Risk Factors for Poor Perinatal and Neonatal Outcomes in Pregnant Women With Subchorionic Hematoma
Kumiko Nakata, Naoyuki Iwahashi, Kaho Nishioka, Megumi Fujino, Tomoko Noguchi, Tamaki Yahata, Mika Mizoguchi, Yuko Tanizaki-Horiuchi, Yasushi Mabuchi, Sawako Minami, Kazuhiko Ino
Objectives: Subchorionic hematoma (SCH) increases the risk of miscarriage, preterm birth, preterm
premature rupture of membranes (pPROM), and neonatal chronic lung disease. The present study
examined perinatal/neonatal outcomes in pregnant women with SCH and investigated risk factors for
poor outcomes.
Methods: Subjects were 45 pregnant women who developed SCH in the 1st to 2nd trimester of pregnancy,
requiring hospital management due to genital bleeding at our hospital between January 2013 and
December 2020. Eight patients, consisting of 5 with neonatal death and 3 whose neonates developed
chronic lung disease, were assigned to the poor neonatal outcome group and the other 37 to the good
neonatal outcome group. We compared maternal background factors, pregnancy-related complications,
perinatal outcomes, and pathological findings of the placenta between the two groups.
Results: Hematoma diameters were significantly longer in the poor neonatal outcome group than in
the good neonatal outcome group, while the rate of patients with bleeding after Week 16 of pregnancy
was significantly higher in the former than in the latter. In the poor neonatal outcome group, pPROM
occurred in 5 (62.5%) of 8 patients, and chronic abruption-oligohydramnios sequence in 6 (75%). Of the
27 patients from whom pathological findings of the placenta were obtained, chorioamnionitis (Blanc’s
stage II or higher) was observed in 3 (37.5%) of 8 patients in the poor neonatal outcome group and in 6
(31.5%) of 19 patients in the good neonatal outcome group, with no significant difference. A multivariate
analysis showed that the presence of bleeding after Week 16 of pregnancy was an independent risk factor
for poor outcomes in SCH patients’ neonates.
Conclusions: Pregnant women with SCH have generally favorable perinatal outcomes. On the other
hand, SCH with bleeding after Week 16 of pregnancy is associated with poor neonatal outcomes;
therefore, careful and close management is necessary.
