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Subchorionic Hemorrhage in Early Pregnancy

By Diane Ursu
Transvaginal ultrasound is often used to diagnose subchorionic hemorrhages.  Photo: Diane UrsuBleeding is quite common during early pregnancy. It usually occurs between weeks five and 10. In his June 23, 2009 eMedicine article, “Subchorionic Hemorrhage,” Avneesh Chhabra, M.D. said that 25% of pregnancies experience vaginal bleeding. While miscarriage is usually thought to be the culprit, sonographic examination often confirms that it is nothing more than a subchorionic hemorrhage.

Subchorionic Hemorrhage and Subchorionic Hematoma

The gestational sac grows exponentially during early pregnancy. It is not unusual for the rapid growth to lead to some tearing around the sac. The torn tissues bleed, just like a scrape in the skin would. The blood usually travels into the vaginal canal and is seen as spotting.


Dr. Chhabra reported that 4—33% of miscarriages are associated with subchorionic hemorrhages; however, that does not mean that the subchorionic hemorrhages were the cause, but that they were present. In other words, a subchorionic hemorrhage is likely present due to the normal, rapid growth of the gestational sac; but a miscarriage is likely caused by something else, such as a genetic error or an autoimmune disorder. In normal pregnancies, subchorionic hemorrhages generally clear up by the second trimester of pregnancy.

Early Pregnancy Ultrasound

Physicians use ultrasound to determine the cause of vaginal bleeding during pregnancy. The uterus, ovaries, and the gestational sac are evaluated during a first trimester ultrasound. A black sliver around the gestational sac is a collection of blood called a subchorionic hemorrhage or subchorionic hematoma.

In some cases, a subchorionic hemorrhage may be present, but will not be seen on ultrasound, because the blood drains into the vaginal canal rather than collecting in the subchorionic space around the gestational sac. Conversely, there may be no bleeding associated with a subchorionic hemorrhage that can be seen on ultrasound because it is not draining into the vaginal canal. Subchorionic hemorrhages that are healing may appear the same shade of gray as the uterine tissue, so they may not be visible on ultrasound.

Placental Abruption

Subchorionic hemorrhage in the third trimester may increase one’s risk for placental abruption, although this is an uncommon occurrence. Placental abruption occurs when the placenta and uterine wall tear away from each other resulting in vaginal bleeding and abdominal pain. It is a very serious condition that warrants an immediate trip to the emergency room. It is important to note that a subchorionic hemorrhage and a placental abruption are not the same thing.

Treatment of Subchorionic Hemorrhage

Physicians may advise their patients to refrain from sexual intercourse and some activities, such as exercise and heavy lifting. More severe cases or multiple gestation pregnancies may require bed rest. In most cases, the subchorionic hemorrhage heals without intervention and the pregnancy continues normally.



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