Large Subchorionic Hematoma: Breus' Mole

Area of Science:

• Reproductive Medicine
• Maternal-Fetal Medicine
• Obstetrics

Background:

• Subchorionic hematomas can complicate pregnancies, potentially leading to adverse outcomes like intrauterine growth retardation (IUGR) and oligohydramnios.
• Twin pregnancies, especially those conceived via intracytoplasmic sperm injection (ICSI), present unique management challenges.
• Anticoagulation therapy, such as Clexane (enoxaparin), for conditions like mitral valve replacement adds complexity to pregnancy management.

Purpose of the Study:

• To report a complex case of a twin pregnancy with a large subchorionic hematoma.
• To describe the management of intrauterine growth retardation and oligohydramnios in this high-risk pregnancy.
• To highlight the delivery outcomes in a twin pregnancy complicated by subchorionic hematoma and single fetal demise.

Main Methods:

• Diagnosis of large subchorionic hematoma, IUGR, and oligohydramnios at 32 weeks' gestation in a twin pregnancy.
• Management included tocolysis with progesterone therapy and antibiotic administration.
• Close monitoring and follow-up until delivery.

Main Results:

• The patient received progesterone therapy and antibiotics for management.
• Delivery was performed via caesarean section at 34 weeks' gestation.
• A male infant was delivered without complication, despite the single fetal demise of the co-twin.

Conclusions:

• Subchorionic hematomas in twin pregnancies require careful management, especially when complicated by IUGR and oligohydramnios.
• Progesterone therapy and antibiotics can be utilized in managing such complex obstetric cases.
• Successful delivery of a viable infant is possible even with single fetal demise in a twin pregnancy.