Subchorionic haemorrhage
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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.
Epidemiology
It typically occurs within the first 20 weeks of gestation. If seen in the first 10-14 days of gestation, they are also sometimes termed implantational bleeds.
Radiographic features
Antenatal ultrasoundUltrasound
A subchorionic haemorrhage may manifest as
- crescentic collection with elevation of the chorionic membrane
. Depending -
depending on the time elapsed since bleeding, the collection will have variable echotexture
; being hyper-echoic initially,- acute: hyperechoic and may be difficult to differentiate from adjacent chorion
-
subacute-chronic: decreasing echogenicity with
decreasing echotexture overtime. In
-
in almost all cases
therethere is extension of the haematoma towards the margin of the placenta 3.
Quantification
In early pregnancy, a sub-chorionic haemorrhage is considered small if it is under 20<20% of the size of the sac and large if it is over 50>50-66% 5.
PrognosisTreatment and prognosis
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 sub-chorionic haemorrhage places the gestation at increased risk of
The presence ofIf the collection extending uptoextends up to the internal os and/or there is dilatation of the internal cervical os, this is an indicatorindication of extremely poor prognosis:, almost always leads to impending abortion.
Differential diagnosis
General imaging differential considerations include:
- retroplacental haemorrhage
- marginal sub-chorionic haematoma can mimic a twin gestational sac (particularly failed early twin gestational sac)
- chorioamniotic separation
-<p><strong>Subchorionic haemorrhage (SCH)</strong> occurs when there is <a href="/articles/perigestational-haemorrhage-2">perigestational haemorrhage</a> and blood collects between the uterine wall and the chorionic membrane in pregnancy. It is a frequent cause of first and second trimester bleeding.</p><h4>Epidemiology</h4><p>It typically occurs within the first 20 weeks of gestation. If seen in the first 10-14 days of gestation, they are also sometimes termed <a href="/articles/implantational-bleeds">implantational bleeds</a>.</p><h4>Radiographic features</h4><h5>Antenatal ultrasound </h5><p>A subchorionic haemorrhage may manifest as crescentic collection with elevation of the chorionic membrane. Depending on the time elapsed since bleeding, the collection will have variable echotexture; being hyper-echoic initially, with decreasing echotexture over time. In almost all cases there is extension of the haematoma towards the margin of the placenta <sup>3</sup>. </p><h6>Quantification</h6><p>In early pregnancy, a sub-chorionic haemorrhage is considered small if it is under 20% of the size of the sac and large if it is over 50% <sup>5</sup>.</p><h4>Prognosis</h4><p>Fetal outcome is dependent on size of the haematoma, maternal age, and gestational age <sup>2</sup>. In most cases the haematoma gradually decreases in size on follow-up. </p><p>A sub-chorionic haemorrhage places the gestation at increased risk of</p><ul>- +<p><strong>Subchorionic haemorrhage (SCH)</strong> occurs when there is <a href="/articles/perigestational-haemorrhage-2">perigestational haemorrhage</a> and blood collects between the uterine wall and the chorionic membrane in pregnancy. It is a frequent cause of first and second trimester bleeding.</p><h4>Epidemiology</h4><p>It typically occurs within the first 20 weeks of gestation. If seen in the first 10-14 days of gestation, they are also sometimes termed <a href="/articles/implantational-bleeds">implantational bleeds</a>.</p><h4>Radiographic features</h4><h5>Ultrasound </h5><ul>
- +<li>crescentic collection with elevation of the chorionic membrane</li>
- +<li>depending on the time elapsed since bleeding, the collection will have variable echotexture<ul>
- +<li>acute: hyperechoic and may be difficult to differentiate from adjacent chorion</li>
- +<li>subacute-chronic: decreasing echogenicity with time</li>
- +</ul>
- +</li>
- +<li>in almost all cases there is extension of the haematoma towards the margin of the placenta <sup>3</sup>
- +</li>
- +</ul><h6>Quantification</h6><p>In early pregnancy, a sub-chorionic haemorrhage is considered small if it is <20% of the size of the sac and large if it is >50-66% <sup>5</sup>.</p><h4>Treatment and prognosis</h4><p>Fetal outcome is dependent on size of the haematoma, maternal age, and gestational age <sup>2</sup>. In most cases the haematoma gradually decreases in size on follow-up. </p><p>A sub-chorionic haemorrhage places the gestation at increased risk of</p><ul>
-</ul><p>The presence of collection extending upto the internal os and/or dilatation of the internal cervical os is an indicator of extremely poor prognosis: almost always leads to <a href="/articles/impending-abortion">impending abortion</a>. </p><h4>Differential diagnosis</h4><p>General imaging differential considerations include:</p><ul>- +</ul><p>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 <a href="/articles/impending-abortion">impending abortion</a>. </p><h4>Differential diagnosis</h4><p>General imaging differential considerations include:</p><ul>
-<li>a <a title="Marginal placental abruption" href="/articles/marginal-placental-abruption">marginal sub-chorionic haematoma</a> can mimic a <a href="/articles/twin-gestational-sac">twin gestational sac</a> (particularly failed early twin gestational sac)</li>- +<li>
- +<a href="/articles/marginal-placental-abruption">marginal sub-chorionic haematoma</a> can mimic a <a href="/articles/twin-gestational-sac">twin gestational sac</a> (particularly failed early twin gestational sac)</li>
Tags changed:
- obstetrics
- abr certifying ultrasound
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