The impact of first-trimester intrauterine hematoma on adverse perinatal outcomes

PURPOSE: The aim of this study was to evaluate whether the presence of an intrauterine hematoma (IUH) on an early pregnancy ultrasound scan showing a live fetus was related to adverse perinatal outcomes. METHODS: We performed a retrospective cohort study to evaluate pregnant women who underwent an ultrasound examination in early pregnancy, between 6 weeks 0 days and 10 weeks 6 days. We compared the perinatal outcomes between women with and without firsttrimester IUH using the Mann-Whitney and Fisher exact tests. Furthermore, we performed a stepwise regression analysis to identify possible predictors of miscarriage among maternal characteristics, ultrasound parameters, and IUH. RESULTS: During the study period, data from 783 pregnancies were included, and the incidence of IUH was 4.5% (35 of 783). We observed a higher proportion of miscarriage following the scan (28.6% vs. 10%, P=0.003) and a larger yolk sac diameter during the scan (4.8 mm vs. 3.8 mm, P 0.999), or the incidence of first-trimester vaginal bleeding (31% vs. 20%, P=0.130). Moreover, heart rate (HR) was the only variable that predicted miscarriage with statistical significance (P=0.017). CONCLUSION: Women with first-trimester IUH had a higher risk of miscarriage after the ultrasound scan. HR was the only variable that predicted miscarriage with statistical significance.

Second trimester cervical length measurement for prediction spontaneous preterm birth in an unselected risk population

OBJECTIVE: To assess the predictive capacity of cervical length (CL) measurement underwent during the second trimester ultrasound for prediction preterm birth <32, 34, and 37 weeks of gestation in an unselected risk population. METHODS: A retrospective cohort study was performed with 751 singleton pregnancies between 20 and 24+6 weeks of gestation. The CL measurement (mm) using the transvaginal route was obtained in a sagittal view and the calipers positioned to measure the linear distance between the triangular area of echodensity at the external os and the internal os. To compare the preterm (<37 weeks) and term births (≥37 weeks), we used unpaired t test. We assessed whether the CL measurement was dependent of gestational age by performing a linear regression and assessing the coefficient of determination (R²). We additionally assessed the accuracy of CL measurement to predict preterm birth by assessing the area under receiver operating characteristics curves with its respective confidence intervals (CIs) 95%. RESULTS: Preterm birth <37 weeks was found in 13.6% (102/751) of pregnant women. Short cervix (≤25 mm) was found in 2.7% (20/751) of pregnancies. Only 30% (6/20) of pregnant women with short cervix have used progesterone to prevent preterm birth. There was a weak correlation between CL measurement and gestational age at delivery (R²=0.01, P=0.002). Receiver operating characteristics curve analysis of the ability of CL measurement to predict preterm birth <32, 34, and 37 weeks, showed an area under the curve of 0.693 (95% CI, 0.512 to 0.874), 0.472 (95% CI, 0.353 to 0.591), 0.490 (95% CI, 0.426 to 0.555), respectively. CONCLUSION: There was a weak correlation between CL measurement and gestational age at delivery. In an unselected population, CL measurement screening at 20 to 24+6 weeks of gestation does not seem to be a good predictor of preterm birth.