Subchorionic Hemorrhage Size - Mild, Small, Large

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Bleeding in the first-half of pregnancy occurs roughly in one-fourth (25%) of females and about half of these pregnancies terminate in abortion. The principal reason for vaginal bleeding in early gestation are SCH and rupture of a marginal placental lining. It"s exact etiology is unknown, even though uterine malformations, history of repeated abortions and severe fungal or bacterial infection have been noted as viable predisposing explanations. The size of the hematoma is graded or measured by correlating the size of gestional sac circumference as follows.

  • Small SCH: Indicates less than 1-0.33 of the chorionic sac circumference elevated through hematoma.
  • Moderate SCH: Suggests one third to at least one-half of of the chorionic sac circumference expanded with  hematoma.
  • Large SCH:  Size indicates about two third or bigger of the chorionic sac circumference extended through hematoma.

It has been observed that there were little chances of spontaneous abortion between pregnancies with small and medium sized subchorionic hemorrhage (7.7% and 9.2%, respectively), but the rate gets double when the size is considered to be large (18%).  Researchers have also documented an equivalent case of G3P1A1 Hispanic woman who has been admitted to emergency department (ED) at 6½ weeks pregnancy with complaint of vaginal bleeding of -day length that showed large size intrauterine hematomas could also be acutely detrimental to maternal health within the second trimester.

Ultrasonic evaluation of the placenta is valuable to outline the prenatal prognosis. The detection of a significant SCH on ultrasound raises the risk for miscarriage; stillbirth, placental abruption and preterm labor. Patients with SCH are at larger risk for eventual fetal death even if indicators of fetal existence are obvious at first on sonographic presentation.


Small hematomas on the placental floor, termed as subamniotic hemorrhage, are a usual finding during 18 to 20 weeks of being pregnant in ultrasound and affect subsequent assessment of fetal growth and well-being. Hemorrhage below or on the fringe of the placenta, or in the back of a nearby area of the fetal membranes, is of bigger predicament. In two case studies each neonate survived the prenatal period favorably. One was born vaginally at 32 weeks of gestation following premature preterm rupture of the membranes, and the 2nd was born by way of emergency caesarean part at 37 weeks on the grounds that of a recurrence of post-partum hemorrhage.

Conclusively intrauterine hematoma is a long established finding in first trimester scans. The clinical implication of an intrauterine hematoma for the duration of the primary trimester of being pregnant is not absolutely clear.