Chorionic Bump in First-Trimester Sonography: Sciencedirect
Chorionic Bump in First-Trimester Sonography: Sciencedirect
Chorionic Bump in First-Trimester Sonography: Sciencedirect
ScienceDirect
Chinese Taipei Society of
Ultrasound in Medicine
journal homepage: www.jmu-online.com
Original Article
KEYWORDS Abstract Objectives: The present research was motivated by providing new insight into early
Chorionic bump, pregnancies with a chorionic bump diagnosis in first-trimester sonography and its impact on
First trimester, live birth rate.
Live birth rate, Methods: To determine the rate of CB, first trimester sonograms of pregnant women referring
Sonography to Akbarabadi Hospital, which is a treatment and training center affiliated to Iran University of
Medical Sciences as well as those referring to a private center were analyzed. The total num-
ber of transvaginal sonographies performed was 1900 cases from whom 8 cases of CB were de-
tected. The chorionic bump size and number and history of infertility or coagulation disorders
were considered as our independent variables and multiple gestation with pregnancy outcome
as dependent ones.
Results: Overall, the prevalence rate of CB was 0.4% (4 per 1000), with 8 patients diagnosed
with CB from 1900 the first trimester pregnant women. Of 8 pregnant women, 5 showed live
birth (62.5%) and 3 experienced fetal demise (37.5%). The chorionic bumps ranged in size from
0.1 cc to 1.8 cc (average, 0.73 cc). No significant relationship was found between history of
smoking, coagulopathy, infertility, multiple gestation and the size of CB.
Conclusions: The main finding was that the frequency of live birth in our sample was 62.5% (5
from 8). The clinical inference is that a chorionic bump on first-trimester sonography does not
definitely guarantee a secure prediction. The correlation between bump size and pregnancy
outcome is not clear, which warrants further research.
2017, Elsevier Taiwan LLC and the Chinese Taipei Society of Ultrasound in Medicine. This is
an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/
by-nc-nd/4.0/).
Authorship & conflicts of interest: The two authors have contributed sufficiently to the project to be included as authors. To the best of
our knowledge, no conflict of interest, financial or other, exists.
* Correspondence to: Razieh Shahnazari, Iran University of Medical Sciences, Hazrat-e Rasool Hospital, Radiology Department, Niyayesh
St, Satarkhan St, Tehran, Iran.
E-mail address: rsh.medicen1990@gmail.com (R. Shahnazari).
http://dx.doi.org/10.1016/j.jmu.2017.04.004
0929-6441/ 2017, Elsevier Taiwan LLC and the Chinese Taipei Society of Ultrasound in Medicine. This is an open access article under the
CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Please cite this article in press as: Younesi L, Shahnazari R, Chorionic Bump in First-trimester Sonography, Journal of Medical Ultrasound
(2017), http://dx.doi.org/10.1016/j.jmu.2017.04.004
+ MODEL
2 L. Younesi, R. Shahnazari
Please cite this article in press as: Younesi L, Shahnazari R, Chorionic Bump in First-trimester Sonography, Journal of Medical Ultrasound
(2017), http://dx.doi.org/10.1016/j.jmu.2017.04.004
Chorionic Bump in First-trimester Sonography
(2017), http://dx.doi.org/10.1016/j.jmu.2017.04.004
Please cite this article in press as: Younesi L, Shahnazari R, Chorionic Bump in First-trimester Sonography, Journal of Medical Ultrasound
+
6 26 5 0.3 14.5 3 Yes Bradycardy e e e e e e e Viable NVD
MODEL
weeks 40 weeks
6 days
6 0.8 19 8 Normal FHR
weeks
6 days
7 35 7 0.9 20 e NO NO e e e e e e e Viable C/S
weeks 38 weeks
1 day
8 30 8 1.5 29 6 Yes NO e e trauma e e e e demise at e
weeks 9 weeks
5 days
a
Mean sac diameter (MSD).
b
Crown-rump length (CRL).
c
Fetal heart rate (FHR).
d
Natural vaginal delivery.
e
Cesarean section.
f
CB was not observed in Patient 5 in sonography three weeks later with the gestation age of 9 weeks.
g
A second experience of nonviable pregnancy outcome, three month after our study, occurred with similar result of abortion in 8th
week.
3
+ MODEL
4 L. Younesi, R. Shahnazari
Please cite this article in press as: Younesi L, Shahnazari R, Chorionic Bump in First-trimester Sonography, Journal of Medical Ultrasound
(2017), http://dx.doi.org/10.1016/j.jmu.2017.04.004
+ MODEL
Chorionic Bump in First-trimester Sonography 5
echogenicity with a low level echo as well as choriodecidual plate, and bulges into the gestational sac [1].Considering
irregularity, focal bulging toward the center and surface MRI findings, CB showed T1 hypersignal intensity and hem-
irregularity was observed inside the sac [1]. orrhage between villus formation and a decidual in patho-
logic evaluation [2].
Also, in sonography avascular was observed with a low-
Discussion level echo [1]. All the above findings can contribute to
differentiation of CB and subchorionic hemorrhage. Unfor-
The aim of this study was to determine the live birth rate of tunately, except for two patients, sonographies were not
pregnancies with a diagnosis of a chorionic bump on first- examined to detect changes over time in the size of CB
trimester sonography, and to give radiologists and gyne- which is a limitation of the present study. However, the
cologists an insight into CB and its importance. The main cases in our study showed a decreased size of CB observed
finding was that the frequency of live birth in our sample in sonography examination performed by other centers.
was 62.5% (5 from 8) which is consistent with Arleo et al. Arleo et al. reported that 91% of live births in their study
who reported a live birth rate of 62% (N Z 119) and Sana showed absorption chorionic bump by 12 weeks suggesting
et al. who observed a live birth rate of 65% (N Z 57). Harris the possibility that the CB can reabsorb the underlying
et al. reported a live birth rate of less than 50% (n Z 15) process [2]. Vaginal bleeding was not observed in the 7
[1]. This low rate has been attributed to a small sample patients in our study and the only case who showed vaginal
size, but interestingly the live birth rate in our study is bleeding had a history of misoprostol which might be the
consistent with the live birth rate reported in recent possible cause of bleeding. Other studies have not observed
studies. Incidence rate in the present study was found to be a significant communication between vaginal bleeding, CB,
0.4% which is less than that reported by Harris et al., i.e., and pregnancy outcome the same as ours. Arleo et al. noted
0.7% and Sana et al., i.e., 1.5e7 per 1000 individuals, and the importance of the number of CBs rather than its size
Arleo et al., i.e., 5e7 per 1000 individuals, which can be [2]. The cases in our study had no more than a single CB and
ascribed to the small sample size in our study. The inci- we believe that the correlation between bump size and
dence of chorionic bump was reported 23 per 1000 by Jo- pregnancy outcome is not clear. Harris and Arleo observed
seph et al. was prominently higher than Sana et al. This can no significant correlation between coagulopathy and preg-
be explained by the fact that chorionic bump is more nancy outcome [1 2]. None of the 5 cases in our study re-
common among pregnant women who are subject to a ported clear abnormality in the newborn or in the second
higher risk for fetal aneuploidy compared to general ob- trimester screening sonography based on the verbal reports
stetric population. Their study found that chorionic bump by the patient. In a case report by Wegrzyn et al., CB was
obviously increased the likelihood of chromosomal abnor- observed along with acrania which, due to its rarity, might
mality in high risk fetuses [9]. Results of four previous be accidental and attributable to deficiency of acid folic or
studies are presented in Table 2 for comparison with our an extraneous factor. Whether there is a correlation be-
study. tween folate deficiency and CB is yet unclear and needs to
The main reason for the small sample size in the present be studied by future research [5]. A systematic study by
study is the shorter time period compared to the time Ammon et al. reported the rate of nonviable pregnancy
frame considered by Sana et al. and Arleo et al., and Harris outcome in week 5e20 to be 11 to 22 percent which obvi-
et al. Secondly, Akbarabadi Hospital is a major referral ously decreases by 2e4 percent after the development of
center for women in Tehran and a large number of first the heart [11].Thus, even considering the first percentage
trimester sonographies are performed by a university above, i.e., 11e22, the rate of nonviable pregnancy
lecturer in the morning and residents in the afternoon and outcome in our study, i.e., 37.5 percent and the rate re-
evening. ported in the study conducted by Arleo (i.e., 18 percent)
However, due to the recent introduction of CB, and the [2] show that CB is a major nonviability risk factor. Given
possibility of failure to diagnose CB or mistaking it with that in our study, two patients had prior experience of
subchorionic hemorrhage only the sonographies performed nonviable pregnancy and one patient suffered a second
by the university lecturer were included in the data and nonviable pregnancy, the question which raises here is
those performed by residents were excluded. According to whether CB is causal to the poor outcome of their current
Harris et al. subchorionic hemorrhage appears to be venous pregnancy or whether poor pregnancy outcome would
mostly conforming to the gestational sac shape while CB ensue even without the presence of CB especially with re-
tends to be more arterial, depicting hypoecho centeric or gard to their prior experience of nonviable pregnancy
oval bleeding on the outer side of the choriodecidual re- outcome given to Joseph et al. A sonographically non-
action. It also develops intervillous space or chorionic isolated chorionic bump is not indicative of considerable
Please cite this article in press as: Younesi L, Shahnazari R, Chorionic Bump in First-trimester Sonography, Journal of Medical Ultrasound
(2017), http://dx.doi.org/10.1016/j.jmu.2017.04.004
+ MODEL
6 L. Younesi, R. Shahnazari
additional aneuploidy risk, whereas a sonographically iso- finding associated with a guarded prognosis. J Ultrasound Med
lated chorionic bump significantly increased the possibility 2006;25:757.
of aneuploidy in high-risk fetuses [9] but in the current [2] Arleo EK, Troiano RN. Chorionic bump on first-trimester so-
study we did not conduct a genetic test on nonviable pa- nography: not necessarily a poor prognostic indicator for
pregnancy. J Ultrasound Med 2015;343:137.
tients. Only, patient 1 and 2 aged 40 and 41 years with
[3] Arleo EK, Dunning A, Troiano RN. Chorionic bump in pregnant
demise outcome and previous history of abortion under- patients and associated live birth raten; a systematic review
went the genetic test with normal results. As mentioned and meta-analysis. J Ultrasound Med 2015;34(4):553e7.
above, Harris et al. and Arleo et al. did not observe a [4] Sana Y, Appiah A, Davison A, Nicolaides KH, Johns J, Ross JA.
correlation between coagulopathy and live birth outcome Clinical significance of first-trimester chorionic bumps: a
[1,2]. However, the possible relationship between CB and matched case-control study. Ultrasound Obstet Gynecol 2013;
maternal factor such as uterine abnormality and systemic 42:585.
disease reasons is still obscure, which should be considered [5] Wegrzyn P, Brawura-Biskupski-Samaha R, Borowski D,
by future research. Gorski A, Wielgos M. The chorionic bump associated with
However, considering the low incidence in both patients acraniaecase report. Ginekol Pol 2013;84(12):1055e8.
[6] Stampone C, Nicotra M, Muttinelli C, Cosemi EV. Transvaginal
and the literature of CB, further studies on chorionic bumps
sonography of the yolk sac in normal and abnormal pregnancy.
and the risk of demise would be helpful for full delineation J Clin Ultrasound 1996;24:3e9.
of this infrequent first-trimester sonographic finding. [7] Makikallio K, Tekay A, Jouppila P. Yolk sac and umbil-
icoplacental hemodynamics during early human embryonic
Acknowledgement development. Ultrasound Obstet Gynecol 1999;14:175e9.
[8] Ahmed MH, Raman V, Musa S. Chorionic bump: off the beaten
path, first trimester sonographic finding.
We thanks Iran University of Medical Science and Akbar- [9] Joseph R, Angelina C, Christian L, Michael GP, L LF. First-
abadi Hospital for providing us with data and facilities to trimester chorionic bump-association with fetal aneuploidy in
conduct this study. a high- risk population. J Clin Ultrasound 2017;45:3e7.
[10] Rumak CM. Diagnostic ultrasound. 4th ed. 2011. Philadelphia:
PA.
References [11] Ammon Avalos L, Galindo C, Li DK. A systematic review to
calculate background miscarriage rates using life table analysis.
[1] Harris RD, Couto C, Karpovsky C, Porter MM, Quhilal S. The Birth Defects Res Part A Clin Mol Teratol 2012;94(6):417e23.
chorionic bump: a first-trimester pregnancy sonographic
Please cite this article in press as: Younesi L, Shahnazari R, Chorionic Bump in First-trimester Sonography, Journal of Medical Ultrasound
(2017), http://dx.doi.org/10.1016/j.jmu.2017.04.004