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Subchorionic hematomas and the presence of autoantibodies Laxmi V. Baxi, MD, and Melissa M. Pearlstone, MD New York, New York Five cases of subchorionic hematoma detected by ultrasonography in patients with threatened abortion are presented. Three of these subjects had antinuclear antibodies, and the remaining two subjects had anticardiolipin antibodies. We recommend that patients with subchorionic hematomas be tested for autoantibodies regardless of their obstetric history. (AM J OBSTET GVNECOL 1991 ;165:1423-4.) Key words: Subchorionic hematoma, autoantibodies, anticardiolipin antibodies, antinuclear antibodies, habitual abortion Lupus and allied disorders, as well as anticardiolipin antibodies, are associated with poor fetal outcome. Re- cently, a high prevalence of antinuclear antibody-pos- itive serum was demonstrated in patients with recurrent pregnanc y losses.' The incidence of anticardiolipin an- tibody in the general obstetric population is I % to 2% ; it is approximately 40% in patients with a poor obstetric history. From the Department of Obstetrics and Gynecology, College of Phy sicians and Surgeons, Columbia University, and Sloane Hospital for Women at Columbia Presbyterian Medical.Center. Received for publication April 10, 1991; accepted April 24, 1991. Reprint requests: Laxmi V. Baxi, MD, Department of Obstetrics and Gynecology, Columbia Presbyterian M edical Center, 622 West 168th Street, New York, NY 10032. 611 130675 In this manuscript we describe five cases of subcho- rionic hematomas that were associated with autoanti- bodies. The patients presented with vaginal bleeding in the late first trimester or early second trimester of pregnancy. The clinical details are summarized in Ta- ble 1. Three of these patients had h ad one or more spon- taneous abortions. One of the remaining two patients was primigravid; the other had had an induced abor- tion. In all these patients subchorion ic hematomas were detected by ultrasonography that was performed be- cause of threatened abortion. Anticardiolipin or anti- nuclear antibodies were also detected. The presence of vaginal bl eeding during early preg- nancy is associated with a 10% to 15% risk of sponta- neo us abortion. The incidence of a subchorionic he- Table I. Clinical features of patients with subchorionic hem atomas Patient and obstetric history Current pregnancy Treatment Pregnancy outcome 32 yr old, gravida 2, Bleeding associated with sub- ANA Cerclage at 13 wk, prednisone Normal spontaneous vaginal de- para 1, previous chorionic hematoma noted 1: 1280 30 mg ora ll y on alternate livery at term, male infant spontaneous at 17 wk days at 10 wk abortion at 20 wk associated with premature cervi- cal dilatation 28 yr old, gravida 4, Bleeding and subchorionic ANA Aspirin 75 mg daily begun at Cesarean section for breech at para 0-0-3-0, hematoma noted at 15 wk 1:160 II wk term, female infant spontaneous abortions at 24 wk and 12 wk 35 yr old, gravida 6, Bleeding at 13 wk , subcho- ANA Aspirin 75 mg daily begun at Normal spontaneous vaginal de- para 1-0-5-1, vol- rionic hematoma noted at 1 :40 9 wk, prednisone 30 mg livery at term, female infant untary termina- lS wk da ily begun at 15 wk tion of pregnancy spontaneous abortions at 12 and 6 wk 24 yr old, gravi da I, Spotting at 6 wk, subcho- ACL Expectant Patient at 14 wk of pt'egnancy para I , one vol- rionic hematoma noted at Ab(+) untar y term ina- 6 wk 5 days and disap- tion of pregnancy pea red at 13 wk 32 yr old, gravida 1, Bleeding at 11 wk, subcho- ACL Aspirin 75 mg daily begun at Neonata l death at 24.8 wk para 0 rionic hematoma persisted Ab(+) 13 wk ANA , Antinuclear antibody; ACL, ant icardiolipin antibody. 1423
