Influence of retrochorial hematomas in the first trimester on perinatal delivery

The objective: to analyze the features of childbirth and the condition of newborns in women whose pregnancy was complicated by retrochorial hematoma (RHH) in the first trimester.Materials and methods. At the beginning of the study, 100 pregnant women aged 18–44 years (mean age 28,08±3,5) were monitored – 70 women in the main and 30 control groups. In 10 cases out of 70, the pregnancy was terminated in the first trimester on the background of RHH. 60 patients of the main group, in whom the pregnancy progressed, were divided into 2 subgroups: subgroup A (n=39) – first-time pregnant women with the threat of abortion due to RHH; subgroup B (n=21) – re-pregnant with a burdened obstetric-gynecological history (OGH) and RHH. The control group (n=30) consisted of first-time and repeat pregnant women with a physiologically normal course of current and previous pregnancies. All women were examined comprehensively. Patients at risk of abortion and RHH received pathogenetically sound therapy to maintain pregnancy. The condition of newborns in the first minutes of life was assessed on the Apgar scale, if necessary, rehabilitation measures were applied.Results. At the beginning of the study, it was revealed that the majority of patients in all groups had a burdened OGH: 22,5% of patients in subgroup A, 30% in subgroup B, 16.6% of pregnant women in the control group, in addition, half of them had a combination of two or more somatic diseases. Every third patient (17-28,3%) of the main group had delivery by cesarean section (CS), in the control group – 16,6%. Spontaneous childbirth in the main group occurred in 71,7% of cases, in the control group – in 80%; premature birth – from 5.1% to 19% in subgroups and in 1 case (3,3%) in the control group. The average duration of pregnancy in the main group was 37,3±2,4 weeks, in the control group – 39,4±0,3 weeks.In a comparative analysis of perinatal results, 54 (90%) full-term newborns were born in the main group, 29 (96,7%) in the control; premature babies – 2 (5,1%) in subgroup A, 4 (19%) in subgroup B, 1 (3,3%) – in the control group. In the main group, the frequency of birth of children in a state of hypoxia requiring resuscitation and intensive therapy was more than 2 times higher than in the control group – 5 (8,3%) and 2 (6,7%), respectively. There were no cases of moderate and severe asphyxia. Newborns of both subgroups A and B, due to intrauterine hypoxia, had pathological conditions in the form of morphological and functional immaturity, neurological disorders, signs of intrauterine infection, but not a single child needed to be transferred to a specialized department for the second stage of nursing.Conclusions. Preservation of pregnancy in patients at risk of abortion and RHH in the first trimester is possible in 85,7% of cases. Analysis of births in this group of patients showed that pregnant women with a burdened OGH, despite the fact that their birth occurred no earlier than 37–38 weeks, belong to the risk group for preterm birth. Children whose miscarriage was complicated by the threat of abortion and the formation of RHH belong to the risk group for the development of intrauterine hypoxia and infectious complications. Comprehensive pathogenetically based therapy reduces the incidence of early reproductive losses, improves perinatal outcomes, perinatal morbidity and promotes prolongation of pregnancy.Key words: retrochorial hematoma, I trimester, premature birth, cesarean section, perinatal complications, placental dysfunction.