Features of the prognosis and outcomes of pregnancy with massive subchorionic thrombosis. A literature review

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Massive subchorionic thrombohematoma, also termed in the literature as Breus’ mole, is a rare condition in which a large maternal blood clot separates the chorionic plate from the chorionic villi. The etiology and pathogenesis of this condition are yet unclear, and the very concept of massive subchorionic thrombohematoma remains vague due to the singularity of clinical cases and the necessity to distinguish it from other types of hematomas. The lack of a unified view on the pathology and clear-cut clinical, laboratory and ultrasound criteria can lead to insufficient attention of doctors and untimely or even incorrect establishing diagnosis, which significantly worsens the prognosis of pregnancy and increases the risk of potential complications. Patients with massive subchorionic thrombohematoma require increased attention due to the high rate of such manifestations as antenatal death, fetal growth retardation, late miscarriage, and preeclampsia. Each case should be carefully analyzed in order to find predictors of thrombohematomas and methods of their prevention.

Full Text

Restricted Access

About the authors

Anna A. Kuznetsova

Almazov National Medical Research Centre

Author for correspondence.
Email: xannakuzx@gmail.com
ORCID iD: 0000-0002-5078-2640
Russian Federation, Saint Petersburg

Ekatherina S. Shelepova

Almazov National Medical Research Centre

Email: shelepova@almazovcentre.ru
ORCID iD: 0000-0002-3233-8239

MD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Natalya A. Osipova

Almazov National Medical Research Centre

Email: osipova@almazovcentre.ru
Russian Federation, Saint Petersburg

Tatyana Yu. Roschina

Almazov National Medical Research Centre

Email: tanya.roshchina.69@mail.ru
Russian Federation, Saint Petersburg

Irina E. Zazerskaya

Almazov National Medical Research Centre

Email: zazera@mail.ru
ORCID iD: 0000-0003-4431-3917

MD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg

References

  1. Petrukhin VA, Rebrova TV, Chechneva MA, et al. Massive subchorial thrombosis. Russian Bulletin of Obstetrician-Gynecologist. 2015;15(4):49-54. (In Russ.). doi: 10.17116/rosakush201515449-54
  2. Barinova IV, Kondrikov NI, Novikova SV, et al. Massive subchorial thrombosis of the placenta and pregnancy outcome karyotype. Obstetrics and Gynecology. 2012;(4-1):61-64.
  3. Barinova IV, Kondrikov NI. Massive subchorial thrombosis. Arkhiv Patologii. 2012;74(6):55-58. (In Russ.)
  4. Fung TY, To KF, Sahota DS, et al. Massive subchorionic thrombohematoma: a series of 10 cases. Acta Obstet Gynecol Scand. 2010;89(10):1357–1361. doi: 10.3109/00016349.2010.512656
  5. Fox H, Sebire N. Pathology of the placenta. Edinburgh: Saunders Elsevier; 2007.
  6. van Den Bosch T, Van Schoubroeck D, Cornelis A, et al. Prenatal diagnosis of a subamniotic hematoma. Fetal Diagn Ther. 2000;15(1):32–35. doi: 10.1159/000020971
  7. Diagnostic imaging of fetal anomalies. Ed. by D.A. Nyberg, J.P. McGahan, D.H. Pretorius, et al. Philadelphia: Lippincott Williams Wilkins; 2003.
  8. Nishida N, Suzuki S, Hamamura Y, et al. Massive subchorionic hematoma (Breus’ mole) complicated by intrauterine growth retardation. J Nippon Med Sch. 2001;68(1):54–57. doi: 10.1272/jnms.68.54
  9. Milovanov AP. Patologiya sistemy mat’-platsenta-plod: rukovodstvo dlya vrachei. Moscow: Meditsina; 1999. (In Russ.)
  10. Mooney EE, Robboy SJ. Nidation and placenta. In: Robboy’s pathology of the female reproductive tract. 2nd ed. London: Elsevier; 2009. P. 829–861. doi: 10.1016/b978-0-443-07477-6.50035-4
  11. Rushton D. Pathology of the placenta. In: Textbook of fetal and perinatal pathology. Ed. by J. Wigglesworth, D. Singer. Malden: Blackwell Science; 1998. P. 145–199.
  12. Gersell DJ, Kraus FT. Diseases of the placenta. In: Kurman R.J, Ellenson L.H, Ronnett B.M. Blaustein s pathology of the female genital tract. Springer, 2011. P. 999–1073.
  13. Blinov AYu, Gavrikova OA, Gol’tsfarb VM, et al. Angiomiksoma pupoviny: sluchay prenatal’noy diagnostiki vo II trimestre beremennosti. Prenatal’naya diagnostika. 2010;1:75–79. (In Russ.)
  14. Breus C. Tuberous subchorionic hematoma of the decidua: a typical form of molar pregnancy. Leipzig: Deuticke; 1892. (In Deu.)
  15. Shanklin DR, Scott JS. Massive subchorial thrombohaematoma (Breus’ mole). Br J Obstet Gynaecol. 1975;82(6):476–487. doi: 10.1111/j.1471-0528.1975.tb00673.x
  16. Baergen R. Manual of pathology of the human placenta. 2nd ed. New York: Springer; 2011.
  17. Benirschke K, Kaufmann P, Baergen R. Pathology of the human placenta. 5th ed. New York: Springer; 2006.
  18. Yanagisawa F, Aoki S, Odagami M, Miyagi E. Massive subchorionic hematoma (Breus’ mole) presents a variety of ultrasonic appearances: a case report and literature review. Clin Case Rep. 2019;7(4):744–748. doi: 10.1002/ccr3.2036
  19. Himoto Y, Okumura R, Tsuji N, et al. Massive subchorionic thrombosis followed by magnetic resonance imaging. J Comput Assist Tomogr. 2012;36(3):330–333. doi: 10.1097/rct.0b013e3182540ced
  20. Madu AE. Breus’ mole in pregnancy. J Obstet Gynaecol. 2006;26(8):815–816. doi: 10.1080/01443610600987035
  21. Fisteag-Kiprono L, Foster K, McKenna D, et al. Antenatal sonographic diagnosis of massive subchorionic hematoma: a case report. J Reprod Med. 2005;50(3):219–221.
  22. Kojima K, Suzuki Y, Makino A, et al. A case of massive subchorionic thrombohematoma diagnosed by ultrasonography and magnetic resonance imaging. Fetal Diagn Ther. 2001;16(1):57–60. doi: 10.1159/000053882
  23. Heller DS, Rush D, Baergen RN. Subchorionic hematoma associated with thrombophilia: report of three cases. Pediatr Dev Pathol. 2003;6(3):261–264. doi: 10.1007/s10024-002-0107-9
  24. Usta IM, Abdallah M, El-Hajj M, et al. Massive subchorionic hematomas following thrombolytic therapy in pregnancy. Obstet Gynecol. 2004;103(5):1079–1082. doi: 10.1097/01.aog.0000109210.93819.07
  25. Şükür YE, Göç G, Köse O, et al. The effects of subchorionic hematoma on pregnancy outcome in patients with threatened abortion. J Turk Ger Gynecol Assoc. 2014;15(4):239–242. DOI: 10.5152%2Fjtgga.2014.14170
  26. Nagy S, Bush M, Stone J, et al. Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy. Obstet Gynecol. 2003;102(1):94–100. doi: 10.1016/s0029-7844(03)00403-4
  27. Sharma G, Kalish RB, Chasen ST. Prognostic factors associated with antenatal subchorionic echolucencies. Am J Obstet Gynecol. 2003;189(4):994–996. doi: 10.1067/s0002-9378(03)00823-8
  28. Maso G, D’Ottavio G, De Seta F, et al. First-trimester intrauterine hematoma and outcome of pregnancy. Obstet Gynecol. 2005;105(2):339–344. doi: 10.1097/01.aog.0000152000.71369.bd
  29. Kuznetsova IV. Intrauterine hematomas as a reason of complicated pregnancy course. Medical Council. 2016;(17):114–118. (In Russ.). doi: 10.21518/2079-701X-2016-17-114-118
  30. Sidel’nikova VM, Sukhikh GT. Nevynashivanie beremennosti: rukovodstvo dlya praktikuyushchikh vrachey. Moscow: MIA; 2011. (In Russ.)
  31. Textbook of periconceptional medicine. Ed. by N. Macklon, I. Greer, E. Steegers. London: CRC Press; 2009. doi: 10.3109/9780203092200
  32. Clark CA, Laskin CA, Spitzer KA. Anticardiolipin antibodies and recurrent early pregnancy loss: a century of equivocal evidence. Hum Reprod Update. 2012;18(5):474–484. doi: 10.1093/humupd/dms020
  33. Shurshalina A.V. Khronicheskiy endometrit u zhenshchin s patologiey reproduktivnoy funktsii: avtoref [abstract dissertation]. Moscow; 2007. [cited 2022 Sept 12]. Available from: https://www.dissercat.com/content/khronicheskii-endometrit-u-zhenshchin-s-patologiei-reproduktivnoi-funktsii
  34. Alanjari A, Wright E, Keating S, et al. Prenatal diagnosis, clinical outcomes, and associated pathology in pregnancies complicated by massive subchorionic thrombohematoma (Breus’ mole). Prenat Diagn. 2013;33(10):973–978. doi: 10.1002/pd.4176
  35. Monkley SJ, Delaney SJ, Pennisi DJ, et al. Targeted disruption of the Wnt2 gene results in placentation defects. Development. 1996;122(11):3343–3353. doi: 10.1242/dev.122.11.3343
  36. Ferreira JC, Choufani S, Grafodatskaya D, et al. WNT2 promoter methylation in human placenta is associated with low birthweight percentile in the neonate. Epigenetics. 2011;6(4):440–449. doi: 10.4161/epi.6.4.14554
  37. West BT, Kavoussi PK, Odenwald KC, et al. Factors associated with subchorionic hematoma formation in pregnancies achieved via assisted reproductive technologies. J Assist Reprod Genet. 2020;37(2):305–309. doi: 10.1007/s10815-019-01684-7
  38. Asato K, Mekaru K, Heshiki C, et al. Subchorionic hematoma occurs more frequently in in vitro fertilization pregnancy. Eur J Obstet Gynecol Reprod Biol. 2014;181:41–44. doi: 10.1016/j.ejogrb.2014.07.014
  39. Tuuli MG, Norman SM, Odibo AO, et al. Perinatal outcomes in women with subchorionic hematoma: a systematic review and meta-analysis. Obstet Gynecol. 2011;117(5):1205–1212. doi: 10.1097/aog.0b013e31821568de
  40. Zhou J, Wu M, Wang B, et al. The effect of first trimester subchorionic hematoma on pregnancy outcomes in patients underwent IVF/ICSI treatment. J Matern Fetal Neonatal Med. 2017;30(4):406–410. doi: 10.1080/14767058.2016.1174682
  41. Khan RI, Taimoor A, Nazir A, et al. Association of subchorionic hematoma with preterm labour in patients with threatened abortion. J Ayub Med Coll Abbottabad. 2021;33(3):451–455.
  42. Saraswat L, Bhattacharya S, Maheshwari A, et al. Maternal and perinatal outcome in women with threatened miscarriage in the first trimester: a systematic review. BJOG. 2010;117(3):245–257. doi: 10.1111/j.1471-0528.2009.02427.x
  43. Zhen LD. Effects of subchorionic haematoma on pregnancy outcomes. Aust Med Stud J. 2017;8(1):41–45. [cited 2022 Oct 20]. Available from: https://www.amsj.org/archives/6064
  44. Hertzberg BS, Middleton WD. Ultrasound: the requisites. 3rd ed. Amsterdam: Elsevier Health Sciences; 2015.
  45. Rashmi K, Anitha GS, Radhika. Prospective study of pregnancy outcome in patients with first trimester bleed in a tertiary centre. Int J Clin Obstet Gynaecol. 2020;4(3):22–25. doi: 10.33545/gynae.2020.v4.i3a.570
  46. Bondick CP, M Das J, Fertel H. Subchorionic hemorrhage. Treasure Island: StatPearls Publishing; 2021.
  47. Ben-Haroush A, Yogev Y, Mashiach R, et al. Pregnancy outcome of threatened abortion with subchorionic hematoma: possible benefit of bed-rest? Isr Med Assoc J. 2003;5(6):422–424.
  48. Miyagi M, Kinjo T, Mekaru K, et al. Massive subchorionic thrombohematoma (breus’ mole) associated with fetal growth restriction, oligohydramnios, and intrauterine fetal death. Case Rep Obstet Gynecol. 2019. doi: 10.1155/2019/9510936
  49. Biesiada L, Krekora M, Krasomski G. Subchorionic hematoma as a risk factor of pregnancy and delivery in women with threatening abortion. Ginekol Pol. 2010;81(12):902–906.
  50. Kondrikov NI. Patologiya matki. Illyustrirovannoe rukovodstvo. Moscow: Prakticheskaya meditsina; 2008. (In Russ.)
  51. Khong TY. The Placenta. In: Keeling JW, Khong TY. Fetal and neonatal pathology. 4th ed. London: Springer, 2007. P. 54–89.
  52. Loi K, Tan KT. Massive pre-placental and subchorionic haematoma. Singapore Med J. 2006;47(12):1084–1086.
  53. Lyashenko EN, Popova-Petrosyan EV, Dovgan AA, et al. Forecast miscarriage of women with subchorial hematoma. Tavricheskiy Mediko-Biologicheskiy Vestnik. 2019;22(1):65–68. (In Russ.)
  54. Pelinescu-Onciul D. Subchorionic hemorrhage treatment with dydrogesterone. Gynecol Endocrinol. 2007;23(Suppl. 1):77–81. doi: 10.1080/09513590701584741
  55. Akhlaghpoor S, Tomasian A. Safety of chorionic villus sampling in the presence of asymptomatic subchorionic hematoma. Fetal Diagn Ther. 2007;22(5):394–400. doi: 10.1159/000103303
  56. Naert MN, Muniz Rodriguez A, Khadraoui H, et al. Association between first-trimester subchorionic hematomas and adverse pregnancy outcomes after 20 weeks of gestation. Singleton Pregnancies. Obstet Gynecol. 2019;134(4):863–868. doi: 10.1097/aog.0000000000003487
  57. Xiang L, Wei Z, Cao Y. Symptoms of an intrauterine hematoma associated with pregnancy complications: a systematic review. PLoS One. 2014;9(11). doi: 10.1371/journal.pone.0111676
  58. Hoddick WK, Mahony BS, Callen PW, et al. Placental thickness. J Ultrasound Med. 1985;4(9):479–482. doi: 10.7863/jum.1985.4.9.479
  59. Cunningham FG, Leveno KJ, Bloom SL, et al. Obstetrical hemorrhage. In: Williams Obstetrics. New York: McGraw-Hill; 2014. P. 111–123.
  60. Proctor LK, Toal M, Keating S, et al. Placental size and the prediction of severe early-onset intrauterine growth restriction in women with low pregnancy-associated plasma protein-A. Ultrasound Obstet Gynecol. 2009;34(3):274–282. doi: 10.1002/uog.7308
  61. Wylie BJ, D’Alton ME. Fetomaternal hemorrhage. Obstet Gynecol. 2010;115(5):1039–1051. doi: 10.1097/aog.0b013e3181da7929
  62. Sepulveda W, Alcalde JL, Schnapp C, et al. Perinatal outcome after prenatal diagnosis of placental chorioangioma. Obstet Gynecol. 2003;102(5):1028–1033. doi: 10.1016/s0029-7844(03)00859-7
  63. Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. 2005;192(5):1458–1461. DOI: .1016/j.ajog.2004.12.074
  64. Smith GC, Shah I, Crossley JA, et al. Pregnancy-associated plasma protein A and alpha-fetoprotein and prediction of adverse perinatal outcome. Obstet Gynecol. 2006;107(1):161–166. doi: 10.1097/01.aog.0000191302.79560.d8
  65. Smith GC. First-trimester determination of complications of late pregnancy. JAMA. 2010;303(6):561–562. doi: 10.1001/jama.2010.102
  66. Abu-Yousef MM, Bleicher JJ, Williamson RA, et al. Subchorionic hemorrhage: sonographic diagnosis and clinical significance. AJR Am J Roentgenol. 1987;149(4):737–740. doi: 10.2214/ajr.149.4.737
  67. Wang L, Zhou Q, Li L, Zeng S. Unique fluid-fluid level ultrasonic appearance in subacute placenta abruption with massive subchorionic hematoma. Int J Gynaecol Obstet. 2018;141(3):391–392. doi: 10.1002/ijgo.12474
  68. Fadl S, Moshiri M, Fligner CL, et al. Placental imaging: normal appearance with review of pathologic findings. Radiographics. 2017;37(3):979–998. doi: 10.1148/rg.2017160155
  69. Fadl SA, Linnau KF, Dighe MK. Placental abruption and hemorrhage-review of imaging appearance. Emerg Radiol. 2019;26(1):87–97. doi: 10.1007/s10140-018-1638-3
  70. Masselli G, Brunelli R, Di Tola M, et al. MR imaging in the evaluation of placental abruption: correlation with sonographic findings. Radiology. 2011;259(1):222–230. doi: 10.1148/radiol.10101547
  71. Masselli G, Brunelli R, Parasassi T, et al. Magnetic resonance imaging of clinically stable late pregnancy bleeding: beyond ultrasound. Eur Radiol. 2011;21(9):1841–1849. doi: 10.1007/s00330-011-2120-8
  72. Bonasoni MP, Comitini G, Blasi I, et al. Large subchorionic cyst located at umbilical cord insertion with vascular displacing and intracystic hemorrhage/hematoma: a case report. Fetal Pediatr Pathol. 2022;41(3):468–474. doi: 10.1080/15513815.2020.1836096
  73. Tripathi V, Agrawal S, Shukla M, et al. A rare case of recurrent and life-threatening breus’ mole. J Obstet Gynaecol India. 2021;71(2):210–212. doi: 10.1007/s13224-020-01417-2
  74. Szlachetka K, Faske E, Laniewski S, et al. A rare case of two consecutive breus’ molar pregnancies. J Ultrasound Med. 2017;36(6):1279–1282. doi: 10.7863/ultra.16.06074
  75. Liu Y, Tong A, Qi X. A large subchorionic hematoma in pregnancy: a case report. Medicine. 2020;99(22):e20280. doi: 10.1097/md.0000000000020280
  76. El-Agwany AS. Large subchorionic hematoma: breus’ mole. J Med Ultrasound. 2017;25(4):248–250. doi: 10.1016/j.jmu.2017.09.006
  77. Satomi M, Hiraizumi Y, Suzuki S. Subchorionic haematoma distinct from the placental tissue at 39 weeks’ gestation. J Obstet Gynaecol. 2012;32(3):304–305. doi: 10.3109/01443615.2011.647734
  78. Asada K, Furukawa R, Saito Y, et al. Massive subchorionic thrombohematoma: termination should not be discouraged by antenatal diagnosis. Acta Obstet Gynecol Scand. 2011;90(8):927–929. doi: 10.1111/j.1600-0412.2011.01142.x

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c) 2023 Eсо-Vector



СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 66759 от 08.08.2016 г. 
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия Эл № 77 - 6389
от 15.07.2002 г.



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies