eMedicine Specialties > Radiology > Obstetrics/Gynecology

Subchorionic Hemorrhage: Multimedia

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

Multimedia

Transverse endovaginal scan of the uterus in a 45...
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Media file 1: Transverse endovaginal scan of the uterus in a 45-year-old woman in 8th week of gestation. Small subchorionic hematoma is anterior to a gestational sac.
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Transverse endovaginal scan of the uterus in a 45...

Transverse endovaginal scan of the uterus in a 45-year-old woman in 8th week of gestation. Small subchorionic hematoma is anterior to a gestational sac.

Sagittal endovaginal scan of the uterus in a 19-y...
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Media file 2: Sagittal endovaginal scan of the uterus in a 19-year-old woman in 20th week of gestation demonstrates a small anterior subchorionic hematoma adjacent to the lower edge of the placenta.
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Sagittal endovaginal scan of the uterus in a 19-y...

Sagittal endovaginal scan of the uterus in a 19-year-old woman in 20th week of gestation demonstrates a small anterior subchorionic hematoma adjacent to the lower edge of the placenta.

Transverse scan demonstrates a hematoma in the sa...
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Media file 3: Transverse scan demonstrates a hematoma in the same patient as in Image 2 in Multimedia.
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Transverse scan demonstrates a hematoma in the sa...

Transverse scan demonstrates a hematoma in the same patient as in Image 2 in Multimedia.

Sagittal endovaginal scan of the uterus demonstra...
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Media file 4: Sagittal endovaginal scan of the uterus demonstrates a small subchorionic hematoma (red arrow) in a 26-year-old woman in the 7th week of gestation. Also note the prominent retroplacental veins (blue arrow), which are normally in pregnancy.
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Sagittal endovaginal scan of the uterus demonstra...

Sagittal endovaginal scan of the uterus demonstrates a small subchorionic hematoma (red arrow) in a 26-year-old woman in the 7th week of gestation. Also note the prominent retroplacental veins (blue arrow), which are normally in pregnancy.

Transverse endovaginal scan of the uterus in 45-y...
(Enlarge Image)
Media file 5: Transverse endovaginal scan of the uterus in 45-year-old woman in the 13th week of a dichorionic-diamniotic twin pregnancy demonstrates an anterior subchorionic hematoma (cursors). Also note the normal chorioamniotic separation in the posterior sac.
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Transverse endovaginal scan of the uterus in 45-y...

Transverse endovaginal scan of the uterus in 45-year-old woman in the 13th week of a dichorionic-diamniotic twin pregnancy demonstrates an anterior subchorionic hematoma (cursors). Also note the normal chorioamniotic separation in the posterior sac.

Sagittal endovaginal scan of the uterus in 37-yea...
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Media file 6: Sagittal endovaginal scan of the uterus in 37-year-old woman in the 13th week of a dichorionic-diamniotic twin pregnancy demonstrates an anterior subchorionic hematoma.
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Sagittal endovaginal scan of the uterus in 37-yea...

Sagittal endovaginal scan of the uterus in 37-year-old woman in the 13th week of a dichorionic-diamniotic twin pregnancy demonstrates an anterior subchorionic hematoma.

Sagittal endovaginal scan in the same patient as ...
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Media file 7: Sagittal endovaginal scan in the same patient as in Image 6 in Multimedia shows extension of the hematoma in the intertwin membrane cleft, where the 2 placentas fuse.
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Sagittal endovaginal scan in the same patient as ...

Sagittal endovaginal scan in the same patient as in Image 6 in Multimedia shows extension of the hematoma in the intertwin membrane cleft, where the 2 placentas fuse.

Sagittal endovaginal scan of a dichorionic-diamni...
(Enlarge Image)
Media file 8: Sagittal endovaginal scan of a dichorionic-diamniotic twin pregnancy in the 13th week of gestation in a 45-year-old woman. An empty gestation sac mimics a subchorionic collection (red arrow). Also note the transient uterine contraction (yellow arrow).
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Sagittal endovaginal scan of a dichorionic-diamni...

Sagittal endovaginal scan of a dichorionic-diamniotic twin pregnancy in the 13th week of gestation in a 45-year-old woman. An empty gestation sac mimics a subchorionic collection (red arrow). Also note the transient uterine contraction (yellow arrow).

Sagittal endovaginal scan of the uterus in a 29-y...
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Media file 9: Sagittal endovaginal scan of the uterus in a 29-year-old woman in 9th week of gestation demonstrates nonfusion and separation of chorion and amnion.
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Sagittal endovaginal scan of the uterus in a 29-y...

Sagittal endovaginal scan of the uterus in a 29-year-old woman in 9th week of gestation demonstrates nonfusion and separation of chorion and amnion.

Transverse endovaginal scan in a 29-year-old woma...
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Media file 10: Transverse endovaginal scan in a 29-year-old woman in 21st week of gestation demonstrates intra-amniotic hemorrhage as fine echoes dispersed in the amniotic fluid.
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Transverse endovaginal scan in a 29-year-old woma...

Transverse endovaginal scan in a 29-year-old woman in 21st week of gestation demonstrates intra-amniotic hemorrhage as fine echoes dispersed in the amniotic fluid.

Sagittal gray-scale endovaginal scan (top) of the...
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Media file 11: Sagittal gray-scale endovaginal scan (top) of the uterus in a 16-year-old mother in 25th week of gestation demonstrates a hypoechoic area adjacent to the lower edge of the placenta; this finding suggests a small subchorionic hematoma. However, color Doppler scan (bottom) at the same level confirms that this finding represents prominent vessels mimicking a subchorionic hematoma.
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Sagittal gray-scale endovaginal scan (top) of the...

Sagittal gray-scale endovaginal scan (top) of the uterus in a 16-year-old mother in 25th week of gestation demonstrates a hypoechoic area adjacent to the lower edge of the placenta; this finding suggests a small subchorionic hematoma. However, color Doppler scan (bottom) at the same level confirms that this finding represents prominent vessels mimicking a subchorionic hematoma.

Sagittal endovaginal gray-scale scan in a 21-year...
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Media file 12: Sagittal endovaginal gray-scale scan in a 21-year-old woman in 33rd week of pregnancy demonstrates prominent retroplacental vessels mimicking a retroplacental hematoma.
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Sagittal endovaginal gray-scale scan in a 21-year...

Sagittal endovaginal gray-scale scan in a 21-year-old woman in 33rd week of pregnancy demonstrates prominent retroplacental vessels mimicking a retroplacental hematoma.

Color Doppler scan in a 21-year-old woman in 33rd...
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Media file 13: Color Doppler scan in a 21-year-old woman in 33rd week of pregnancy (same patient as in Image 12 in Multimedia) demonstrates prominent retroplacental vessels mimicking a retroplacental hematoma.
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Color Doppler scan in a 21-year-old woman in 33rd...

Color Doppler scan in a 21-year-old woman in 33rd week of pregnancy (same patient as in Image 12 in Multimedia) demonstrates prominent retroplacental vessels mimicking a retroplacental hematoma.

More on Subchorionic Hemorrhage

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

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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

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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

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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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