Chorionic bump: Progression to a subamniotic hematoma

Ultrasound ◽  
2021 ◽  
pp. 1742271X2110085
Author(s):  
Claudia Galleguillos ◽  
Waldo Sepulveda
Keyword(s):  
Early Pregnancy ◽  
Deleterious Effect ◽  
Pregnancy Loss ◽  
Alternative Explanation ◽  
First Trimester ◽  
Early Embryo ◽  
Ultrasound Finding ◽  
Second Trimester ◽  
First Trimester Scan

Introduction A chorionic bump is an increasingly recognized ultrasound finding in first-trimester scans, which has been associated with early pregnancy loss. In ongoing second-trimester pregnancies, however, chorionic bumps usually resolve over time with no deleterious effect on the fetus. In this report, we describe the incidental ultrasound detection of a chorionic bump in early pregnancy and its progression to a subamniotic hematoma in the second trimester of pregnancy that persisted as such until delivery. Case Report A round, echogenic mass protruding from the choriodecidual surface measuring 13 × 11 × 8 mm was first identified during a transvaginal scan at 6.3 weeks’ gestation. Subsequent follow-up scan at 8.3 weeks revealed an increase in the size of the chorionic bump to 25 × 20 × 19 mm, which remained stable as determined by the routine late first-trimester scan. At the second-trimester scan, a subamniotic hematoma was identified in the surface of the placenta, close to the insertion of the umbilical cord. Subsequently, the pregnancy proceeded uneventfully. Discussion The etiopathology and clinical significance of a chorionic bump remain unclear. The case herein reported demonstrates that a chorionic bump can grow considerably without having a deleterious effect on the early embryo and, occasionally, can persist throughout pregnancy as a subamniotic hematoma. Conclusion A chorionic bump can occasionally progress to a subamniotic hematoma from the second trimester onwards. This observation further supports the hypothesis that a chorionic bump is the result of choriodecidual bleeding. An alternative explanation for the development of subamniotic hematomas is proposed.

scholarly journals Is There an Association Between Early Pregnancy Losses and Low 25-Hydroxy Vitamin D Levels?

2017 ◽  
Vol 1 (1) ◽  
pp. 1-5
Author(s):  
Lebriz Hale Aktun ◽  
Yeliz Aykanat ◽  
Oktay Olmuscelik
Keyword(s):  
Vitamin D ◽  
Early Pregnancy ◽  
Pregnancy Loss ◽  
First Trimester ◽  
Normal Pregnancy ◽  
First Trimester Pregnancy ◽  
Pregnancy History ◽  
Trimester Pregnancy ◽  
25 Hydroxy Vitamin D

Objective: Since the etiology of pregnancy losses during first trimester has not still been clear, we aim to analyze the relationship between vitamin D deficiency and early pregnancy losses. Patients and Methods: The study was conducted on 200 women. Plasma was collected from 100 nulliparous women with singleton at 7-10 weeks of gestation (50 with viable gestation and 50 with pregnancy loss) and 100 non-gravid reproductive age women (50 with a successful pregnancy history and 50 with one or more spontaneous first trimester pregnancy loss history). Serum 25 (OH) D and calcium levels were compared between groups. Results: The serum 25(OH) D levels for the groups turned out to be 47.64 ± 3.2 (95% CI: 44.4-50.8 ng/ml) for normal pregnancy group, 27.3 ± 1.2 (95% CI: 26.1-28.5 ng/ml) for the group of early pregnancy loss, 38.5 ± 5.1 (95% CI: 33.4-43.6 ng/ml) for the non gravid women with healthy pregnancy history and 11.6 ± 4.2 (95% CI: 7.9 - 15.6 ng/ml) for the non-gravid women with history of 1 or more first trimester pregnancy loss. There was a strong correlation between low 25(OH) D levels and early pregnancy loss (odds ratio (OR): 1.70, 95% CI: 1.2-2.3, p <0.001). The calcium levels were significantly lower in pregnancy loss group than normal pregnancy and non-gravid groups (p=0.005, p=0.033 respectively). Conclusions: Although our study is emphasized on role of vitamin D in early pregnancy it is not possible to recommend screening and supplementation of vitamin D in early pregnancy, as prognosis of pregnancies receiving supplementation and the incidence of pregnancy related complications in follow-up are not known. Well designed studies with long term follow up results needed. Keywords: 25 hydroxy vitamin D, Pregnancy loss, 25 (OH) D vitamin

scholarly journals SARS-CoV-2 in first trimester pregnancy: a cohort study

2020 ◽  
Author(s):  
N la Cour Freiesleben ◽  
P Egerup ◽  
K V R Hviid ◽  
E R Severinsen ◽  
A M Kolte ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pregnant Women ◽  
Early Pregnancy ◽  
Pregnancy Loss ◽  
First Trimester ◽  
Nuchal Translucency ◽  
First Trimester Pregnancy ◽  
Trimester Pregnancy ◽  
Increased Risk ◽  
First Trimester Scan

Abstract STUDY QUESTION Does maternal infection with severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) in first trimester pregnancy have an impact on the fetal development as measured by nuchal translucency thickness and pregnancy loss? SUMMARY ANSWER Nuchal translucency thickness at the first trimester scan was not significantly different in pregnant women with versus without SARS-CoV-2 infection in early pregnancy and there was no significantly increased risk of pregnancy loss in women with SARS-CoV-2 infection in the first trimester. WHAT IS KNOWN ALREADY Pregnant women are more vulnerable to viral infections. Previous coronavirus epidemics have been associated with increased maternal morbidity, mortality and adverse obstetric outcomes. Currently, no evidence exists regarding possible effects of SARS-CoV-2 in first trimester pregnancies. STUDY DESIGN, SIZE, DURATION Cohort study of 1019 women with a double test taken between 17 February and 23 April 2020, as a part of the combined first trimester risk assessment, and 36 women with a first trimester pregnancy loss between 14 April and 21 May 2020, prior to the double test. The study period was during the first SARS-CoV-2 epidemic wave in Denmark. PARTICIPANTS/MATERIALS, SETTING, METHODS Cohort 1 included pregnant women with a double test taken within the study period. The excess serum from each double test was analyzed for SARS-CoV-2 antibodies. Results were correlated to the nuchal translucency thickness and the number of pregnancy losses before or at the time of the first trimester scan. Cohort 2 included women with a pregnancy loss before the gestational age for double test sample. Serum from a blood test taken the day the pregnancy loss was identified was analyzed for SARS-CoV-2 antibodies. The study was conducted at a public university hospital serving ∼12% of pregnant women and births in Denmark. All participants in the study provided written informed consent. MAIN RESULTS AND THE ROLE OF CHANCE Eighteen (1.8%) women had SARS-CoV-2 antibodies in the serum from the double test suggestive of SARS-CoV-2 infection in early pregnancy. There was no significant difference in nuchal translucency thickness for women testing positive for previous SARS-CoV-2 infection (n = 16) versus negative (n = 966) (P = 0.62). There was no significantly increased risk of pregnancy loss for women with antibodies (n = 1) (OR 3.4, 0.08–24.3 95% CI, P = 0.27). None of the women had been hospitalized due to SARS-CoV-2 infection. None of the women with pregnancy loss prior to the double test (Cohort 2) had SARS-CoV-2 antibodies. LIMITATIONS, REASONS FOR CAUTION These results may only apply to similar populations and to patients who do not require hospitalization due to SARS-CoV-2 infection. A limitation of the study is that only 1.8% of the study population had SARS-CoV-2 antibodies suggestive of previous infection. WIDER IMPLICATION OF THE FINDINGS Maternal SARS-CoV-2 infection had no effect on the nuchal translucency thickness and there was no significantly increased risk of pregnancy loss for women with SARS-CoV-2 infection in first trimester pregnancy. Evidence concerning COVID-19 in pregnancy is still limited. These data indicate that infection with SARS-CoV-2 in not hospitalized women does not pose a significant threat in first trimester pregnancies. Follow-up studies are needed to establish any risk to a fetus exposed to maternal SARS-CoV-2 infection. STUDY FUNDING/COMPETING INTEREST(S) Prof. H.S.N. and colleagues received a grant from the Danish Ministry of Research and Education for research of COVID-19 among pregnant women. The Danish government was not involved in the study design, data collection, analysis, interpretation of data, writing of the report or decision to submit the paper for publication. A.I., J.O.-L., J.B.-R., D.M.S., J.E.-F. and E.R.H. received funding from a Novo Nordisk Foundation (NNF) Young Investigator Grant (NNF15OC0016662) and a Danish National Science Foundation Center Grant (6110-00344B). A.I. received a Novo Scholarship. J.O.-L. is funded by an NNF Pregraduate Fellowship (NNF19OC0058982). D.W. is funded by the NNF (NNF18SA0034956, NNF14CC0001, NNF17OC0027594). A.M.K. is funded by a grant from the Rigshospitalet’s research fund. H.S.N. has received speaker’s fees from Ferring Pharmaceuticals, Merck Denmark A/S and Ibsa Nordic (outside the submitted work). N.l.C.F. has received a grant from Gedeon Richter (outside the submitted work). A.M.K. has received speaker’s fee from Merck (outside the submitted work). The other authors did not report any potential conflicts of interest. TRIAL REGISTRATION NUMBER N/A

Evaluation of Normal Heart Rate in Early Pregnancy Corresponding to Gestational Age between Six to Eight Weeks

Med Phoenix ◽  
2017 ◽  
Vol 2 (1) ◽  
pp. 34-37
Author(s):  
Akhilesh Kumar Jha ◽  
Bikranta Rimal ◽  
Tarannum Khatun
Keyword(s):  
Heart Rate ◽  
Early Pregnancy ◽  
Well Being ◽  
Clinical Decision ◽  
First Trimester ◽  
Normal Heart ◽  
Normal Heart Rate ◽  
First Trimester Of Pregnancy ◽  
Singleton Pregnancies

Background: Ultrasonography is the reliable and safe way for the evaluation of pregnancy. Heart rate can be detected more confidently from the Ultrasonography. Heart rate is an important parameter for the evaluation of early pregnancy. The purpose of this study was to evaluate the normal heart rate in embryos/fetuses between 6 and 8 weeks of gestation.Method: In our region people are poor and most of them do not know the benefit of regular follow up examination during pregnancy. So most of pregnant women come to our centre at late stage of pregnancy. The number of pregnancy cases is good in our centre but the number of early pregnancy cases coming to regular follow up examination is low. Thus the study was conducted in 51 normal singleton pregnancies undergoing routine ultrasound examination during the first trimester of pregnancy. The duration of study was 6 weeks.Result: Out of 51 singleton pregnancies, 20 cases (39.2%) heart rate were between 131-150 beat per minute and 25 cases (49.0 %) heart rate were between 151-170 beat per minute. However 4 cases (7.8%) were between 110-120 beat per minute and 2 cases (3.9%) were more than 171 beat per minute. There were zero cases above the 180 beat per minute.Conclusion: The result of this study will help to evaluate abnormal and normal fetal heart rate so that early clinical decision whether to continue the pregnancy or terminate it can be taken, as Ultrasonography is only the method used in screening fetal well being in most of the region of our country.Med Phoenix Vol.2(1) July 2017, 34-37

scholarly journals Distribution of diandric and digynic triploidy depending on gestational age

2021 ◽  
Author(s):  
Diana Massalska ◽  
Katarzyna Ozdarska ◽  
Tomasz Roszkowski ◽  
Julia Bijok ◽  
Anna Kucińska-Chahwan ◽  
...  
Keyword(s):  
Gestational Age ◽  
Pregnancy Loss ◽  
First Trimester ◽  
Parental Origin ◽  
Second Trimester ◽  
Chain Reaction ◽  
Spontaneous Pregnancy ◽  
First Trimester Of Pregnancy ◽  
Polymerase Chain ◽  
Fluorescent Polymerase Chain Reaction

Abstract Purpose To establish the distribution of diandric and digynic triploidy depending on gestational age. Methods 107 triploid samples tested prospectively in a single genetic department during a four-year period were analyzed for parental origin of triploidy by Quantitative Fluorescent Polymerase Chain Reaction (QF-PCR) (n=95) with the use of matching parental samples or by MS-MLPA (n=12), when parental samples were unavailable. Tested pregnancies were divided into three subgroups with regard to the gestational age at spontaneous pregnancy loss: <11 gestational weeks, 11–14 gestational weeks, and >14 gestational weeks. Results Diandric triploidy constituted overall 44.9% (46.5% in samples miscarried <11 gestational weeks, 64.3% in samples miscarried between 11 and 14 gestational weeks, and 27.8% in pregnancies which survived >14 gestational weeks). Conclusions The distribution of diandric and digynic triploidy depends on gestational age. The majority of diandric triploid pregnancies is lost in the first trimester of pregnancy. In the second trimester, diandric cases are at least twice less frequent than digynic ones.

scholarly journals Thyroid dysfunction among Indian pregnant women and its effect on the maternal and fetal outcome

2021 ◽  
Vol 10 (3) ◽  
pp. 893
Author(s):  
Aditi Jain ◽  
Raksha M. ◽  
Kanakalatha D. Nakum
Keyword(s):  
Early Pregnancy ◽  
Tertiary Care ◽  
First Trimester ◽  
Antenatal Clinic ◽  
Fetal Outcome ◽  
Overt Hypothyroidism ◽  
Thyroid Disorders ◽  
Care Hospital ◽  
Thyroid Disorder

Background: Screening of thyroid disorders in antenatal women during first trimester, to recommend management of thyroid disorder during pregnancy and to know the maternal and fetal outcome of such pregnancy.Methods: This is a prospective study for the incidence of thyroid disorder in early pregnancy and the outcome of such pregnancy. 100 cases were randomly selected from the antenatal clinic at a tertiary care hospital in India and after fulfilling the inclusion criteria they were subjected to screening for thyroid disorder till 13 weeks of pregnancy. TSH is often considered the “gold standard” for assessing thyroid function. If the participant had normal value then she was not subjected to follow up, but if abnormal, then follow up was done after 4-8 weeks, thyroid profile was repeated and if values were altered, they were medically managed and closely monitored. The obstetric and perinatal outcome of the pregnancy was noted.Results: In this screening study to detect and manage thyroid disorder, 100 antenatal women were selected randomly, from which 49 women where primigravidae and 51 women were multi-gravidae, 17 of them were of <20years, 54 were between 21 to 25 years. There was 5 percent incidence of thyroid disorder in the study group. There were 3 cases of hyperthyroidism and 2 cases of overt hypothyroidism which had poor fetal and maternal outcome on follow up.Conclusions: Our study shows that the evaluation of thyroid disorders in early pregnancy and timely intervention will lead to a decrease in the complications thereby improving the maternal and fetal outcome.

scholarly journals P024: Obtaining consensus on optimal management and follow-up of patients presenting to the emergency department with early pregnancy complications – a modified Delphi study

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S71-S72
Author(s):  
A. Cornelis ◽  
R. Clouston ◽  
P. Atkinson
Keyword(s):  
Emergency Department ◽  
Family Medicine ◽  
Nurse Practitioners ◽  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Delphi Study ◽  
Pregnancy Loss ◽  
Early Pregnancy Loss ◽  
Modified Delphi

Introduction: Complications in early pregnancy are common and have many physical and emotional consequences. Locally, there is no early pregnancy loss clinic or standardized guide in the emergency department (ED) for referral and follow-up decisions, and both initial management of patients and follow up can be inconsistent. This study aimed to obtain consensus on the best approach to initial work-up, management, and follow up for patients who present to the ED with early pregnancy complications, with the goal of using this consensus to produce a standardized guide for emergency provider use. Methods: A literature review was completed to produce evidence-based recommendations which were used to initiate a modified Delphi consensus process. A survey was distributed, with three rounds completed. Participants included emergency providers, obstetrician-gynecologists, a radiologist, a sample of family medicine physicians including some involved in primary care obstetrics, and nurse practitioners. An obstetric specialist from outside the local region was also involved. Results: Consensus was reached on several key recommendations, however some areas remained without clear accepted best practice. There was consensus that physical components of early pregnancy complications are addressed well, but that we could improve on patient flow and more consistent follow up. Important investigations to be done for patients were identified. The timing of formal ultrasound, necessity and timing of obstetrician consultation, and safety of discharge was addressed for various patient scenarios including stable and unstable patients, with and without adnexal pain, with intrauterine pregnancy of uncertain viability, and with pregnancy of unknown location. Management of confirmed early pregnancy loss in the ED and family medicine clinics was addressed. Barriers to an early pregnancy loss clinic included lack of funding, space, and staffing as well as lack of resources and uncertain patient volumes. A feasible alternative to an early pregnancy loss clinic was for willing providers to keep appointment times available to facilitate confirmation of follow-up prior to discharge. Other suggested alternatives included an early pregnancy loss clinic, a nurse educator, and having a standardized guideline in the ED. Conclusion: Through a consensus approach, several recommendations were agreed upon for improving care for patients presenting to the ED with early pregnancy complications.

scholarly journals Role of human chorionic gonadotrophin to prevent repeated early pregnancy loss

2016 ◽  
Vol 48 (1-2) ◽  
pp. 7-10
Author(s):  
Eti Saha ◽  
Fouzia Begum ◽  
Zannatul Ferdous Jesmin
Keyword(s):  
Early Pregnancy ◽  
Pregnancy Loss ◽  
First Trimester ◽  
Additional Treatment ◽  
Chorionic Gonadotrophin ◽  
Human Chorionic Gonadotrophin ◽  
Early Pregnancy Loss ◽  
Significant Difference ◽  
Improve Pregnancy Outcome ◽  
History Of

Early pregnancy loss is a frustrating experience for both the patient and the physician. Approximately 5% of couples trying to conceive have 2 consecutive miscarriages and approximately 1% couples have 3 or more consecutive losses. Objective of this study is to determine whether therapy with dydrogesterone or Human chorionic Gonadotrophin hormone (HCG) in history of repeated pregnancy loss during the first trimester of pregnancy will improve pregnancy outcome. This is a prospective open comparative study.Women having early pregnancy presenting to a private clinic with history of early pregnancy loss, having no medical disorder were included in this study. Eligible subjects were randomised to receive either dydrogesterone 20mg daily or injection Human Chorionic Gonadotrophins (HCG) 5000 iu intramuscularly at 72 hours interval up to fourteen weeks of pregnancy or no additional treatment. Follow up of those patients were done with transabdominal ultrasonography. Hundred women were recruited. There was no statistically significant difference between the three groups with regard to pretreatment status. The continuing pregnancy success rate was higher in women treated with dydrogesterone (79.17%) and highest with Injection Human Chorionic, Gonadotrophin (86.36%) compared with women received no treatment (70%), (p=0.358). Hormonal support with either dydrogesterone or Human Chorionic Gonadotrophin may increase the chances of a successful pregnancy in women with a history of spontaneous abortion.Bang Med J (Khulna) 2015; 48 : 7-10

scholarly journals LO40: Services for emergency department patients experiencing early pregnancy complications: a survey of Ontario hospitals

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S21-S22
Author(s):  
R. Glicksman ◽  
S. McLeod ◽  
J. Thomas ◽  
C. Varner
Keyword(s):  
Emergency Department ◽  
Early Pregnancy ◽  
Pregnancy Complications ◽  
Pregnancy Loss ◽  
Transvaginal Ultrasound ◽  
Point Of Care Ultrasound ◽  
Early Pregnancy Loss ◽  
Online Questionnaire ◽  
Follow Up Care

Introduction: Women experiencing complications of early pregnancy frequently seek care in the emergency department (ED), as most have not yet established care with an obstetrical provider. The primary objective of this study was to explore the services available (ED management, ultrasound access, and follow-up care) for ED patients experiencing early pregnancy loss or threatened early pregnancy loss in Ontario hospitals. Methods: The emergency medicine chiefs of 71 Ontario hospital EDs with an annual census of more than 30,000 ED patient visits in 2017 were invited to complete a 30-item, online questionnaire using modified Dillman methodology. These hospitals constitute greater than 85% of the annual ED visits in Ontario, creating a sample reflective of the services available to most women older than 18 years old seeking care for early pregnancy complications in the province. Results: Respondents from 63 EDs across Ontario completed the survey (response rate 88.7%). Of the EDs surveyed, 34 (54.0%) reported they did not have access to early pregnancy clinic services for women who presented to the ED with early pregnancy complications that were safe to discharge home. At these hospitals, it was found that patients were followed up in 14 (41.2%) EDs for the same complications including pregnancy of unknown location and threatened abortion. Respondents also stated that radiologist-interpreted ultrasound was only available to 22 (34.9%) of hospital sites 24 hours a day, 7 days per week for women with early pregnancy complications. Of hospital site respondents, 55 (87.3%) reported point-of-care ultrasound (POCUS) use in the ED for patients with early pregnancy complications, and 27 (49.1%) reported the ED had access to transvaginal ultrasound probes for POCUS assessment by emergency physicians. Additionally, the proportion of ED physicians who were certified as Canadian Emergency Ultrasound independent practitioners ranged from 10% to 100%. Conclusion: The results of this study highlight the reliance of some hospitals on the ED to provide ongoing follow-up care to patients experiencing complications of early pregnancy. The lack of clinical resources and specialized personnel in Ontario hospital EDs makes supporting these women longitudinally unrealistic, exposing them to undue risk and complications.

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