Differentiated approach to the management of pregnancy and childbirth in cases of recurrent retrochorial hematomas

Abstract

DOI: 10.52705/2788-6190-2026-03-7
УДК 618.3403.215-036.87:618.3/.5-079

Objective of the study. To develop and implement a differentiated approach to the management of pregnancy and childbirth in cases of recurrent retrochorial hematomas.
Materials and methods. To achieve this objective, a comprehensive clinical-laboratory and instrumental examination of 90 women was conducted. Based on the results of clinical examination and ultrasound data, they were divided into three groups: 30 pregnant women with recurrent retrochorial hematoma (main group), 30 pregnant women with retrochorial hematoma detected only in the early stages of pregnancy (6-12 weeks inclusive) (comparison group), and 30 prospectively examined patients with uncomplicated pregnancy, having no significant extragenital pathology or aggravating factors in their obstetric-gynecological history (control group). The complex of conducted studies included clinical, biochemical, and statistical methods.
Results. As evidenced by our results, such a comprehensive approach to therapy and pregnancy management allowed for a significant reduction in the frequency of detection of recurrent hematomas and large-volume hematomas. In total, the number of recurrences exceeding 2 was noted 4,7 times less frequently than with the conventional approach to therapy, and large-volume hematomas – 3,9 times less frequently.
Taking into account the reduction in the number and volume of recurrences of uteroplacental hemorrhage, the frequency of threatened preterm birth in the group with the differentiated approach decreased by 2,0 times, extremely early and early preterm births (up to 28 weeks) - by 4,9 times, and preterm births up to 36 weeks - by 5 times.
Isthmic-cervical insufficiency was detected in only 4 (16,3%) cases compared to 13 (26,4%) in the group without the differentiated approach, which is 1,6 times less frequent. Correction was performed for 3 women via the placement of an obstetric pessary; delivery occurred at 35 weeks of gestation in only one woman from subgroup A with isthmic-cervical insufficiency. Premature rupture of membranes at various stages of gestation occurred 7,6 times less frequently in the subgroup treated with the differentiated approach, which significantly reduced perinatal complications and the incidence of purulent-septic diseases.
Conclusions. The implementation of complex differentiated therapy in cases of recurrent uteroplacental hemorrhage allows for a significant reduction in the incidence of complications during labor and the postpartum period.