Subchorionic haemorrhage
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View Tariq Walizai's current disclosures- Subchorionic hemorrhage
- Subchorionic haematoma
- Subchorionic hematoma
- Sub-chorionic haemorrhage (SCH)
- Subchorionic haemorrhage (SCH)
- Subchorionic haemorrhage
- Sub-chorionic hemorrhage (SCH)
Subchorionic haemorrhage 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.
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Epidemiology
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.
Radiographic features
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 the adjacent chorion
subacute-chronic: decreasing echogenicity with time
in almost all cases there is an 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, medium-sized if it is 20-50% 9, and large if it is >50-66% of the size of the gestational sac 5.
Large haematomas by size (>30-50%) and volume (>50 mL) worsen the patient's prognosis 9.
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Treatment and prognosis
Fetal outcome is dependent on the size of the haematoma, maternal age, and gestational age 2. In most cases, the haematoma gradually decreases in size on follow-up and can resolve over 1-2 weeks 9. A subchorionic haemorrhage places the gestation at increased risk of:
If the collection extends 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.
Differential diagnosis
General imaging differential considerations include:
marginal subchorionic haematoma can mimic a twin gestational sac (particularly failed early twin gestational sac)
References
- 1. Bennett GL, Bromley B, Lieberman E et-al. Subchorionic hemorrhage in first-trimester pregnancies: prediction of pregnancy outcome with sonography. Radiology. 1996;200 (3): 803-6. Radiology (abstract) - Pubmed citation
- 2. Trop I, Levine D. Hemorrhage during pregnancy: sonography and MR imaging. AJR Am J Roentgenol. 2001;176 (3): 607-15. AJR Am J Roentgenol (full text) - Pubmed citation
- 3. Abu-yousef MM, Bleicher JJ, Williamson RA et-al. Subchorionic hemorrhage: sonographic diagnosis and clinical significance. AJR Am J Roentgenol. 1987;149 (4): 737-40. AJR Am J Roentgenol (abstract) - Pubmed citation
- 4. Norman SM, Odibo AO, Macones GA et-al. Ultrasound-detected subchorionic hemorrhage and the obstetric implications. Obstet Gynecol. 2010;116 (2 Pt 1): 311-5. doi:10.1097/AOG.0b013e3181e90170 - Pubmed citation
- 5. Nagy S, Bush M, Stone J et-al. Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy. Obstet Gynecol. 2003;102 (1): 94-100. - Pubmed citation
- 6. Ball RH, Ade CM, Schoenborn JA et-al. The clinical significance of ultransonographically detected subchorionic hemorrhages. Am. J. Obstet. Gynecol. 1996;174 (3): 996-1002. Am. J. Obstet. Gynecol. (link) - Pubmed citation
- 7. Pearlstone M, Baxi L. Subchorionic hematoma: a review. Obstet Gynecol Surv. 1993;48 (2): 65-8. - Pubmed citation
- 8. Sauerbrei EE, Pham DH. Placental abruption and subchorionic hemorrhage in the first half of pregnancy: US appearance and clinical outcome. Radiology. 1986;160 (1): 109-12. Radiology (abstract) - Pubmed citation
- 9. Juliana Leite, Pamela Ross, A. Cristina Rossi, Philippe Jeanty. Prognosis of Very Large First‐Trimester Hematomas. (2006) Journal of Ultrasound in Medicine. 25 (11): 1441. doi:10.7863/jum.2006.25.11.1441 - Pubmed
- 10. Howard T. Heller, Elizabeth A. Asch, Sara M. Durfee, Robin P. Goldenson, Hope E. Peters, Elizabeth S. Ginsburg, Peter M. Doubilet, Carol B. Benson. Subchorionic Hematoma: Correlation of Grading Techniques With First‐Trimester Pregnancy Outcome. (2018) Journal of Ultrasound in Medicine. 37 (7): 1725. doi:10.1002/jum.14524
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- Differential diagnosis for PV bleeding in pregnancy
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