# Association between the proportion of subchorionic hematoma within the gestational sac and miscarriage rate in IVF/ICSI patients

## TL;DR

This study found that subchorionic hematoma in early pregnancy is linked to higher miscarriage rates in IVF/ICSI patients, especially when it occupies a larger portion of the gestational sac.

## Contribution

The study identifies the proportion of subchorionic hematoma within the gestational sac as a novel risk factor for miscarriage in ART patients.

## Key findings

- Patients with subchorionic hematoma had a higher miscarriage rate than those without.
- The proportion of hematoma in the gestational sac was a significant risk factor for miscarriage.
- Miscarriage risk increased as the hematoma's proportion in the gestational sac increased.

## Abstract

The main objective of this study was to summarize and analyze the pregnancy outcomes in the assisted reproductive technology (ART) population with subchorionic hematoma (SCH) in the first trimester. Moreover, we aimed to explore the risk factors for adverse pregnancy outcomes in patients with SCH.

A retrospective cohort study was conducted on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) patients who achieved pregnancy between February 2017 and November 2022 at the Reproductive Medicine Center of the Sixth Affiliated Hospital of Sun Yat-sen University. Eligible patients were divided into two groups according to whether SCH was detected.

After appropriate screening, 275 patients with SCH and 336 patients without SCH were enrolled. Patients with SCH had a significantly higher miscarriage rate than patients without SCH (13.5% vs. 8.3%, p = 0.04). Miscarriage patients in the SCH group had more embryos transferred (p = 0.04), earlier detection of SCH (p = 0.002), and a smaller gestational sac (GS)’s area (p = 0.03). Moreover, the proportion of SCH in the GS was a statistically significant risk factor for miscarriage (p = 0.016). The miscarriage rate progressively increased with increasing SCH’s proportion in the GS (p for trend: 0.003).

SCH increased miscarriage rate in the ART population. Patients with SCH combined with miscarriages had more embryos transferred, earlier detection of SCH, and smaller GS areas when SCH was first detected. Multivariate logistic regression analysis showed that the SCH proportion in the GS was a statistically significant risk factor for SCH associated with miscarriage. The miscarriage rate increased progressively with the SCH proportion in the GS.