Subchorionic haemorrhage

Dr Henry Knipe and Radswiki et al.

Subchorionic haemorrhage (SCH) occurs when there is perigestational haemorrhage and blood collects between the uterine wall and the chorionic membrane in pregnancy. It is a frequent cause of first and second trimester bleeding.

It typically occurs within the first 20 weeks of gestation. When seen in the first 10-14 days of gestation, they are also termed implantational bleeds.

Ultrasound 
  • crescentic collection with elevation of the chorionic membrane
  • depending on the time elapsed since bleeding, the collection will have variable echotexture
    • acute: hyperechoic and may be difficult to differentiate from adjacent chorion
    • subacute-chronic: decreasing echogenicity with time
  • in almost all cases there is extension of the haematoma towards the margin of the placenta 3
Quantification

In early pregnancy, a subchorionic haemorrhage is considered small if it is <20% of the size of the sac, and large if it is >50-66% 5.

Fetal outcome is dependent on size of the haematoma, maternal age, and gestational age 2. In most cases the haematoma gradually decreases in size on follow-up. A subchorionic haemorrhage places the gestation at increased risk of:

If the collection extends up to the internal os and/or there is dilatation of the internal cervical os, this is an indication of extremely poor prognosis, almost always leads to impending miscarriage

General imaging differential considerations include:


Ultrasound - obstetric
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Article Information

rID: 13250
System: Obstetrics
Section: Pathology
Synonyms or Alternate Spellings:
  • Subchorionic hemorrhage
  • Subchorionic haematoma
  • Subchorionic hematoma
  • Sub-chorionic haemorrhage (SCH)
  • Subchorionic haemorrhage (SCH)
  • Subchorionic haemorrhage
  • Sub-chorionic hemorrhage (SCH)

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