| BackgroundSubchorionic hematoma(SCH)is a common obstetric phenomenon resulting from partial detachment of the chorionic membrane from the uterine wall,appearing as a hypoechoic or anechoic crescent-shaped area between chorion and uterine wall in the ultrasound image.Patients undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfers(IVF/ICSI-ET)have a higher incidence of SCH.However,there is still no consensus about the effects of SCH on pregnancy outcomes.PurposeThis study aimed to investigate the association between the first-trimester SCH after fresh embryo transfers and pregnancy outcomes.MethodsThis was a retrospective cohort study involving 3074 patients in Shandong University Affiliated Reproductive Hospital from February 2017 to December 2018.All of patients acquired clinical singleton pregnancies after fresh embryo transfers in their first IVF/ICSI cycles.According to first-trimester ultrasound examinations at 6-8 weeks of gestation,patients were divided into SCH and non-SCH groups.Symptomatic patients with vaginal bleeding and asymptamatic patients without bleeding were analyzed separately.Propensity score matching(PSM)was adopted to control for potential confounding factors in asymptomatic subcohort,and multivariable regression was adopted in symptomatic subcohort due to the small sample size.The primary outcomes included livebirth,miscarriage and preterm,and secondary outcomes included hypertensive disorders of pregnancy(HDP),gestational diabetes mellitus(GDM),cesarean section,gestational age(GA)at delivery,sex of newborns and birthweight of newborns.Besides,to further explore the key factors influencing the livebirth of SCH patients,we divided SCH patients into two groups based on whether an alive baby was delivered,and compared the characteristics between the two groups.ResultsA total of 3074 patients who acquired singleton clinical pregnancies after fresh embryo transfers were enrolled,and the incidence of SCH was 17.1%.There were 434 asymptomatic SCH patients,2333 asymptomatic non-SCH patients,92 symptomatic SCH patients and 215 symptomatic non-SCH patients.In asymptomatic subcohort,415 SCH patients and 807 non-SCH patients were finally matched and included via PSM.No significant differences were observed in the livebirth rate(91.3%vs 92.9%,P=0.314),miscarriage rate(8.4%vs 6.7%,P=0.267),and preterm birth rate(4.8%vs 5.7%,P=0.519)between two groups.Secondary outcomes including HDP(2.4%vs 4.6%,P=0.061),GDM(5.5%vs 6.4%,P=0.534),cesarean section(62.0%vs 60.9%,P=0.727),GA at delivery(39.3±1.6 wk vs 39.2±1.5 wk,P=0.485),sex of newborns(male:53.6%vs 54.4%,P=0.790)and birthweight of newborns(3369.6 ± 521.8 g vs 3382.7±486.3 g,P=0.678)were also comparable.In symptomatic subpopulation,the multivariable regression analysis was performed to control for confounding factors and the results showed that first-trimester SCH was not associated with livebirth(adjusted odd ration[aOR]0.522,95%confidence interval[CI]0.2481.100),miscarriage(aOR 1.995,95%CI 0.945-4.211)and preterm(aOR 1.497,95%CI 0.5673.950).Secondary outcomes between the two groups,including HDP(aOR:1.415,95%CI:0.385-5.199),GDM(aOR:1.089,95%CI:0.391-3.039),cesarean section(aOR:0.998,95%CI:0.563-1.769),GA at delivery(adjusted β:-0.246,95%CI:-0.737-0.244),sex of newborns(male:aOR:0.837,95%CI:0.481-1.454)and birthweight of newborns(adjusted β:-34.080,95%CI:-181.516-113.356),were also similar.Vaginal bleeding was more common in SCH patients without live-born babies(29.4%vs 16.2%,P=0.018).The multivariable logistic regression model also verified that vaginal bleeding was associated with a decreased livebirth rate for SCH patients(OR 0.466,95%CI 0.240-0.904).DiscussionFirst-trimester SCH was not associated with pregnancy outcomes in singleton pregnancies after fresh embryo transfers.Vaginal bleeding was the risk factor of pregnancy loss for patients with SCH. |
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