Does a small subchorionic hemorrhage detected on early pregnancy ultrasound at 6 weeks, measuring 6 cubic centimeters (cc), require further testing?

From the Guidelines

A small synchronic hemorrhage measuring 6cc detected on an early pregnancy ultrasound at 6 weeks does require further testing and monitoring to ensure proper pregnancy development and to rule out any potential complications. According to the American College of Radiology Appropriateness Criteria 1, ultrasound is the primary imaging modality for evaluating patients with vaginal bleeding in the first trimester of pregnancy.

Key Considerations

• The presence of a small hemorrhage, also known as a subchorionic hematoma, can be associated with an increased risk of miscarriage, but many resolve on their own without complications 1.
• It is essential to schedule a follow-up ultrasound in 1-2 weeks to assess if the hemorrhage is resolving or growing.
• During this time, it's advisable to avoid strenuous physical activity and sexual intercourse to minimize the risk of further complications.
• Monitoring is crucial to ensure proper pregnancy development and to promptly identify any potential issues that may arise.

Recommendations

• If you experience increased vaginal bleeding, severe abdominal pain, or dizziness, seek immediate medical attention.
• There is no specific medication needed at this stage, but close monitoring and follow-up ultrasounds are necessary to assess the hemorrhage and fetal development as the pregnancy progresses.
• The hemorrhage occurs when blood collects between the uterine wall and the gestational sac membrane, and while most small hemorrhages at this early stage have a good prognosis, follow-up is important to monitor both the hemorrhage and fetal development.

From the Research

Small Synchronic Haemorrhage in Early Pregnancy

• A small synchronic haemorrhage, also known as a subchorionic hemorrhage, is a condition where blood accumulates between the chorion and decidua basalis in early pregnancy 2.
• The presence of a subchorionic hemorrhage can be detected by ultrasound, which is a common diagnostic tool used in early pregnancy 3, 4, 5.

Risk of Adverse Pregnancy Outcomes

• Studies have shown that the presence of a subchorionic hemorrhage in early pregnancy can be associated with an increased risk of adverse pregnancy outcomes, such as miscarriage, preterm birth, and fetal growth restriction 3, 4, 5.
• However, the size and location of the hematoma, as well as the presence of other risk factors, can influence the likelihood of adverse outcomes 3, 4, 5.
• A study found that women with a subchorionic hemorrhage were at increased risk of placental abruption and preterm delivery, but not at increased risk of other adverse pregnancy outcomes 5.

Management and Further Testing

• There is no proven treatment for subchorionic hemorrhage, but serial growth ultrasounds, umbilical artery Doppler studies, and antenatal fetal testing may be considered, particularly if the hemorrhage is large or if treatment requires a maternal blood transfusion 6.
• In cases where a small synchronic haemorrhage is detected, further testing and monitoring may be necessary to assess the risk of adverse pregnancy outcomes and to guide management decisions 3, 4, 5.
• The American College of Obstetricians and Gynecologists (ACOG) recommends that women with a history of subchorionic hemorrhage be monitored closely for signs of placental abruption and preterm labor 5.

Size and Location of Hematoma

• The size and location of the hematoma can influence the likelihood of adverse outcomes, with larger hematomas and those that extend to the margin of the placenta being associated with a higher risk of complications 4.
• A study found that the size of the hematoma was significantly greater in the miscarriage group, and that all subchorionic hematomas disappeared, but 2% of retroplacental hematomas did not disappear until the end of the second trimester 3.

Clinical Implications

• The presence of a subchorionic hemorrhage in early pregnancy can have significant clinical implications, including an increased risk of adverse pregnancy outcomes and the need for closer monitoring and management 6, 3, 4, 5.
• Healthcare providers should be aware of the potential risks and complications associated with subchorionic hemorrhage and take steps to monitor and manage affected pregnancies accordingly 6, 3, 4, 5.