Prevalence, Clinical Presentation and Initial Management of Subchorionic Hematoma Among Women With Per Vaginal Bleeding in the First Trimester of Pregnancy at Kenyatta National Hospital in Year 2019-2020

Abstract

chorion and uterine wall and occurs usually in first trimester. The incidence of SCH based on studies done globally is between 3.5% to 39.5% It carries a risk of complicating pregnancy outcomes, including inducing miscarriages, preeclampsia, antepartum haemorrhage, preterm labour, placental insufficiency, fetal growth restriction, and stillbirths. Despite the common occurrence of SCH in pregnancy and the adverse pregnancy outcomes associated with it, there is limited data on its burden and effect on pregnancies in Kenya. Objective: To determine the prevalence, sonographic features, clinical characteristics, and initial management of subchorionic hematoma at Kenyatta National Hospital (KNH). Methodology: A retrospective cross-sectional study was conducted at KNH in 2021 where the data of 145 women who were seen with vaginal bleeding in early pregnancy at the gynaecology outpatient clinic and the accident and emergency unit between January 2019 and December 2020 was reviewed. Patient demographic, reproductive, and medical characteristics and their ultrasound findings were extracted from hospital files. The data was uploaded into a Statistical Package for Social Scientists software (version 25 for Windows) and cleaned. Demographic and reproductive data was summarized as means with standard deviations and as counts with percentages. The exact Clopper Pearson method was used to calculate the prevalence of SCH with 95% confidence interval estimates and sonographic, clinical characteristics, and the initial management of patients who were diagnosed with SCH assessed using counts and percentages. Comparative analyses of women with and without SCH were conducted using the Chi-square test or Fishers test at 95% confidence interval. A P value <0.05 was statistically significant. Results: 145 participants were recruited. The mean age of participants was 29.3 years. Most were in age group <35 years (76.6%), married (64.8%), multigravida (72.4%), and did not have comorbidities such as HIV infection (97.2%), chronic kidney disease (CKD) (99.3%), and uterine anomalies (91.0%). The prevalence of SCH was 18.6% (27/145), 95% CI=12.6-25.9. Women with versus those without SCH were more likely to present with vomiting (11.1% versus 2.5%), but less likely to have lower abdominal pain (37.0% versus 60.2%) or dizziness (3.7% versus 11.0%). Most SCH were small (81.5%) at a mean gestation of 8.85 ±2.13 weeks and required treatment (81.5%), mostly progestin (90.9%). SCH resolved after treatment in approximately 38.9% of the cases who proceeded to deliver at term. Conclusions: The prevalence of SCH among women who develop per vaginal bleeding in first trimester in Kenya is higher at 18.6% compared to studies from high income countries that have reported rates as low as 3.5%. Women with SCH were more likely to vomit but less likely to have lower abdominal pain or dizziness compared to those without SCH. Progestin was the most common initial treatment for SCH and most pregnancies proceeded to deliver at term. Recommendations: Due to the high prevalence of SCH in our population it is important to create more awareness on the condition among pregnant women and educate health care providers to have a high index of suspicion and investigate for SCH whenever a pregnant woman presents with per vaginal bleeding in the first trimester of pregnancy. There is need for a larger study to look at the risk factors associated with SCH and pregnancy outcomes in women with SCH in our population.