Subchorionic Hemorrhage in the Second and Third Trimesters of Pregnancy: A Review

Abstract

ImportanceSubchorionic hemorrhage (SCH) in the second and third trimesters of pregnancy can be associated with maternal morbidity and fetal morbidity/mortality. Management of SCH in the second or third trimesters can be complicated, especially in the setting of a large SCH that requires hospitalization and blood transfusion.ObjectiveThe aim of this review is to describe SCH in second and third trimesters, risk factors, diagnosis, maternal and fetal outcomes, and management of this uncommon pregnancy complication.Evidence AcquisitionA PubMed, Web of Science, and CINAHL search was undertaken with no limitations on the number of years searched.ResultsThere were 123 abstracts and/or articles reviewed, with 48 articles being the basis of review. The only known risk factors for SCH are maternal factor deficiency and anticoagulation therapy. The diagnosis is usually made by ultrasound imaging. Subchorionic hemorrhage in second and third trimesters has been associated with several adverse fetal outcomes including preterm birth, preterm prelabor rupture of membranes, fetal growth restriction, fetal demise, and neonatal pulmonary morbidity. There is no proven treatment for SCH, although there are several investigational therapies reported.ConclusionsSubchorionic hemorrhage can be complex and difficult to manage in the second and third trimesters. There are no recommendations or guidelines for management; however, serial growth ultrasounds, umbilical artery Doppler studies, and antenatal fetal testing should be considered particularly if the SCH is large or treatment requires a maternal blood transfusion.RelevanceSubchorionic hemorrhage in the second and third trimester is associated with poor fetal outcomes and maternal morbidity, especially if the SCH is significant.Target AudienceObstetricians and gynecologists, midwives, family physicians.Learning ObjectivesAfter completion of this article, the reader should be better able to identify SCH in the second and third trimesters; describe potential complications associated with SCH; and predict adverse outcomes associated with SCH.

Sanji Peiyuan decoction combined with dydrogesterone in the treatment of massive subchorionic hematoma: A case report

“…[15] Dydrogesterone, a member of the "progestin" class, is a stereoisomer of natural progesterone. [16] It exhibits characteristics akin to natural progesterone, boasts a strong affinity for progesterone receptors, and is highly bioavailable post-oral consumption. It doesn't exert any androgenic or anti-androgenic effects on the fetus, thus eliminating risks of fetal genital abnormalities.…”