The patient is a 29 y/o G5P4 at 12 weeks GA who presents with c/o vaginal spotting and mild abdominal cramping. What is the clinical significance of the findings here?
Diagnosis: subchorionic hemorrhage
This transabdominal pelvic ultrasound demonstrates a single, live IUP with a fetal heart rate of 146. It is evident in this clip that there is a hypoechoic fluid collection on the right lateral aspect of the uterus between the uterine wall and the chorionic membrane, consistent with a moderate sized subchorionic hemorrhage. There is no free abdominal fluid noted.
Take home points:
- Subchorionic hemorrhage, present in 3% of pregnancies, increases the risk of fetal complications. [1]
- spontaneous abortion (from 8.9% to 17.6%; OR 2.18, 95% CI 1.29–3.68)
- stillbirth (from 0.9% to 1.9%, pooled OR 2.09, 95% CI 1.20–3.67)
- abruption (from 0.7% to 3.6%, OR 5.71, 95% CI 3.91–8.33)
- preterm delivery (from 10.1% to 13.6%, OR 1.40, 95% CI 1.18–1.68)
- preterm premature rupture of membranes (from 2.3% to 3.8%, OR 1.64, 95% CI 1.22–2.21)
- Patients who are noted to have a SCH should recieve the appropriate dose of Rhogam if Rh negative, even in the absence of vaginal bleeding.[2]
- The providor should arrange close followup with patient’s OBGYN to follow the hematoma until resolution.
- The patient should be instructed to have pelvic rest until cleared by her OBGYN. [3]
- Some sources recommend bed rest, although this has not been proven to improve outcome. [3]
1. Tuuli MG1, Norman SM, Odibo AO, Macones GA, Cahill AG. Perinatal outcomes in women with subchorionic hematoma: a systematic review and meta-analysis. Obstet Gynecol. 2011 May;117(5):1205-12. [article]
2. DeCherney A, Nathan L, Goodwin TM et al. Current Diagnosis & Treatment Obstetrics & Gynecology, Eleventh Edition. McGraw Hill Professional; 2012.
3. Snell BJ. Assessment and management of bleeding in the first trimester of pregnancy. J Midwifery Womens Health. 2009;54(6):483-91.
