abortion complicated by retrochoric hematoma allows prolonging pregnancy and achieving favorable perinatal outcomes. The absence of side effects and good tolerance extend the possibilities of using Utrozhestan by women with retrochoric hematoma in case of a threat of termination of pregnancy.

Author Biographies

Т. Г. Романенко, P.L. Shupik National Medical Academy of the Postgraduate Education

MD, professor of Obstetrics and Gynecology Department #1 

О. М. Суліменко, P.L. Shupik National Medical Academy of the Postgraduate Education

Clinical resident at Obstetrics and Gynecology Department No. 1

References

  1. Zhabitska, L.A. New aspects of pathogenesis of miscarriage, treatment and prevention. Thesis for PhD degree. Kyiv (2007): 169 р.
  2. Solovova, L.D. Complex approach to the treatment of threatening termination of pregnancy with retrochoric hematomas. Thesis for PhD degree. Samara (2014): 190 p.
  3. Soldo, V., Cutura, N., Zamurovic, M. “Threatened miscarriage in the first trimester and retrochohematomas: sonographic evaluation and significance.” Clin Exp Obstet Gynecol 40.4 (2013): 548–50.
  4. Xiang, L., Wei, Z., Cao, Y. “Symptoms of an Intrauterine Hematoma Associated with Pregnancy Complications: A Systematic Review.” PLoS ONE 9.11 (2014): e111676.
  5. Agarkova, I.A. Prevention of early pregnancy loss in women with undeveloped pregnancy. Thesis abstract for PhD degree. Samara (2013): 27 p.
  6. Savelyeva, G.M., et al.Obstetrics: textbook. Moscow. GEOTAR-Media (2008).
  7. Nagy, S., Bush, M., Stone, J., et al. “Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy.” Orv Hetil 146.42 (2005): 2157–61.
  8. Nagy, S., Bush, M., Stone, J., et al. “Clinical Significance of Subchorionic and Retroplacental Hematomas Detected in the First Trimester of Pregnancy.” Obstet Gynecol 102 (2003): 94–100.
  9. Pelinescu-Onciul, D. “Subchorionic hemorrhage treatment with dydrogesterone.” Gynecol Endocrinol 23 Suppl. 1 (2007): 77–81.
  10. Asato, K., Mekaru, K., Heshiki, C., et al. “Subchorionic hematoma occurs more frequently in in vitro fertilization pregnancy.” Eur J Obstet Gynecol Reprod Biol 181 (2014): 41–44.
  11. Ignatko, IV, Martirosyan, N.T. “Prediction of perinatal outcomes in women with the threat of abortion and partial separation of the chorion in the first trimester.” In: Materials of the IX All-Russian Scientific Forum “Mother and Child”. Moscow (2007): 88–9.
  12. Kyser, K.L. “Meta-analysis of subchorionic hemorrhage and adverse pregnancy outcomes.” Proceedings in obstetrics and gynecology 2.4 (2012).
  13. Saraswat, L, Bhattacharya, S., Maheshwari, A, Bhattacharya, S. “Maternal and perinatal outcome in women with threatened miscarriage in the first trimester: a systematic review.” BJOG 117.3 (2010): 245–57. DOI: 10.1111/j.1471-0528.2009.02427.x
  14. Strasburger, J.F., Wakai, R.T. “Fetal cardiac arrhythmia detection and in utero therapy.” Nature reviews cardiology 7.5 (2010): 277–90. DOI: 10.1038/nrcardio.2010.32
  15. Crane, S., Collins, L., Hall, J., et al. “Reducing utilization by uninsured frequent users of the emergency department: combining case management and drop-in group medical appointments.” J Am Board Fam Med 25.2 (2012): 184–91.
  16. Asato, K., Mekaru, K., Heshiki, C., et al. “Subchorionic hematoma occurs more frequently in in vitro fertilization pregnancy.” Eur J Obstet Gynecol Reprod Biol 181 (2014): 41–4.
  17. Leite, J., Ross, P., Rossi, A.C., Jeanty, P. “Prognosis of Very Large First-Trimester Hematomas.” J Ultrasound in Medicine 25.11 (2006): 1441–5.
  18. Pirogova, V.I. “Clinico-paraclinical aspects of pregnancy, which was complicated by retrochorial hematoma.” Reproductive endocrinology 5.19 (2014): 108–10.
  19. Ferri, F.F. “Vaginal Bleeding During Pregnancy.” In: Ferri’s clinical advisor. Mosby (2014): 1143. e1.
  20. Kovaleva, Y.V. “Retrochorrial hematoma. Questions of etiopathogenesis, diagnosis, therapy.” Journal of Obstetrics and Women’s Diseases LXII.4 (2013).
  21. Mondoeva, S.S., Sukhanova, G.A., Podzolkova, N.M. “Endothelial dysfunction is an additional factor in the development of fetal loss syndrome in patients with thrombophilia. Ways of correction.” Problems of reproduction 6 (2009): 65–7.
  22. Krukier, I. “Production of NO and oxidative destruction of proteins in the place during normal pregnancy and placental insufficiency.” Bull Exp Biol Ved 136.4 (2000): 369–371.
  23. McPherson, J.A., Odibo, A.O., Shanks, A.L., et al. “Adverse outcomes in twin pregnancies complicated by early vaginal bleeding.” Am J Obstet Gynecol 208 (2013): 56.e1.
  24. Chhabra, A., Lin, E.C. “Subchorionic Hemorrhage Imaging.” Medscape.com, Apr 2014. Available from: [https://emedicine.medscape.com/article/404971-overview], last accessed Sept 16, 2018.
  25. Palatnik, A., Grobman, W.A. “The relationship between first-trimester subchorionic hematoma, cervical length, and preterm birth.” Am J Obstet Gynecol 213.3 (2015): 403.e1-4.
  26. Tower, C.L., Regan, L. “Intrauterine hematomas in a recurrent miscarriage population.” Hum Reprod 16 (2001): 2005–7.
  27. Seki, H., et al. “Persistent subchorionic hematoma with clinical symptoms until delivery.” Int J Obstet Gynaecol 63 (1998): 123–8.
  28. Mandruzzato, G.P., et al. “The intrauterine hematoma: diagnostic and clinical aspects.” J Ultrasound 17 (1989): 503–10.
  29. Kuznetsova, N.B. Prevention of perinatal complications in pregnant women with retrochorial hematomas taking into account their pathogenesis. Thesis for MD degree. Moscow (2017).
  30. Lvova, A.G. Predicting the course of pregnancy in the syndrome of fetal loss on the basis of echographic evaluation of the fetal egg and fetoplacental hemodynamics. Thesis abstract for Phd degree. Moscow (2003): 24 p.
  31. Andreeva, E.S., Stepankova, E.A. “Features of morphological changes in the placenta in patients with the threat of abortion and chorion detachment with the formation of intrauterine hematoma.” Bulletin of the RUFP. Series “Medicine” 5 (2012): 36–9.
  32. Andreeva, E.S.The course and outcome of pregnancy, complicated by detachment of the chorion/ Thesis abstract for PhD degree. Moscow (2013): 20–2.
  33. Arzhanova, O.N., Kosheleva, N.G. “Etiopathogenesis of miscarriages.” Journal of Obstetrics and Women’s Diseases LIII.1 (2004): 37–41.
  34. Ignatko, I.V. Pregnancy of high risk of perinatal pathology: pathogenesis of placental insufficiency, early diagnosis and obstetric tactics. Thesis abstract for MD degree. Moscow (2005): 48 p.
  35. Choudhury, S.R., Knapp, L.A. “Human reproductive failure I: Immunological factors.” Hum Reprod 7.2 (2000): 113–34.
  36. Cole, L.A. “Biological functions of hCG and hCG-related molecules.” Reprod Biol Endocrinol 8 (2010): 102.
  37. Granger, J.P., Alexander, B.T., et al. “Pathophysiology of pregnancy-induced Hypertension.” Am J Hypertens 14.6 (2001): 178S–185S.
  38. Hertelendy, F., Zakar, T. “Regulation of myometrial smooth muscle functions.” Curr Pharm Des 10.20 (2004): 2499–517.
  39. Gerald, J., et al. “Physiology of Alpha-Fetoprotein as a Biomarker for Perinatal. Distress: Relevance to Adverse Pregnancy Outcome.” Exp Biol Med 232 (2007): 993–1004.
  40. Murashko, L.E., Klimenchenko, N.I. “Experience in the use of micronized progesterone in the first half of pregnancy.” Obstetrics and Gynecology 5–6 (2010): 58–9.
  41. Zygmunt, M., Sapa, J. «Progesterone – a new look at the long-known drug. Literature review.” Reproductive endocrinology 1.33 (2017): 17–25.
  42. Volkova, E.V., Gaidamakina, L.F., Demidova, A.I., et al. “The course of pregnancy, complicated by retrochorial hematoma in the first trimester.” Pharmateka 12.325 (2016).
  43. Vaisbuch, E., de Ziegler, D., Leong, M., et al. “Luteal-phase support in assisted reproduction treatment: real-life practices reported worldwide by an updated website-based survey.” Reprod Biomed Online 28.3 (2014): 330–5.
  44. Coomarasamy, A., et al. “A Randomized Trial of Progesterone in Women with Recurrent Miscarriages.” N Engl J Med 373 (2015): 2141–8.
  45. Nepomnaschy, P.A., et al. “Cortisol levels and very early pregnancy loss in humans.” Proc Natl Acad Sci USA 103 (2006): 3938–42.
  46. “Successful pregnancy outcome: micronized progesterone.” Post-release on the materials of Plenum of the AOGU, Aug 21–22, 2017. Health of Ukraine. Obstetrics 3 (2017).
  47. Volkova, E.V., Gaidamakina, L.F., Demidova, A.I., et al. “The course of pregnancy, complicated by retrochorial hematoma in the first trimester.” Pharmateka 12.325 (2016).
  48. van Oppenraaij, R.H.F., et al. “Predicting adverse obstetric outcome after early pregnancy events and complications: a review.” Human Reproduction Update 15 (2009): 409–21.
  49. “Actual problems of reproductive health.” From materials of the II national congress “Discussion issues of modern obstetrics”. Reproductive endocrinology 5.13 (2013).

Downloads

Published

2018-10-12

How to Cite

Романенко, Т. Г., & Суліменко, О. М. (2018). Prevention of obstetric complications against the background of retrochoric hematoma in the i trimester of pregnancy. REPRODUCTIVE ENDOCRINOLOGY, (42), 60–66. https://doi.org/10.18370/2309-4117.2018.42.60-66

Issue

No. 42 (2018)

Section

Pregnancy and childbirth

License

Copyright (c) 2018 Т. Г. Романенко, О. М. Суліменко

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

    1. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.