Currently, most women with SCH are regularly monitored using ultrasound until the haematoma resolves. Otherwise, women with SCH are managed similarly to other women with threatened miscarriage, with advice on bed rest and supplementary progestogen. However, bed rest is not considered to be beneficial for women with threatened miscarriage based on the results of a Cochrane review [36]. There was one non-randomised controlled trial that showed a lower miscarriage rate in women with SCH that had bed rest 6.
However, given that the study lacked randomisation and was performed retrospectively, the evidence is weak and inconclusive. The beneficial effects of progestogen may be related to its immunomodulatory properties. Progestogen increases the production of progesterone-induced blocking factor, which favors T-helper cell type 2 response []. Besides that, progestogen may also help by promoting implantation and inhibiting uterine contraction and cervical dilation [39,41].
In several trials, progestogen was beneficial for women with SCH [40,41]. Although the results are encouraging, more studies are needed to confirm the benefits of progestogen. Patients and clinicians should weigh the cost and benefits carefully, before starting on progestogen treatment. A novel drug, called vaginal alpha lipoic acid ALA , is currently being investigated for its potential use in SCH management [42].
A randomised controlled trial has shown that women taking 10 mg of vaginal ALA had faster resorption of SCH compared to women taking mg progesterone and women without any medication [42]. ALA is thought to be beneficial because of its immunomodulatory properties [42]. However, the trial was a small pilot study with only 76 patients [42].
It is still unclear whether faster resorption of SCH would improve clinical outcomes. For women with symptoms of threatened miscarriage, SCH is the most common ultrasound abnormality detected. It has been suggested that the cause of SCH may be poor placentation, which leads to formation of weak marginal uteroplacental veins that tear and bleed.
SCH significantly increases the risk of placental abruption but studies are still conflicting on whether it increases the risk of pregnancy loss and other adverse outcomes including PTD, SGA, pre-eclampsia, and chorioamnionitis.
Predictors of poor outcomes include the size of haematoma, location with greater placental involvement, persistency of haematoma, earlier gestational age of diagnosis, and severity of symptoms.
Management of SCH involves regular ultrasound monitoring. There are potential benefits with bed rest and supplementary progestogen in some studies but the evidence is still limited. Vaginal ALA is a novel treatment option that is still under investigation. In the future, larger controlled studies that measure all the various prognostic factors will help provide better information on the risk posed by SCH.
I would like to thank Dr. Shavi Fernando for his advice and the Monash Diagnostic Imaging Department for providing the ultrasound image of the subchorionic haematoma. Subchorionic bleeding in threatened abortion: sonographic findings and significance. Hemorrhage during pregnancy: sonography and MR imaging. The effects of subchorionic hematoma on pregnancy outcome in patients with threatened abortion.
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Mt Sinai J Med. Always consult your doctor for a diagnosis. In addition to a complete medical history and physical examination, an ultrasound a test using sound waves to create a picture of internal structures may be used to diagnose placenta previa. An ultrasound can show the location of the placenta and how much is covering the cervix. A vaginal ultrasound may be more accurate in diagnosis. Although ultrasound may show a low-lying placenta in early pregnancy, only a few women will develop true placenta previa.
It is common for the placenta to move upwards and away from the cervix as the uterus grows, called placental migration. There is no treatment to change the position of the placenta. Once placenta previa is diagnosed, additional ultrasound examinations are often performed to track its location. Bed rest or hospital admission may be necessary. It may be necessary to deliver the baby, depending on the amount of bleeding, the gestational age, and condition of the fetus. Cesarean delivery is necessary for most cases of placenta previa.
Severe blood loss may require a blood transfusion. Placental abruption is the premature separation of a placenta from its implantation in the uterus.
Within the placenta are many blood vessels that allow the transfer of nutrients to the fetus from the mother. If the placenta begins to detach during pregnancy, there is bleeding from these vessels. The larger the area that detaches, the greater the amount of bleeding.
Placental abruption occurs about once in every births. It is also called abruptio placenta. Other than direct trauma to the uterus such as in a motor vehicle accident, the cause of placental abruption is unknown. It is, however, associated with certain conditions, including the following:. Placental abruption is dangerous because of the risk of uncontrolled bleeding hemorrhage. Although severe placental abruption is rare, other complications may include the following:. The most common symptom of placental abruption is dark red vaginal bleeding with pain during the third trimester of pregnancy.
It also can occur during labor. However, each woman may experience symptoms differently. Log In. Sign Up. Become a Gold Supporter and see no ads. Log in Sign up. Articles Cases Courses Quiz. About Recent Edits Go ad-free. Edit article. View revision history Report problem with Article. Citation, DOI and article data. Radswiki, T. Subchorionic hemorrhage. Reference article, Radiopaedia. URL of Article. On this page:. Subchorionic hemorrhage in first-trimester pregnancies: prediction of pregnancy outcome with sonography.
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