PREGNANCY AND CHILDBIRTH OUTCOMES IN WOMEN WITH EARLY GESTATIONAL SUBCHORIONIC HEMATOMA

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 151 PREGNANCY AND CHILDBIRTH OUTCOMES IN WOMEN WITH EARLY GESTATIONAL SUBCHORIONIC HEMATOMA Yu.G. Rasoul-Zadeh1, D.N. Shukurkhujaeva2 Tashkent State Medical University1,2 https://doi.org/10.5281/zenodo.17841516 Abstract. Subchorionic hematoma is an urgent problem in modern obstetrics. Subchorionic hematoma leads to complications in perinatal outcomes, which in turn affects the health of future generations. Preventive measures in the first trimester improve perinatal outcomes. Keywords: sub-chorionic hematoma, pregnant women, perinatal outcomes, early gestation. Introduction Subchorionic hematoma (SCH) in first-trimester pregnancies has been estimated to range from 0.46% to 22% among the general obstetric population during the past decade [1-3]. Subchorionic haemorrhage (SCH) is a fluid accumulation within the uterine cavity resulting from the detachment of trophoblasts from the uterine wall [2]. A subchorionic hematoma (SCH) refers to blood that has collected between the chorionic membrane and the uterine wall due to the detachment of the chorion from the endometrium [5,6]. It is the most common cause of firsttrimester haemorrhage and the most prevalent sonographic abnormalities in pregnant women exhibiting signs of impending loss [1,7]. The incidence of subclinical hypothyroidism (SCH) in the general obstetric population is estimated to range from 1.7% to 3.1%, but in pregnant women displaying indications of an impending abortion, it may escalate to 20% [ 1,8]. A prevalent observation in routine obstetric ultrasonography is a subchorionic hematoma. During the first trimester, it presents as a hypoechoic or anechoic crescent-shaped region posterior to the gestational sac; in the second trimester, it is located posterior to the fetal membranes. The exact aetiology remains unidentified; however, partial detachment of the chorionic membrane from the uterine wall is believed to be the underlying factor [2]. The incidence of subchorionic hematoma varies significantly in the literature, with reported instances between 0.5% and 22% [3,4]. This variance can most likely be attributable to variations in the definition, the gestational age of diagnosis, the populations tested, and the ultrasonography method and resolution applied. Research has produced variable findings concerning the clinical significance of subchorionic hematoma, a disease initially documented by Mantoni and Pedersen in 1981[5,6]. Subchorionic haemorrhage is considered a sign of placental dysfunction, which may lead to preterm labour, premature rupture of membranes, placental abruption, pre-eclampsia, and fetal growth restriction [7]. Nonetheless, whereas numerous studies showed a correlation with adverse perinatal outcomes, others did not establish such a connection [8-12]. Recent extensive investigations have been published to elucidate the relationship between pregnancy outcomes and subchorionic hematoma [1,13,14]. The resolution of an intrauterine hematoma remains ambiguous, as does the significance of this ultrasonography finding on prognosis. The existence of a hematoma has been associated with a miscarriage risk of 4–33%, contingent upon the gestational age at which the issue is identified [6]. Unfavourable sociobiological circumstances, a complicated obstetric and gynaecological history, viral and SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 152 inflammatory disorders, and the existence of extragenital pathology have a significant influence [5]. The research also addresses the significance of immunological factors in spontaneous miscarriage, notably antiphospholipid syndrome (APS) [6]. The most common conditions are hypofunction of the corpus luteum and increased production of androgens of various origins [ 7]. Hormonal problems in a woman's body significantly contribute to the aetiology of spontaneous abortion. Presently, despite numerous studies demonstrating the significant efficacy of preconception preparation for women with a history of miscarriage, physicians frequently conduct examinations and treatments during pregnancy, often in the later stages, which does not always facilitate the identification and rectification of existing disorders. Consequently, women experiencing threatening miscarriage have adverse pregnancy outcomes for the fetus, resulting in elevated perinatal morbidity. Consequently, one facet of enhancing fertility is to examine the implications of vaginal bleeding during early pregnancy. Research findings indicate that multiple violations of implantation processes in pregnant women experiencing first-trimester bleeding elevate the risk of premature births and the delivery of lowbirth-weight infants, including those with inadequate weight for their gestational age, while concurrently reducing gestational duration [9]. Numerous publications have examined birth outcomes for fetuses, demonstrating that the occurrence of spotting during the first trimester of pregnancy elevates the risk of delivering a fetus with an Apgar score below 7 at 5 minutes, necessitating transfer to the NICU, and increasing neonatal mortality rates [10]. Other authors suggest that this demographic of women faces an elevated risk of developing fetal growth restriction syndrome (FGR) and delivering low birth weight infants [11]. The primary pathogenic element of ORP is placental insufficiency resulting from compromised uteroplacental circulation, leading to prolonged fetal hypoxia and metabolic disturbances [12]. In contemporary understanding, ORP is a clinical indication of placental insufficiency, occurring in 80–90% of instances involving underlying maternal conditions, preeclampsia/eclampsia, multiple gestations, and extended miscarriage threats [13]. The prevalence of ORP in multiple pregnancies is 30–40% [14]. The World Health Organisation reports that the prevalence of babies with growth limitation varies from 31.1% in Central Asia to 6.5% in industrialised European nations. In the United States, ORP manifests in 10–15% of newborns, whereas severe intrapartum hypoxia is present in 30% of infants exhibiting indications of ORP. The prevalence of ORP in Russia varies between 2.4% and 17% [15]. Consequently, children with intrauterine growth limitation constitute 67.4 per 1000 live term births and 179.5 per 1000 preterm births. In cases with ORF, a delay in body weight and/or fetal length frequently coincides with a delay in the development of specific organs, usually parenchymal ones. These repercussions are more prevalent when haemorrhage transpires throughout the second trimester [19]. A meta-analysis identified a correlation between vaginal bleeding and adverse pregnancy outcomes; however, discrepancies existed in the reported risks and the strength of the association among studies [31]. Multiple studies have already identified a correlation between hematoma size and subsequent problems [5,8]. This relationship remains disputed for women who arrive with a threatening miscarriage throughout the first trimester [4,6]. Subchorionic bleeding can significantly influence pregnancy outcomes. A significant hematoma could potentially jeopardise the pregnancy by applying direct pressure on the blood volume. The determination may depend on the hematoma's location, proximity to the placenta, and volume of the hematoma [5,32]. Haemorrhaging in the first trimester, regardless of the presence of a SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 153 hematoma, may induce a persistent inflammatory response in the decidua, resulting in myometrial contractions and potential pregnancy expulsion [33]. Poor placentation is observed in almost two-thirds of early pregnancy failures, characterised by a compromised and fragmented trophoblast shell and reduced cytotrophoblast invasion into the lumen at the termini of the spiral arteries [34]. Subsequent pregnancy problems, such as hypertension, preterm labour, and, more recently, premature rupture of membranes (PROM), have been associated with inadequate placentation and insufficient invasion of normal spiral arteries [35-37]. During a typical pregnancy, oxidative stress increases as maternal circulation evolves, potentially serving a physiological function in promoting placental differentiation and modulating cellular activity [38]. As oxygen tension increases, the expression of antioxidant enzymes in placental tissues also elevates [39]. The early perfusion of the intervillous space, observed in subchorionic haemorrhage, prior to the establishment of placental mechanisms for managing oxidative stress, may contribute to pregnancy loss [38]. In conclusion, the study's findings indicate that women diagnosed with subchorionic hematoma (SCH) in the first trimester face an elevated risk of adverse pregnancy outcomes, including reduced gestational ages at delivery and increased incidences of first-trimester bleeding, irrespective of hematoma size. Additionally, there is a heightened risk of preterm delivery, delivery before 37 weeks' gestation, first-trimester vaginal bleeding, early pregnancy loss, placental abruption, and intrauterine growth restriction, particularly among women with larger hematomas. These results underscore the necessity of recurrent sonographic examinations for pregnant women with SCH to monitor the clinical progression of SCH and to detect anticipated adverse pregnancy outcomes, such as IUGR, at an early stage. The results indicate a minor correlation between subchorionic hematoma and both early and late pregnancy loss, preterm premature rupture of membranes, and preterm delivery, with a more significant association with placental abruption. These findings will be important in advising women with subchorionic hematoma. Currently, there are no definitive solutions to avert these issues; however, the alertness of patients and clinicians will facilitate prompt identification and treatment when they occur. Ultimately, because of the study's heterogeneity, the probability of adverse perinatal outcomes must be evaluated in the context of each patient's presentation and additional risk factors. 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