The clinical significance of ultrasonographically detected subchorionic hemorrhages


      OBJECTIVES: The null hypothesis is that there is no difference in outcome when pregnancies with ultrasonographically documented subchorionic hemorrhages are compared with those without these hemorrhages. STUDY DESIGN: We performed a case-control study, utilizing our computerized ultrasonographic database. Cases were matched with two or three controls in two separate control groups. Matching criteria were maternal age, gestational age at scan, and invasive procedures (chorionic villus sampling or amniocentesis). General exclusion criteria were absence of fetal heart motion and fetal anomalies. Presence of subchorionic hemorrhage was an exclusion criterion for both control groups; however, in addition, presence of vaginal bleeding was a further criterion for one of the two. Statistical analysis was performed with the χ2 analysis and Yates' correction. Odds ratios and 95% confidence intervals were calculated. RESULTS: There was no difference in maternal characteristics between the cases and controls. The incidence of subchorionic hemorrhage was 1.3%. There was an increased risk of miscarriage (odds ratio 2.8, 95% confidence interval 1.7 to 7.4), stillbirth (4.5, 1.5 to 13.2), abruptio placentae (11.2, 2.7 to 46.4), and preterm labor (2.6, 1.5 to 4.6) when cases were compared with controls without subchorionic hemorrhage or bleeding. These risks were also increased in comparison with the control group with bleeding, except with respect to miscarriage. In this case the risks were similar in both cases and controls but increased with respect to the controls without bleeding. The mean birth weight was lower in the cases than in both control groups. CONCLUSION: The presence of an ultrasonographically detected subchorionic hemorrhage increases the risk of miscarriage, stillbirth, abruptio placentae, and preterm labor. The presence of bleeding alone appears to increase the risk of miscarriage. It is unclear whether the subchorionic hemorrhage is causative or whether it is simply a sign of an underlying process that produces these negative effects. (AM J OBSTET GYNECOL 1996;174:996-1002.)


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bloch C
        • Altchek A
        • Levy-Ravetch M
        Sonography in early pregnancy: the significance of subchorionic hemorrhage.
        Mt Sinai J Med. 1989; 56: 290-292
        • Stabile I
        • Campbell S
        • Grudzinskas JG
        Threatened miscarriage and intrauterine hematomas.
        J Ultrasound Med. 1989; 8: 289-292
        • Pedersen JF
        • Mantoni M
        Prevalence and significance of subchorionic hemorrhage in threatened abortion: a sonographic study.
        AJR Am J Roentgenol. 1990; 154: 535-537
        • Pedersen JF
        • Mantoni M.
        Large intrauterine haematomata in threatened miscarriage.
        Br J Obstet Gynaecol. 1990; 97: 75-77
        • Mantoni M
        • Pedersen JF
        Intrauterine haematoma: an ultrasonic study of threatened abortion.
        Br J Obstet Gynaecol. 1981; 88: 47-51
        • Goldstein SR
        • Subramanyam BR
        • Raghavendra BN
        • Horii SC
        • Hilton S
        Subchorionic bleeding in threatened abortion: sonographic findings and significance.
        AJR Am J Roentgenol. 1983; 141: 975-978
        • Ylöstalo P
        • Ammala P
        • Seppala M
        Intrauterine haematoma and placental protein 5 in patients with uterine bleeding during pregnancy.
        Br J Obstet Gynaecol. 1984; 91: 353-356
        • Jouppila P
        Clinical consequences after ultrasonic diagnosis of intrauterine hematoma in threatened abortion.
        J Clin Ultrasound. 1985; 13: 107-111
        • Sauerbrei EE
        • Pham DH
        Placental abruption and subchorionic hemorrhage in the first half of pregnancy: US appearance and clinical outcome.
        Radiology. 1986; 160: 109-112
        • Abu-Yousef MM
        • Bleicher JJ
        • Williamson RA
        • Weiner CP
        Subchorionic hemorrhage: sonographic diagnosis and clinical significance.
        AJR Am J Roentgenol. 1987; 149: 737-740
        • Børlum KG
        • Thomsen A
        • Clausen I
        • Eriksen G
        Long-term prognosis of pregnancies in women with intrauterine hematomas.
        Obstet Gynecol. 1989; 74: 231-233
        • Spirt BA
        • Kagan EH
        • Rozanski RM
        Abruptio placenta: sonographic and pathologic correlation.
        AJR Am J Roentgenol. 1979; 133: 877-881
        • Nyberg DA
        • Mack LA
        • Benedetti TJ
        • Cyr DR
        • Schuman WP
        Placental abruption and placental hemorrhage: correlation of sonographic findings with fetal outcome.
        Radiology. 1987; 164: 357-361
        • Glantz S.
        A primer of biostatistics: the program.
        : McGraw-Hill, New York1992
        • Ananth CV
        • Savitz DA
        Vaginal bleeding and adverse reproductive outcomes: a meta-analysis.
        Paediatr Perinatol Epidemiol. 1994; 8: 62-78
        • Pearlstone M
        • Baxi L
        Subchorionic hematoma: a review.
        Obstet Gynecol Surv. 1993; 48: 65-68
        • Mantoni M
        Ultrasound signs in threatened abortion and their prognostic significance.
        Obstet Gynecol. 1985; 65: 471-475
        • Baxi LV
        • Pearlstone MM
        Subchorionic hematomas and the presence of autoantibodies.
        AM J OBSTET GYNECOL. 1991; 165: 1423-1424