eMedicine Specialties > Radiology > Obstetrics/Gynecology

Subchorionic Hemorrhage

Avneesh Chhabra, MD, Staff Radiologist, Department of Radiology, Drexel University College of Medicine
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

Updated: Jun 23, 2009

Introduction

Background

Subchorionic hemorrhage (subchorionic hematoma) is the most common sonographic abnormality in the presence of a live embryo. Vaginal bleeding affects 25% of all women during the first half of pregnancy and is a common reason for first-trimester ultrasonography. Sonographic visualization of a subchorionic hematoma is important in a symptomatic woman because pregnant women with a demonstrable hematoma have a prognosis worse than women without a hematoma. However, small, asymptomatic subchorionic hematomas do not worsen the patient's prognosis.^{1,2,3,4,5,6,7}

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.

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.

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.

Pathophysiology

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 same patient as in Image 2 in Multimedia.

The subchorionic hematoma often regresses, especially if it is small or moderate in size. Large hematomas, which strip at least 30-40% of placenta away from endometrium, may enlarge further, compressing the gestational sac and leading to premature rupture of membranes with consequent spontaneous abortion.

Frequency

United States

The incidence of subchorionic hemorrhage (subchorionic hematoma) is 1.3% of all pregnancies. In pregnant patients with first-trimester vaginal bleeding, the incidence increases to almost 20%. Bennett et al⁹ reported a spontaneous abortion rate of 9.3% in patients with first-trimester vaginal bleeding who had a live fetus and subchorionic hematoma. Overall, hematoma is associated with a 4-33% rate of miscarriage depending on the gestational age when the complication occurs.

Mortality/Morbidity

• The presence of sonographically detected subchorionic hemorrhage (subchorionic hematoma) increases the risk of miscarriage, stillbirth, abruptio placentae, and preterm labor.
• The rate of spontaneous abortion directly varies with the size of subchorionic hematoma and the mother's age. The rate of spontaneous abortion is inversely related to gestational age. The frequency of fetal demise is higher with retroplacental hematoma than with marginal subchorionic hematoma.

Race

No significant racial differences have been reported with subchorionic hemorrhage (subchorionic hematoma).

Age

Bennett et al⁹ reported that the spontaneous abortion rate in women aged 35 years or older is twice as high as that in younger women. After age 35 years, the first-trimester miscarriage rate reflects maternal age.

Anatomy

Before the fertilized ovum reaches the uterus, the mucous membrane of the body of the uterus increases in vascularity and thickness; it is then called the decidua. The part that covers the ovum is named the decidua capsularis. The portion that intervenes between the ovum and the uterine wall is named the decidua basalis; the placenta subsequently develops here. A small amount of bleeding may result from the implantation of the fertilized ovum in the first trimester.

The chorion consists of 2 layers: an outer layer formed by the trophoblast and an inner layer formed by the somatic mesoderm. The trophoblast undergoes rapid proliferation and forms numerous processes called chorionic villi, which invade the uterine decidua and simultaneously absorb from it nutritive materials for embryonic growth. The chorionic villi increase in size and ramify, while the mesoderm, which carries branches of the umbilical vessels, grows into them; in this way, they are vascularized. Branches of the umbilical arteries carry blood to the villi. After circulating through the capillaries of the villi, the umbilical veins return blood to the embryo.

The placenta connects the fetus to the uterine wall and is the organ by which the nutritive, respiratory, and excretory functions of the fetus are performed. The placenta is composed of fetal and maternal portions. The fetal portion consists of the villi of the chorion, and the maternal portion is formed by the decidua placentalis containing the intervillous space.

Chorionic separation from its site of endometrial attachment can lead to hemorrhaging (hematomas) in various locations in the vicinity of its original implantation. These hematomas are referred to as marginal subchorionic hematomas, in which only the placental margin is separated; retroplacental hematoma, in which bleeding is behind the placenta; and subamniotic (preplacental) hemorrhage, in which a hematoma collects anterior to the placenta and is limited by the umbilical cord.¹⁰

Subchorionic hemorrhage (hematoma) is the most common, and preplacental hematoma is the rarest. The incidence of retroplacental hematoma increases in the third trimester.

Presentation

Most patients with a small subchorionic hemorrhage (subchorionic hematoma) in the first trimester are asymptomatic.¹¹ Common manifestations of subchorionic hematoma are idiopathic premature labor, painless vaginal bleeding, abdominal pain, and threatened abortion in the first or second trimesters.¹²

Symptoms of third-trimester placental abruption, observed in approximately 1% of gestations, are vaginal bleeding, a painful and tense uterus, fetal distress,¹³ and disseminated intravascular coagulation. Marginal abruptions are more common than retroplacental abruptions in women with mild clinical symptoms.

Preferred Examination

Ultrasonography is the imaging modality of choice for subchorionic hemorrhage (subchorionic hematoma) because it can be performed rapidly at the patient's bedside and because it has no known risk, as with radiation.^14,15

Limitations of Techniques

The sensitivity of sonography is low and varies between 2% and 20%, as blood may pass vaginally and not collect in the subchorionic space. Hematomas may also appear isoechoic relative to the placenta.

Differential Diagnoses

Leiomyoma, Uterus (Fibroid)

Other Problems to Be Considered

Focal myometrial contraction (see Image 8)
Chorioamnionic separation (see Image 5)
Intra-amniotic hemorrhage (see Image 10)
Umbilical-cord hematoma
Prominent retroplacental veins (see Images 4, 11-13)
Empty gestation sac in a twin pregnancy (see Image 8)

Computed Tomography

Findings

CT scanning is relatively contraindicated during pregnancy because of the risk of radiation to the fetus. Pregnant patients may undergo CT for reasons such as an evaluation of trauma or acute abdomen. Scans may show an incidental or injury-related hyperattenuating subchorionic hemorrhage (subchorionic hematoma).

Degree of Confidence

The sensitivity of CT may be high compared with that of sonography. However, because of the risk of radiation with CT, no large comparisons of the 2 modalities have been reported.

False Positives/Negatives

Normal chorioamniotic separation should not be confused with placental abruption.

Magnetic Resonance Imaging

Findings

MRI is not routinely performed to detect subchorionic hemorrhage (subchorionic hematoma); a more common indication is the detection of fetal anomalies.¹⁶ MRI may incidentally show a subchorionic hematoma and help in characterizing and determining the acuity of the hematomas by showing changes in signal intensity produced by various blood products. T1-weighted spin-echo and gradient-echo images are particularly useful in evaluating the hemorrhage.

In one study, fetal MRI techniques were evaluated to determine whether they were sufficient for the assessment of placental pathologies, and based on the study findings, MRI was considered by the authors to be a promising tool for the assessment of placental insufficiency. Pathologically, 26 placentas showed infarctions (96.2% on MR scans); 2 retroplacental hematomas were detected by MRI and confirmed by pathology; 9 of 14 subchorionic hematomas were confirmed; 6 of 8 intervillous hemorrhages were seen on MRI; and 3 of 6 cases of severe chorioamnionitis were diagnosed prenatally.¹⁷

Degree of Confidence

Fetal motion sometimes limits MRI. However, the observer can confidently determine the age of the blood products.

Ultrasonography

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 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 29-year-old woman in 9th week of gestation demonstrates nonfusion and separation of chorion and amnion.

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.

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 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 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 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-old woman in 33rd week of pregnancy demonstrates prominent retroplacental vessels mimicking a retroplacental hematoma.

Findings

Acute subchorionic hemorrhages (subchorionic hematomas) vary in echogenicity and are seen between the chorion and the uterine wall on sonograms (see Images above and Images 1-7 in Multimedia). Isoechoic hematomas may be missed on initial sonograms, or they may be recognized as heterogeneous and thickened placentas.

Color Doppler sonography may help in distinguishing the avascular hematoma from the highly vascular placenta. Follow-up sonography may also help in resolving hematomas.

A subchorionic hematoma can be considered large if it is greater than 50% of the size of the gestation sac, medium if it is 20-50%, and small if it is less than 20%. Large hematomas by size (>30-50%) and volume (>50 mL) worsen the patient's prognosis.

Hematomas may resolve over 1-2 weeks. During this time, they may be seen as complex fluid collections with mixed echogenicity. In addition, sonographic findings also confirm fetal viability¹⁸ and can help in differentiating and diagnosing other conditions associated with miscarriage in the first trimester, such as ectopic pregnancy, blighted ovum, and twin gestation.

Degree of Confidence

Ultrasonography lacks high sensitivity for small bleeds. However, it is the most useful modality in a pregnant patient with vaginal bleeding. The finding of a subchorionic or retroplacental hematoma as demonstrated on sonography performed immediately after an episode of vaginal bleeding indicates a prognosis worse than that expected if no hematoma were seen.^{14,15,19,20,21}

False Positives/Negatives

Uterine fibroids or focal myometrial contractions (see Image below and Image 8 in Multimedia) can cause the placenta to appear thickened, or they may look like subchorionic or retroplacental hematomas. Hematomas are avascular on color Doppler scanning. Fibroids have a characteristic hypoechoic appearance with or without calcifications and typical peripheral blood flow in color Doppler images. Color flow is seen in contracted myometrium, and transient myometrial contractions usually resolve within 30 minutes of scanning.

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).

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.

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.

Prominent retroplacental and myometrial vessels should be distinguished from heterogeneous bleeding. The vessels appear as serpentine, anechoic structures and demonstrate flow on color Doppler sonography (see Images below and Images 4, 11-13 in Multimedia); these features differentiate them from avascular hematomas.

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.

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-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 week of pregnancy (same patient as in Image 12 in Multimedia) demonstrates prominent retroplacental vessels mimicking a retroplacental hematoma.

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.

Multimedia

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.

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.

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

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.

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.

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.

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.

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).

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.

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.

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.

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.

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.

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].

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.

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

© 1994- by Medscape.
All Rights Reserved
(http://www.medscape.com/public/copyright)