A case of large subchorionic hematoma

Abstract

The cases of persistent subchorionic hematoma are not rare. The management includes the conventional approaches to the treatment of threatened miscarriage. This case demonstrates a large subchorionic hematoma as a cause of preterm placental abruption and preterm birth via cesarean section. We present the case of a 23-year-old G1P0 patient with a massive subchorionic hematoma during the first, second, and third trimesters. The woman was admitted to the gynecological clinic several times because of threatened miscarriages at 9, 11, 13, and 20 weeks of pregnancy. Since then, multiple subchorionic or intermembranous hematomas were visualized on ultrasound. They were resistant to progesterone and tranexamic acid. However, hemodynamic Doppler ultrasound did not reveal any abnormalities of the uteroplacental, umbilical, or fetal hemocirculation later on. Fetal growth parameters were appropriate. The patient was admitted with bleeding due to preterm placental abruption at 35 weeks of gestation. A live preterm male baby was born via urgent cesarean, weighing 2300 g, measuring 46 cm in length, with an Apgar score of 6-7. Placental histological examination revealed a massive placental thrombohematoma (Breus’ mole). The mother had a shortened pQ interval on the ECG tracing and an incomplete uterine septum. A true umbilical knot was found. The newborn passed through the neonatal resuscitation unit. After 10 days, both the mother and her baby were released from the hospital. A persistent subchorionic hematoma and prolonged mild bloody discharge raise suspicion for Breus’ mole. The initial venous source hemorrhage triggered the rupture of arterial utero-placental vessels. Maternal cardiac events, uterine and umbilical anomalies were involved in this case. Preterm placental abruption occurred because of placental thrombohematoma.