Effects of bleeding on uteroplacental, umbilicoplacental and yolk-sac hemodynamics in early pregnancy

Objective To determine the influence of vaginal bleeding with or without a persisting subchorionic hematoma on uteroplacental, umbilicoplacental and y olk-sac hemodynamics in early pregnancy. \ Design Twenty-six consecutive patients with vaginal bleeding entered this l ongitudinal study 1 -3 days after the beginning of vaginal bleeding and wer e re-examined every 1-2 weeks. In three cases vaginal bleeding occurred at the 5th completed gestational week, in 13 at the 7th week, in nine at the 8 th week and in one case at the 10th week. A subchorionic hematoma was ident ified in one case at the 5th week, in nine cases at the 7th week, in nine c ases at the 8th week, and in seven cases at the 10th week. Four pregnancies ended in miscarriage. Blood velocity waveforms of uterine, arcuate, radial , spiral, umbilical, chorionic and yolk-sac arteries were obtained by trans vaginal pulsed Doppler ultrasound and peak systolic velocities, time-averag ed maximum velocities and pulsatility indices were calculated. The results were compared with our earlier observations in normal pregnancy obtained wi th a similar study protocol. Results At the 7th week, radial artery pulsatility-index values (mean (SD)) were higher in pregnancies with vaginal bleeding (1.84 (0.59), P = 0.04) a nd in pregnancies with a subchorionic hematoma (1.96 (0.63); P = 0.03) than in normal pregnancies (1.40 (0.46)). The pulsatility-index values of uteri ne, arcuate, spiral, umbilical and chorionic arteries did not differ betwee n the groups. Vaginal bleeding with or without a subchorionic hematoma at t he 8th week did not affect any of the measured parameters. Persistence of t he subchorionic hematoma until the 10th week did not affect uterine, arcuat e, radial, spiral, umbilical or chorionic artery hemodynamics. Yolk-sac hem odynamic parameters did not differ between the groups. Conclusions Vaginal bleeding with or without a subchorionic hematoma is ass ociated with increased radial artery impedance at the 7th week of pregnancy . Persistence of the subchorionic hematoma does not affect utero- and umbil icoplacental circulation.