eMedicine Specialties > Radiology > Obstetrics/Gynecology

Subchorionic Hemorrhage: Follow-up

Author: Avneesh Chhabra, MD, Staff Radiologist, Department of Radiology, Drexel University College of Medicine
Coauthor(s): Kiran Batra, MD, DNB, Neuroradiology Fellow, Radiology Resident, Drexel University College of Medicine; Nancy A Mohsen, MD, Assistant Professor, Department of Radiology, Drexel University College of Medicine, Hahnemann Hospital; Michael J Hallowell, MD, RVT, Chairman and Associate Professor, Department of Radiologic Sciences, Drexel University College of Medicine; Clinical Service Chief, Department of Radiology, Hahnemann University Hospital; Kathleen A Kuhlman, MD, Associate Professor, Director of Reproductive Ultrasound, Department of Obstetrics and Gynecology, Drexel University College of Medicine; Victoria Tway, RDMS, Clinical Supervisor of Reproductive Ultrasound, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Drexel Center for Genetics, Fetal and Maternal Medicine, Drexel University College of Medicine
Contributor Information and Disclosures

Updated: Jun 23, 2009

Intervention

Bed rest is usually advised for patients with first-trimester bleeding, and serial ultrasonography may be performed as clinically indicated to monitor fetal viability and the size of the hematoma.

Medicolegal Pitfalls

  • Isoechoic hematomas should be suspected in cases of first-trimester bleeding with a thickened and heterogeneous placenta.
  • Follow-up ultrasonography should be performed as clinically indicated.
 


More on Subchorionic Hemorrhage

Overview: Subchorionic Hemorrhage
Imaging: Subchorionic Hemorrhage
Follow-up: Subchorionic Hemorrhage
Multimedia: Subchorionic Hemorrhage
References
Further Reading

References

  1. Deutchman M, Tubay AT, Turok D. First trimester bleeding. Am Fam Physician. Jun 1 2009;79(11):985-92. [Medline].

  2. Johns J, Hyett J, Jauniaux E. Obstetric outcome after threatened miscarriage with and without a hematoma on ultrasound. Obstet Gynecol. Sep 2003;102(3):483-7. [Medline].

  3. Kadir R, Chi C, Bolton-Maggs P. Pregnancy and rare bleeding disorders. Haemophilia. Feb 27 2009;[Medline].

  4. Koifman A, Levy A, Zaulan Y, Harlev A, Mazor M, Wiznitzer A, et al. The clinical significance of bleeding during the second trimester of pregnancy. Arch Gynecol Obstet. Jul 2008;278(1):47-51. [Medline].

  5. Kurjak A, Schulman H, Zudenigo D, et al. Subchorionic hematomas in early pregnancy: clinical outcome and blood flow patterns. J Matern Fetal Med. Jan-Feb 1996;5(1):41-4. [Medline].

  6. Pearlstone M, Baxi L. Subchorionic hematoma: a review. Obstet Gynecol Surv. Feb 1993;48(2):65-8. [Medline].

  7. Pedersen JF, Mantoni M. Prevalence and significance of subchorionic hemorrhage in threatened abortion: a sonographic study. AJR Am J Roentgenol. Mar 1990;154(3):535-7. [Medline].

  8. Leite J, Ross P, Rossi AC, Jeanty P. Prognosis of very large first-trimester hematomas. J Ultrasound Med. Nov 2006;25(11):1441-5. [Medline].

  9. Bennett GL, Bromley B, Lieberman E, Benacerraf BR. Subchorionic hemorrhage in first-trimester pregnancies: prediction of pregnancy outcome with sonography. Radiology. Sep 1996;200(3):803-6. [Medline].

  10. Nagy S, Bush M, Stone J, et al. Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy. Obstet Gynecol. Jul 2003;102(1):94-100. [Medline].

  11. Trop I, Levine D. Hemorrhage during pregnancy: sonography and MR imaging. AJR Am J Roentgenol. Mar 2001;176(3):607-15. [Medline].

  12. Hodgson DT, Lotfipour S, Fox JC. Vaginal bleeding before 20 weeks gestation due to placental abruption leading to disseminated intravascular coagulation and fetal loss after appearing to satisfy criteria for routine threatened abortion: a case report and brief review of the literature. J Emerg Med. May 2007;32(4):387-92. [Medline].

  13. Yoshida S, Kikuchi A, Sunagawa S, Takagi K, Ogiso Y, Yoda T, et al. Pregnancy complicated by diffuse chorioamniotic hemosiderosis: obstetric features and influence on respiratory diseases of the infant. J Obstet Gynaecol Res. Dec 2007;33(6):788-92. [Medline].

  14. Abu-Yousef MM, Bleicher JJ, Williamson RA, Weiner CP. Subchorionic hemorrhage: sonographic diagnosis and clinical significance. AJR Am J Roentgenol. Oct 1987;149(4):737-40. [Medline].

  15. Ball RH, Ade CM, Schoenborn JA, Crane JP. The clinical significance of ultransonographically detected subchorionic hemorrhages. Am J Obstet Gynecol. Mar 1996;174(3):996-1002. [Medline].

  16. Gupta R, Sharma R, Jain T, Vashisht S. Antenatal MRI diagnosis of massive subchorionic hematoma: a case report. Fetal Diagn Ther. 2007;22(6):405-8. [Medline].

  17. Linduska N, Dekan S, Messerschmidt A, Kasprian G, Brugger PC, Chalubinski K, et al. Placental pathologies in fetal MRI with pathohistological correlation. Placenta. Jun 2009;30(6):555-9. [Medline].

  18. Poulose T, Richardson R, Ewings P, Fox R. Probability of early pregnancy loss in women with vaginal bleeding and a singleton live fetus at ultrasound scan. J Obstet Gynaecol. Nov 2006;26(8):782-4. [Medline].

  19. Nyberg DA, Cyr DR, Mack LA, et al. Sonographic spectrum of placental abruption. AJR Am J Roentgenol. Jan 1987;148(1):161-4. [Medline].

  20. Richards DS, Bennett BB. Prenatal ultrasound diagnosis of massive subchorionic thrombohematoma. Ultrasound Obstet Gynecol. May 1998;11(5):364-6. [Medline].

  21. Dighe M, Cuevas C, Moshiri M, Dubinsky T, Dogra VS. Sonography in first trimester bleeding. J Clin Ultrasound. Jul-Aug 2008;36(6):352-66. [Medline].

  22. Akhlaghpoor S, Tomasian A. Safety of chorionic villus sampling in the presence of asymptomatic subchorionic hematoma. Fetal Diagn Ther. 2007;22(5):394-400. [Medline].

Further Reading

ACR Appropriateness Criteria® first trimester bleeding. American College of Radiology - Medical Specialty Society.  1996 (revised 2005).  9 pages.  NGC:004650

ACR Appropriateness Criteria® second and third trimester bleeding. American College of Radiology - Medical Specialty Society.  1996 (revised 2005).  2 pages.  NGC:004652

Early Pregnancy Evaluation by Three-Dimensional Ultrasound

Keywords

subchorionic hemorrhage, subchorionic hematoma, vaginal bleeding, first-trimester bleeding, second-trimester bleeding, marginal subchorionic hematoma, retroplacental hematoma, subamniotic hemorrhage, preplacental hemorrhage, abruptio placentae, placenta, abruption, gestational bleeding

Contributor Information and Disclosures

Author

Avneesh Chhabra, MD, Staff Radiologist, Department of Radiology, Drexel University College of Medicine
Avneesh Chhabra, MD is a member of the following medical societies: American Medical Association, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

Kiran Batra, MD, DNB, Neuroradiology Fellow, Radiology Resident, Drexel University College of Medicine
Kiran Batra, MD, DNB is a member of the following medical societies: American Roentgen Ray Society, Pennsylvania Radiological Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Nancy A Mohsen, MD, Assistant Professor, Department of Radiology, Drexel University College of Medicine, Hahnemann Hospital
Nancy A Mohsen, MD is a member of the following medical societies: American College of Radiology
Disclosure: Nothing to disclose.

Michael J Hallowell, MD, RVT, Chairman and Associate Professor, Department of Radiologic Sciences, Drexel University College of Medicine; Clinical Service Chief, Department of Radiology, Hahnemann University Hospital
Disclosure: Nothing to disclose.

Kathleen A Kuhlman, MD, Associate Professor, Director of Reproductive Ultrasound, Department of Obstetrics and Gynecology, Drexel University College of Medicine
Disclosure: Nothing to disclose.

Victoria Tway, RDMS, Clinical Supervisor of Reproductive Ultrasound, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Drexel Center for Genetics, Fetal and Maternal Medicine, Drexel University College of Medicine
Disclosure: Nothing to disclose.

Medical Editor

Christopher L Sistrom, MD, Associate Chair for Research, Assistant Professor, Department of Radiology, University of Florida School of Medicine
Christopher L Sistrom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, Association of University Radiologists, Phi Beta Kappa, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Karen L Reuter, MD, FACR, Professor, Department of Radiology, Lahey Clinic Medical Center
Karen L Reuter, MD, FACR is a member of the following medical societies: American Association for Women Radiologists, American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

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