Faculty Collaboration Database

The relationship between first-trimester subchorionic hematoma, cervical length, and preterm birth. Am J Obstet Gynecol 2015 Sep;213(3):403.e1-4

Date

05/20/2015

Pubmed ID

25981842

DOI

10.1016/j.ajog.2015.05.019

Scopus ID

2-s2.0-84940459076 (requires institutional sign-in at Scopus site)   28 Citations

Abstract

OBJECTIVE: The objective of the study was to evaluate the association between a sonographically diagnosed subchorionic hematoma (SCH) in the first trimester and subsequent midtrimester cervical length and preterm birth.

STUDY DESIGN: In this cohort study, 512 women with an SCH on their first-trimester ultrasound were compared with 1024 women without a first-trimester SCH. All women underwent routine transvaginal cervical length measurement between 18 and 22 weeks. Women with multifetal gestation, cerclage, or a uterine anomaly were excluded. A multivariable linear regression was performed to assess the independent association of SCH with cervical length, and a logistic regression was done to determine whether the presence of SCH was associated with preterm birth independent of the cervical length.

RESULTS: In a univariable analysis, the presence of a SCH was significantly associated with a shorter mean cervical length as well as a cervical length less than the 10th percentile (4.27 cm vs 4.36 cm, P = .038; 1.9% vs 0.5%, P = .006, respectively). Preterm birth also was more common in women with an SCH (12.5% vs 7.3%, P = .001). Even after adjusting for potentially confounding factors, a significant negative association existed between the presence of an SCH and cervical length (centimeters) (linear regression coefficient, -0.08; 95% confidence interval, -0.17 to -0.005). In a multivariable regression, SCH remained associated with preterm birth, even with cervical length entered into the equation as a covariate (adjusted odds ratio, 1.58; 95% confidence interval, 1.09-2.32).

CONCLUSION: First-trimester SCH is associated with both a shorter cervical length and preterm birth. Our data suggest, however, that mechanisms other than cervical shortening may be involved in preterm birth among women with SCH.

Author List

Palatnik A, Grobman WA

Author

Anna Palatnik MD Associate Professor in the Obstetrics and Gynecology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Cervical Length Measurement
Cervix Uteri
Chorion
Female
Hematoma
Humans
Linear Models
Logistic Models
Pregnancy
Pregnancy Complications
Pregnancy Trimester, First
Pregnancy Trimester, Second
Premature Birth
Retrospective Studies
Risk Factors