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Massive Subchorionic Hematomas Following Thrombolytic Therapy in Pregnancy

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon

Address reprint requests to: Ihab M. Usta, MD, Department of Obstetrics and Gynecology, American University of Beirut-Medical Center, Beirut-Lebanon, PO Box: 113-6044/C53, HAMRA 110 32090; e-mail: iu00{at}aub.edu.lb.

BACKGROUND: Medical therapy for thrombosed valve in pregnancy has become an acceptable alternative to surgery, especially in hemodynamically compromised patients. Placental changes after thrombolytic therapy have rarely been reported.

CASES: Sonograms were done within 24 hours after administration of thrombolytic agents at 15 and 26 weeks of gestation, respectively, in 2 women whose pregnancies were complicated with thrombosis of prosthetic mitral valves. Both patients developed massive subchorionic hematomas, which persisted in 1 patient who underwent cesarean delivery at 34 weeks of gestation for cardiac indications (Apgar scores 9 and 10 at 1 minute and 5 minutes, respectively). The hematomas resolved in the other patient, who delivered at term.

CONCLUSION: Massive subchorionic hematomas may be observed in patients after thrombolytic therapy. Other reports are needed to establish whether such placental findings are common lesions after such therapy and to determine their impact on pregnancy outcome.

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