A preplacental hematoma (H), detected at 18 menstrual weeks, located between the placenta (P) and the fetus (F) [8].

<p>A preplacental hematoma (H), detected at 18 menstrual weeks, located between the placenta (P) and the fetus (F) <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0111676#pone.0111676-Nyberg1" target="_blank">[8]</a>.</p

A 10-week fetal head adjacent to a moderate-size (one-third to one-half of the chorionic sac circumference) subchorionic hematorna (arrows) [26].

<p>A 10-week fetal head adjacent to a moderate-size (one-third to one-half of the chorionic sac circumference) subchorionic hematorna (arrows) <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0111676#pone.0111676-Bennett1" target="_blank">[26]</a>.</p

An 8-week fetus associated with a small (less than one-third of the chorionic sac circumference) subchorionic hematoma (arrows) [26].

<p>An 8-week fetus associated with a small (less than one-third of the chorionic sac circumference) subchorionic hematoma (arrows) <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0111676#pone.0111676-Bennett1" target="_blank">[26]</a>.</p

A resolving subchorionic hematoma (H), detected at 13 menstrual weeks, extending beneath the margin (arrow) of the placenta (P) [8].

<p>A resolving subchorionic hematoma (H), detected at 13 menstrual weeks, extending beneath the margin (arrow) of the placenta (P) <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0111676#pone.0111676-Nyberg1" target="_blank">[8]</a>.</p

Symptoms of an Intrauterine Hematoma Associated with Pregnancy Complications: A Systematic Review

<div><p>Objective</p><p>To evaluate the predictive value of the symptoms of an intrauterine hematoma (IUH) for adverse pregnancy outcomes.</p><p>Methods</p><p>A literature review was performed with the search terms, including intrauterine/subchorionic/retroplacental/subplacental hematoma/hemorrhage/bleeding/collection/fluid, covering the period from January, 1981 to January, 2014. We just focused on the pregnancy outcomes associated with different symptoms of an IUH.</p><p>Results</p><p>It is generally agreed that a retroplacental, posterior or subchorionic in the fundus of uterus, and/or persistent IUH is associated with adverse outcomes in the ongoing pregnancy. However, the prognosis value of both volume and gestational age at diagnosis of IUH still remains controversial. Some researchers argue that a large IUH is associated with an increased risk of adverse events during pregnancy while others refuted. It is believed by some that the earlier an IUH was detected, the higher the risk for adverse outcomes would be, while no or weak association were reported by other studies. The prognostic value of the simultaneous presence of vaginal bleeding on pregnancy outcome is also controversial.</p><p>Conclusions</p><p>Both the position relative to the placenta or uterus and duration of IUH have strong predictive value on the prognosis in the ongoing pregnancy. However, the prognostic values of the IUH volume, gestational age at diagnosis and the simultaneous presence of vaginal bleeding remain controversial up to now. Moreover, most of previous reports are small, uncontrolled studies with incomplete information. Prospective, large sample, cohorts studies which take all detailed symptoms of an IUH into consideration are needed when we evaluate its clinical significance in the prognosis of pregnancy.</p></div

An 8-week fetus associated with a large (at least two-thirds of the chorionic sac circumference) subchorionic hematoma (arrows) [26].

<p>An 8-week fetus associated with a large (at least two-thirds of the chorionic sac circumference) subchorionic hematoma (arrows) <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0111676#pone.0111676-Bennett1" target="_blank">[26]</a>.</p

Flow diagram of studies in the review.

<p>Flow diagram of studies in the review.</p

A large retroplacental hematoma (H) detected at 25 menstrual weeks, detaching more than 50%of the placenta (P).

<p>Retroplacental venous complex (arrows) separated the hematoma and placenta (a); 1 week later, a resolving hematoma (H) contained (arrows) posterior to the placenta (P) (b) <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0111676#pone.0111676-Nyberg1" target="_blank">[8]</a>.</p

Symptoms of An Intrauterine Hematoma Associated with Pregnancy Complications.

<p>IUH, intrauterine hematoma; SCH, subchorionic hematoma; PTD, preterm delivery; SGA, small for gestational age.</p><p>–– indicates data not reported.</p><p>Symptoms of An Intrauterine Hematoma Associated with Pregnancy Complications.</p

Cerclage placement in twin pregnancies with cervical dilation: a systematic review and meta-analysis

Existing guidelines and studies on the benefits of cerclage in twin pregnancies with a dilated cervix have low reliability and inconsistent conclusions. New randomized control trials and cohort studies focusing on twin pregnancies with cervical insufficiency were published recently. Therefore, this meta-analysis aimed to compare outcomes of cerclage placement and expectant treatment in twin pregnancies with a dilated cervix using recent data. We screened the PubMed, Web of Science, ClinicalTrials.gov, and Cochrane Library databases to identify randomized controlled trials and cohort studies comparing maternal and perinatal outcomes of twin pregnancies with cervical dilation, with and without cerclage placement, published until December 2020. Estimates were pooled using random-effects or fixed-effect models depending on the heterogeneity. Mean difference, 95% confidence interval, and relative risk were used to compare the outcomes. The risk of bias was assessed using the Cochrane Handbook and the Newcastle-Ottawa Scale. The meta-analyses followed the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines for systematic reviews of observational studies. Five studies, comprising 275 twin pregnancies, met the inclusion criteria; of those, 167 underwent cerclage and 108 were expectantly managed. Cerclage placement significantly prolonged the interval from the time of diagnosis to delivery and reduced the incidence of preterm delivery, perinatal death, and complications. The fetal outcomes improved significantly in cases managed with cerclage. Therefore, emergent cerclage is a potential option for managing twin pregnancies with cervical dilation of at least 1 cm.</p