Chorionic hematoma#Cause and diagnosis
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Chorionic hematoma is the pooling of blood (hematoma) between the chorion, a membrane surrounding the embryo, and the uterine wall.Nagy, Sándor MD; Bush, Melissa MD; Stone, Joanne MD; Lapinski, Robert H. PhD; Gardó, Sándor MD, DSci. Clinical Significance of Subchorionic and Retroplacental Hematomas Detected in the First Trimester of Pregnancy [http://journals.lww.com/greenjournal/Fulltext/2003/07000/Clinical_Significance_of_Subchorionic_and.19.aspx]. Obstetrics & Gynecology: July 2003 - Volume 102 - Issue 1 - p 94-100 It occurs in about 3.1% of all pregnancies, it is the most common sonographic abnormality and the most common cause of first trimester bleeding.Avneesh Chhabra, MD et al.
"Subchorionic Hemorrhage" [http://emedicine.medscape.com/article/404971-overview], Medscape.
Cause and diagnosis
Chorionic hematomas can be caused by the separation of the chorion from the endometrium (inner membrane of the uterus). Hematomas are classified by their location between tissue layers:Trop, Isabelle and Levine, Deborah. Hemorrhage During Pregnancy: Sonography and MR Imaging [http://www.ajronline.org/cgi/content/full/176/3/607]. Amer J Roentgenology 2001; 176:607-615.
- Subchorionic hematomas, the most common type, are between the chorion and endometrium.
- Retroplacental hematomas are entirely behind the placenta and not touching the gestational sac.
- Subamniotic or preplacental hematomas are contained within amnion and chorion. Rare.
Most patients with a small subchorionic hematoma are asymptomatic.Trop I, Levine D. Hemorrhage during pregnancy: sonography and MR imaging. AJR Am J Roentgenol. Mar 2001;176(3):607-15. Symptoms include vaginal bleeding, abdominal pain, premature labor and threatened miscarriage.Hodgson DT, Lotfipour S, Fox JC. Vaginal bleeding before 20 weeks gestation due to placental abruption leading to disseminated intravascular coagulation and fetal loss after appearing to satisfy criteria for routine threatened abortion: a case report and brief review of the literature. J Emerg Med. May 2007;32(4):387-92
Ultrasonography is the preferred method of diagnosis.Abu-Yousef MM, Bleicher JJ, Williamson RA, Weiner CP. Subchorionic hemorrhage: sonographic diagnosis and clinical significance. AJR Am J Roentgenol. Oct 1987;149(4):737-40. A chorionic hematoma appears on ultrasound as a hypoechoic crescent adjacent to the gestational sac. The hematoma is considered small if it is under 20% of the size of the sac and large if it is over 50%.
Prognosis and treatment
The presence of subchorionic bleeding around the gestational sac does not have a significant association with miscarriage overall.{{cite news |title=Miscarriage risk is not increased with subchorionic hematoma |url=https://www.mdedge.com/obgyn/article/78173/obstetrics/miscarriage-risk-not-increased-subchorionic-hematoma |work=www.mdedge.com |language=en}}{{Cite journal | doi = 10.1002/uog.12736|title=OP03.03: Does the presence of subchorionic haematoma increase the risk of miscarriage?|date = 2013| author1 =N. Stamatopoulos| author2 =C. Lu| author3 =F. Infante| author4 =U. Menakaya| author5 =I. Casikar| author6 =S. Reid| author7 =M. Mongelli| author8 =G. Condous|journal=Ultrasound in Obstetrics & Gynecology |volume= 42 |issue =s1|pages=54| doi-access =}} However, the case of intrauterine hematoma observed before 9 weeks of gestational age has been associated with an increased risk of miscarriage.{{Cite journal | doi = 10.1097/01.AOG.0000152000.71369.bd| pmid = 15684162| title = First-Trimester Intrauterine Hematoma and Outcome of Pregnancy| journal = Obstetrics & Gynecology| volume = 105| issue = 2| pages = 339–44| year = 2005| last1 = Maso | first1 = G. | last2 = Dʼottavio | first2 = G. | last3 = De Seta | first3 = F. | last4 = Sartore | first4 = A. | last5 = Piccoli | first5 = M. | last6 = Mandruzzato | first6 = G. | s2cid = 12502344}} In one study women who complied with instructions for bed rest for the duration of bleeding had a lower rate of miscarriage and a higher rate of term pregnancy than non-compliant women. The study had several limitations; results were severely confounded by inherent differences between compliant and non-compliant women.Ben-Haroush A, Yogev Y, Mashiach R, Meizner I. Pregnancy outcome of threatened abortion with subchorionic hematoma: possible benefit of bed-rest? Journal Isr Med Assoc J. 2003 Jun;5(6):422-4
References
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See also
{{Pregnancy}}
{{Pathology of pregnancy, childbirth and the puerperium}}