Subchorionic Hematoma in Threatened Abortion: Sonographic Evaluation and Significance

Abstract

In a study of 92 women with subchorionic hematoma evaluated with sonographic scan in King Khalid University Hospital, it was found that the mean ages and live births of patients who carried their pregnancies to viability were higher when compared with the patients who aborted. There was a statistically significant association between the gestational age at diagnosis of subchorionic hematoma and the size of the hematoma. There was, however, no statistically significant association found between the gestational age at diagnosis, size and site of the hematoma and the outcome of pregnancy. It was concluded that subchorionic hematoma which appear either in the second trimester, or are larger, or located in the lower uterine segment, may be associated with higher rates of abortion or preterm deliveries. Nevertheless, there is no statistically significant impact of these on the outcome of pregnancy. Ann Saudi Med 1996;16(6):650-653. L Al-Nuaim, N Chowdhury, B Adelusi, Subchorionic Hematoma in Threatened Abortion: Sonographic Evaluation and Significance. 1996; 16(6): 650-653 Vaginal bleeding, one of the features of early pregnancy miscarriage, occurs in up to 25% of all pregnancies, 1-3 although the reported incidence of at least 16% of clinically recognized pregnancies, quoted by Hertig and Livingstone 4 some 50 years ago, is probably still correct today. The natural worry of women with threatened abortion is the loss of their pregnancies, and in about 30% to 50% of cases, that fear may be justifiable. 5,6 The symptoms and signs of threatened abortion are so variable that the outcome of the pregnancy cannot be reliably predicted by the clinical features at presentation. 7 Thus, various biochemical and biophysical tests have been applied extensively in attempts to improve the accuracy of predicting the outcome of these pregnancies. [8][9][10] At present there is no single test that can accurately determine outcome of pregnancy after threatened abortions. However, ultrasonic examination has revolutionized clinical practice by providing definite evidence of the viability of a pregnancy as early as six weeks. 1,10,11 One of the sonographic features used in the evaluation of fetal viability in early pregnancy is the presence of subchorionic hematoma, which appears to have gained some prominence lately. 1-3,10-13 Indeed, it has been suggested that this can be used to predict the outcome of pregnancy when correlated with fetal activities such as motion and cardiac function. 1 We present here a prospective study of the ultrasonographic evaluation of patients with vaginal bleeding in early and second trimester of pregnancy, to determine the gestational age at diagnosis of, and the size and site of subchorionic hematoma, and to correlate these with pregnancy outcome. Material and MethodsDuring the period September 1992 to August 1994, 1082 pregnant patients who had completed between six and 23 weeks of gestation, as based on sonographic estimation of age using the crown-rump length (CRL) or biparietal diameter (BPD), were ...

A retrospective study of pregnancy outcomes when intravenous immunoglobulin is used for the treatment of recurrent spontaneous miscarriages with subchorionic hematoma

“…Dongol et al [27] conducted a prospective study of 70 patients with threatened miscarriage symptoms, and found that 43% of the patients had a SCH, and that a size ≥ 20 cm 2 may increase the risk of spontaneous miscarriage. And it was associated with an increased risk of preterm birth, which is consistent with a study by Al et al [28] There is no consensus on effective treatments for SCH. Some studies [29,30] used fat emulsion combined with vaginal progesterone to treat SCH, and found the treatment alleviated symptoms of a threatened miscarriage.…”

Prediction of early pregnancy failure by use of first trimester ultrasound screening

“…20 When outcome was assessed in relation to size of hematoma, 7 of 37 patients (19%) who had small hematoma (13.1cm 2 ) aborted, compared with 12 (21.8%) of 55 patients with large hematoma (13.2cm 2 ). 20 We found only four cases with IUH and one of them (25%) which had IUH volume >10 ml on USG ended in early miscarriage (Table 3) (Figure 4). (Table 4) and all the abnormal parameters were predictive of poor pregnancy outcome ( Table 5).…”

The effects of first-trimester subchorionic hematoma on pregnancy outcomes: a retrospective cohort study

“…These studies were subject to a smaller sample size and lack of consistent methods used to assess bleeding volume. [22]. The cut-off value of hematoma size also varied across studies.…”