First-Trimester Intrauterine Hematoma and Outcome

of Pregnancy
Gianpaolo Maso, MD, Giuseppina DOttavio, MD, Francesco De Seta, MD, Andrea Sartore, MD,
Monica Piccoli, MD, and Giampaolo Mandruzzato, MD
OBJECTIVE: To evaluate the outcome of pregnancies com-
plicated by rst-trimester intrauterine hematoma.
METHODS: An analysis was performed on 248 cases. The
pregnancy outcome was correlated with hematoma vol-
ume, gestational age (weeks), and maternal age (years).
RESULTS: One hundred eighty-two cases were eligible for
the study. Clinical complications occurred in 38.5% of the
cases (adverse outcome group). Spontaneous abortion
(14.3%), fetal growth restriction (7.7%), and preterm deliv-
ery (6.6%) were the most frequent clinical conditions ob-
served. Considering the hematoma variables in adverse
and favorable outcome groups, we found a signicant
difference only for gestational age at diagnosis. The me-
dian gestational age was signicantly lower (P <.02) in the
adverse outcome group (7.27, I and III quartiles 6.228.78)
than in the favorable outcome cases (8.62, I and III quar-
tiles 6.709.98). Among clinical conditions, the median
gestational age was signicantly lower (P .02) in preg-
nancies complicated by spontaneous abortion (6.60, I and
III quartiles 5.958.36) than in cases not ending in a mis-
carriage (8.50, I and III quartiles 6.709.91). The overall
risk of adverse outcome was 2.4 times higher when the
hematoma was diagnosed before 9 weeks (odds ratio 2.37,
95% condence interval 1.204.70). In particular, intra-
uterine hematoma observed before 9 weeks signicantly
increases the risk of spontaneous abortion (odds ratio
14.79, 95% condence interval 1.95112.09)
CONCLUSION: Intrauterine hematoma can affect the out-
come of pregnancy. The risk of spontaneous abortion is
related to gestational age and is signicantly increased if
diagnosed before 9 weeks. (Obstet Gynecol 2005;105:
33944. 2005 by The American College of Obstetri-
cians and Gynecologists.)
LEVEL OF EVIDENCE: III
Intrauterine hematoma is not an uncommon nding at
ultrasound scanning in the early stages of pregnancies.
Pre-existing medical conditions, autoimmune diseases,
and immunological factors have been associated with
intrauterine hematoma, but the etiology of this condition
is still unknown.
15
Intrauterine or subchorionic hema-
toma is dened as a collection of uid in the uterine
cavity, and it is believed to result from subchorionic
bleeding caused by a partial detachment of the tropho-
blast from the uterine wall. This condition can be diag-
nosed only by ultrasonography. Mantoni and Pedersen
6
rst described its sonographic patterns. On ultrasound
examination, it appears as an anechoic area that has a
falciform shape, and it is usually observed behind or
below the gestational sac, separating the chorion from
the inner wall of the uterus. Small echogenic structures
can be found in such areas, and they are believed to be
blood clots.
The reported incidence of intrauterine hematoma has
a wide range, between 0.5%
7
and 22%,
8
mainly associ-
ated with vaginal bleeding. The discrepancy in these
rates might be related to different patient populations,
study design, range of gestational ages, and lack of a
standard denition. Moreover, the different approaches
to ultrasound scanning, ie, transabdominal or transvag-
inal, may be a factor in this epidemiological issue.
9
The clinical signicance of this sonographic nding
remains controversial, and observational studies focus-
ing on this topic reported conicting results.
5
Many
authors reported adverse outcome of pregnancy related
to hematoma volume.
6,1013
Others observed that the
subchorionic hematoma did not represent a risk factor
for complications of pregnancy.
1416
Two large-series,
controlled studies on unselected obstetric populations
have been addressed to clarify this issue, concluding that
this condition is signicantly associated with adverse
clinical conditions.
17,18
The aim of our study was to investigate whether the
volume of intrauterine hematoma observed in the rst
trimester of a viable pregnancy and 2 other variables
From the Department of Obstetrics and Gynecology, IRCCS Burlo Garofolo,
University of Trieste, Trieste, Italy.
The authors thank Dr. Sandro Zicari, University of Trieste, for his assistance with the
statistical analysis of data and Drs. Giancarlo Conoscenti and Mariangela Rustico
fortheir contribution in preparing the manuscript.
VOL. 105, NO. 2, FEBRUARY 2005
339 2005 by The American College of Obstetricians and Gynecologists. 0029-7844/05/$30.00
Published by Lippincott Williams & Wilkins. doi:10.1097/01.AOG.0000152000.71369.bd
(such as maternal age and gestational age at the time of
the diagnosis) are predictive factors of adverse outcome.
MATERIALS AND METHODS
We reviewed the information from a 7-year period
(19911997) collected from our database (tertiary refer-
ral center) on 248 unselected viable pregnancies with a
history of vaginal bleeding/spotting and diagnosis of
intrauterine hematoma. Patients informed consent to
participate in the study was obtained in all the cases
before the analysis. The study was exempt from institu-
tional review board approval. All cases were diagnosed
by transvaginal sonography (Acuson XP10 System,
transducer 57 MHz; Acuson Corporation, Mountain
View, CA) in the rst trimester of pregnancy (613
weeks of gestation). Gestational age was calculated on
the basis of the last menstrual period and was corrected
when the crown-rump length measurements were more
than 7 days different fromthis. Ahematoma was dened
as previously described by Mantoni and Pedersen.
6
The
volumes of the hematomas were estimated by measuring
the maximum transverse, antero-posterior, and longitu-
dinal diameters, multiplying these values by a constant
of 0.523.
19
The management and follow up of the study
cases were decided on the basis of the clinical and sono-
graphic picture. However, when serial scans were per-
formed, only the hematoma volume and the gestational
age at the rst examination were considered for the
analysis. We included in our study only the cases with
calculated hematoma volume and complete follow-up of
pregnancy. Patients who underwent elective abortion
and/or invasive procedures and cases with multiple preg-
nancies, recurrent miscarriage (dened as a history of 2
or more consecutive rst-trimester losses), uterine pa-
thology (myomas), and malformations were excluded.
The outcome of pregnancy was dened as adverse if one
of the following conditions was present:
1. Spontaneous abortion, dened as loss before 20
weeks of gestation;
2. Fetal growth restriction, dened as birth weight of
less than the tenth percentile for gestational age
according to our population norms;
3. Intensive care for threatened preterm delivery,
dened as need of admission and tocolytic therapy;
4. Preterm delivery, dened as delivery before 37
weeks of gestation;
5. Placental abruption, dened as a clinically relevant
event determined by the managing physician; or
6. Fetal distress, dened as abnormal fetal heart
monitoring traces or fetal blood sampling suggestive
of hypoxemia/acidemia.
Outcome of pregnancy was rst evaluated according to
hematoma volume (milliliters), gestational age (weeks), and
maternal age at the time of diagnosis (years).
In the second part of the study, we tested the results of
Bennett et al,
10
who found that large intrauterine hema-
toma volume, advanced maternal age ( 35 years), and
early gestational age at diagnosis ( 9 weeks) might
affect adversely the outcome of pregnancy. Our evalua-
tion of the size of the hematoma was different from the
one proposed by Bennett, who dened the size of the
hematoma as the degree of the gestational sac circumfer-
ence elevated by the hematoma. We arbitrarily stratied
the hematoma volumes as small, medium, and large,
according to volume values, respectively, of less than 1
mL, between 1 and 10 mL, and larger than 10 mL.
All statistical evaluations were performed with SPSS
11.5 statistical software (SPSS Inc, Chicago, IL). The
Student t test was used to compare continuous variables
between the groups. When the Kolmogorov-Smirnov
normality test failed (P .05), the Mann-Whitney rank
sum test was used. The univariate association between
the variables of the hematoma and the outcome of preg-
nancy was assessed by computing the corresponding
odds ratios (ORs) for prevalence data and, when neces-
sary, by Fisher exact test. The null hypothesis was
rejected with equal to 0.05.
RESULTS
One hundred eighty-two cases (73.4%) met the inclusion
criteria for the analysis. The mean maternal age ( stan-
dard deviation SD) was 30.7 years ( 4.8) (range
19.644), the median of the hematoma volume at the
diagnosis was 1.36 mL (I quartile 0.48 mL, III quartile
3.38 mL; range 0.002103.6 mL), and the mean gesta-
tional age ( SD) at diagnosis was 8.2 weeks ( 2.1)
(range 5.313.1). Of the cases, 67.6% (123/182) were
diagnosed before 9 weeks of gestation. Clinical compli-
cations occurred in 38.5% of the cases (70/182). Table 1
Table 1. Intrauterine Hematoma and Associated Clinical
Conditions
Outcome of Pregnancy
Cases
n %
Favorable 112 61.5
Spontaneous abortion 26 14.3
Fetal growth restriction 14 7.7
Threatened preterm delivery 13 7.1
Preterm delivery 12 6.6
Abruptio placentae 2 1.1
Fetal distress 3 1.6
Total 182 100
340 Maso et al Intrauterine Hematoma OBSTETRICS & GYNECOLOGY
shows the distribution and rates of the clinical conditions
observed in our cases: spontaneous abortion (14.3%),
fetal growth restriction (7.7%), and preterm delivery
(6.6%) were the most frequent.
Considering the hematoma volumes, maternal age,
and gestational age at diagnosis in adverse and favorable
groups, we found a signicant difference only for gesta-
tional age at diagnosis. The median gestational age was
signicantly lower overall in the adverse outcome group
than in the favorable outcome cases (Table 2). When we
separately analyzed every complication, a correlation
was found only between gestational age at diagnosis and
spontaneous abortion: a signicantly earlier median ges-
tational age was observed in cases complicated by spon-
taneous abortion (Table 2).
Using the cutoff values for the intrauterine hematoma
variables according to Bennett et al,
10
modifying the eval-
uationof the size, we didnot ndany difference of outcome
considering the hematoma volumes. There was an in-
creased rate of adverse pregnancy outcome for cases diag-
nosed at maternal age over 35 years, but this nding was
not statistically signicant (P .052, Table 3). On the
contrary, when we considered the gestational age at diag-
nosis, the overall risk of adverse outcome was 2.4 times
higher in cases observed before 9 weeks (Table 3).
Once again, when we considered separately every
single complication, we only observed a statistically sig-
nicant correlation between spontaneous abortion and
gestational age at diagnosis. Spontaneous abortion oc-
curred in 20.3% of the cases diagnosed before 9 weeks,
whereas the rate of this specic complication for the cases
diagnosed after this gestational age was only 1.7%.
To avoid potential bias, adjusted odds ratios for out-
come of pregnancy and spontaneous abortion were cal-
culated with a logistic regression model including the
hematoma volume, maternal age, and gestational age at
diagnosis. The results were comparable to univariate
analysis (crude odds ratios).
Table 2. Outcome of Pregnancy and Characteristics of Intrauterine Hematoma
Outcome
P
Spontaneous Abortion
P Adverse Favorable Yes No
MA at diagnosis (y)
Mean SD 31.0 5.4 30.6 4.4 .56* 32.3 5.8 30.5 4.6 .08*
Range 29.732.3 29.831.4 29.934.6 29.831.2
IUH volume (mL)
Median 1.35 1.40 .82

1.37 1.34 .83

IIII quartiles 0.443.77 0.523.02 0.443.41 0.543.18

GA at diagnosis (wk)
Median 7.27 8.62 .02

6.60 8.50 .02

IIII quartiles 6.228.78 6.709.98 5.958.36 6.709.91

MA, maternal age; SD, standard deviation; IUH, intrauterine hematoma; GA, gestational age
* Student t test: P .05.

Mann-Whitney rank sum test.

Table 3. Association Between Adverse Pregnancy Outcome and Subchorionic Hematoma Variables
0utcome
OR (95% CI) OR (95% CI)*
Spontaneous
Abortion
OR (95% CI) OR (95% CI)*
Adverse
(n 70)
Favorable
(n 112)
Yes
(n 26)
No
(n 156)
IUH volume
Small ( 1 mL) 30 (39.5) 46 (60.5) Referent Referent 10 (13.2) 66 (86.8) Referent Referent
Medium (1.010 mL) 32 (37.2) 54 (62.8) 0.91 (0.461.80) 0.88 (0.411.86) 13 (15.1) 73 (84.9) 1.18 (0.453.12) 1.80 (0.585.64)
Large ( 10 mL) 8 (40.0) 12 (60.0) 1.02 (0.333.10) 1.01 (0.303.03) 3 (15.0) 17 (85.5) 1.14 (0.225.38) 1.54 (0.463.72)
MA at diagnosis
35 y 51 (35.2) 94 (64.8) Referent Referent 17 (11.7) 128 (88.3) Referent Referent
35 y 19 (51.4) 18 (48.6) 1.95 (0.884.29) 1.89 (0.894.03) 9 (24.3) 28 (75.7) 2.42 (0.896.51) 2.31 (0.886.06)
GA at diagnosis
9 wk 55 (44.7) 68 (55.3) 2.37 (1.204.70) 2.22 (1.134.40) 25 (20.3) 98 (79.7) 14.79 (1.95112.09) 18.29 (2.3641.46)
9 wk 15 (25.4) 44 (74.6) Referent Referent 1 (1.7) 58 (98.3) Referent Referent
OR, odds ratio; CI, condence interval; IUH, intrauterine hematoma; MA, maternal age; GA, gestational age.
Data are presented as n (% of total cases in each subgroup).
* Adjusted odds ratios obtained with logistic regression model including IUH volume, maternal age, and gestational age at diagnosis.
341 VOL. 105, NO. 2, FEBRUARY 2005 Maso et al Intrauterine Hematoma
DISCUSSION
The relationship between clinical symptoms (pelvic pain/
bleeding), clinical and sonographic features of intrauter-
ine hematoma (gestational age at the time of diagnosis,
maternal age at diagnosis, size/volume of the hema-
toma), and the outcome of pregnancy has been differ-
ently and separately investigated in the majority of the
studies, with conicting results being reported.
1418
Only Ball et al,
17
in their large case-control study, eval-
uated the prognostic signicance of clinical bleeding and
intrauterine hematoma variables, drawing no denitive
conclusions.
Our observational study on symptomatic cases af-
fected by this condition was unique in investigating
together the subchorionic hematoma variables to ad-
dress whether the maternal age and characteristics re-
lated to intrauterine hematoma (the gestational age at the
time of diagnosis, volume of the hematoma) might be
predictive of a different outcome of pregnancy. Maternal
age and gestational age at the time of diagnosis are
possible prognostic factors in pregnancies complicated
by subchorionic hematoma. It is nevertheless important
to consider that both advanced maternal age and early
gestational ages, independently of the presence of the
intrauterine hematoma, are known to be signicantly
associated with an increased risk of spontaneous abor-
tion, mainly related to chromosomal or structural fetal
anomalies.
20
Therefore, these variables might be consid-
ered risk factors per se, independently of the presence or
absence of hematoma.
Dealing with subchorionic hematoma and maternal
age, Bennett et al
10
observed that the spontaneous abor-
tion rate was approximately twice as high for women
aged 35 years or older as for younger women (13.8%and
7.3%, respectively). Our results demonstrated a correla-
tion between adverse outcome/spontaneous abortion
rate and advanced maternal age, but this did not reach
statistical signicance, probably because of the low
power of the study.
Gestational age at diagnosis is the other variable rarely
considered in the studies dealing with this topic. Our
results are similar to those observed in the retrospective
study by Bennett et al
10
of 516 cases complicated by
subchorionic hematoma and focusing on spontaneous
abortion risk. In our experience, using the same gesta-
tional-age cutoff, we observed that the risk of spontane-
ous abortion is nearly 15 times greater for cases diag-
nosed before 9 weeks of gestation than for those
observed after this period. This observation can be help-
ful to the clinician in the risk assessment of the pregnancy
complicated by intrauterine hematoma, bearing in mind
that a diagnosis made before 9 weeks gives a 20% likeli-
hood of miscarriage, whereas this possibility is far more
remote (less than 2%) when the hematoma is diagnosed
after this cutoff gestational age.
Finally, one of the features that could more directly
inuence the pregnancy outcome is hematoma volume.
Doppler studies revealed a signicant relationship be-
tween hematoma enlargement and the reduction of
blood ow velocities in spiral arteries, with a potential
threat to the continuance of the pregnancy by a direct
pressure-volume effect.
21
The results from available studies on hematoma vol-
ume and pregnancy outcome are again controversial.
Many observational reports revealed a signicant corre-
lation between large hematomas and adverse outcome
of pregnancy,
6,1013
while others failed to demonstrate
this association (Jakab A Jr, Juhasz B, Toth Z. Outcome
of the rst trimester subchorial hematoma abstract.
Tenth International Congress, The Fetus as a Patient.
Brijuni, Croatia; 1994. p. 54).
2226
In our study, the
median hematoma volume was not signicantly different
in adverse outcome and favorable outcome groups (P
.49). Moreover, no correlation with pregnancy outcome
has been observed when hematoma volume was arbi-
trarily stratied as small, medium, and large. Our
results differed from those of Bennett et al
10
who found
that large volumes, dened as a degree larger than the
2/3 of the gestational sac circumference elevated by the
hematoma, increased 2.4-fold the risk of spontaneous
abortion. This difference might be due to our arbitrary
denition of hematoma size, giving the absolute
value of hematoma, without relating it to the size of the
gestational sac. However, we did not nd any correlation
with pregnancy outcome when the stratied volumes
were matched with every single gestational week
613
(our unpublished data). These different results might be
also the consequence of our limited sample size or might
be explained by considering that the majority of our
cases showed small hematomas (volumes 5 mL were
observed in 87.1% of the cases).
Alternatively, the explanation for these discrepancies
on this variable might be addressed by considering the
physiopathological mechanism of formation of the sub-
chorionic hematoma. In fact, the size might be the nal
result of 2 processes: the amount of subchorionic bleed-
ing and the amount of the bleeding through the cervix.
Therefore, the size of the hematoma may not represent a
reliable estimation of the overall severity of the process,
which could ultimately be calculated only by knowing the
total amount of blood collected in the uterus, reabsorbed,
and lost through the cervix. On this basis, therefore, it
might be postulated that the presence and location of a
hematoma, as a sign of the impaired placentation, rather
than its volume, is important for pregnancy outcome.
17
342 Maso et al Intrauterine Hematoma OBSTETRICS & GYNECOLOGY
As in the majority of the studies on subchorionic
hematomas, our data have mainly focused on the corre-
lation between the characteristics of the hematoma and the
risk of miscarriage. However, some controversial data have
recently been reported in the literature about the risks of
other late complications of pregnancy, such as stillbirth,
abruptio placentae, preterm delivery, intrauterine growth
restriction, fetal distress, and preeclampsia,
17,18
when intra-
uterine hematoma is diagnosed (Table 4). Many of these
clinical conditions are a consequence of impaired placenta-
tion, and it might be postulated that the presence of a
subchorionic hematoma in early stages affects the normal
process of trophoblast invasion.
2931
Given the absence of a control group, it is not possible
to estimate in our study the relative risk of pregnancy
complications in patients with intrauterine hematoma.
Moreover, because of our limited sample size, it has not
been possible to have a reliable estimation of the association
between the presence of this condition and the unfavorable
pregnancy outcomes other than the spontaneous abortion.
Nevertheless, our observational study gave an overall inci-
dence of pregnancy complications in these patients as high
as roughly 40%, without including all the possible clinical
adverse conditions due to a lack of data.
From our results it is not possible to draw denitive
conclusions to all the unanswered questions about the
short- and long-term effects of subchorionic hematoma
in pregnancy. However, our study demonstrated that, in
the presence of this nding and clinical bleeding, the prog-
nosis of pregnancy is signicantly related to the gestational
age at the time of diagnosis, whereas the size of the hema-
toma does not seem to have a clinical signicance. This
might be useful for caregivers in appropriately counseling
the patient about the short-termoutcome of pregnancyand,
particularly, about the risk of miscarriage.
REFERENCES
1. Heller DS, Rush D, Baergen RN. Subchorionic hematoma
associated with thrombophilia: report of three cases. Pedi-
atr Dev Pathol 2003;6:2614.
2. Alijotas J, Izquierdo M, Serra B, Cusido MT, Ribera M,
Carrera JM. Antinuclear autoantibodies, complement
level, hypergammaglobulinemia and spontaneous intra-
uterine hematoma in pregnant women. Am J Reprod
Immunol 2003;50:16.
3. Baxi LV, Pearlstone MM. Subchorionic hematoma and
the presence of autoantibodies. Am J Obstet Gynecol
1991;165:14234.
4. Khong TY, Hague WM. The placenta in maternal hyper-
homocysteinaemia. Br J Obstet Gynaecol 1999;106:
2738.
Table 4. Review of Literature on Intrauterine Hematomas
Authors (year) n
IUH
Frequency (%)
SA
n (%)
PTD
n (%)
Pl Ab
n (%)
Stillbirth/PM
n (%)
Mantoni (1981)
6
12 NA 2 (16.6) 1 (8.3) NA NA
Goldstein (1983)
22
10 20 2 (20.0) NA NA NA
Ylostalo (1984)
27
16 NA NA NA 5 (31.2) NA
Jouppila (1985)
24
33 NA 6 (18.1) 3 (9.0) NA NA
Sauerbrei (1986)
11
30 NA 3 (10.0) NA NA 4 (15.3)
Nyberg (1987)
25
65 NA 6 (9.2) 12 (18.5) NA 3 (4.6)
Abu-Yousef (1987)
12
21 NA 7(33.3) 3 (14.2) NA NA
Stabile (1987)
19
20 NA 0 NA NA NA
Bloch (1989)
26
31 NA 3 (9.7) 2 (6.4) NA NA
Borlum* (1989)
8
86 22.1 19 (22.1) NA NA NA
Mandruzzato (1989)
13
62 NA 8 (12.9) 7 (11.2) NA 1 (1.6)
Pedersen (1990)
23
23 4 1 (4.3) 2 (8.6) NA NA
Baxi (1991)
3
5 NA 1(20.0) NA NA NA
Jakab (1994)

35 NA 8 (22.8) NA NA NA
Bennett (1996)
10
516 NA 48 (9.3) NA NA NA
Kupesic (1996)
21
59 NA 10 (16.9) 3 (5.1) NA NA
Ball* (1996)
17
317 1.3 16 (7.0) 8 (3) 8 (3) 8 (3)
Seki (1998)
7
22 0.46 3 (13.6) 17 (77.2) NA NA
Tower* (2001)
14
41 12 6 (14.6) 8 (19.5) NA NA
Nagy* (2003)
18
230 3.1 43 (18.7) 30 (13.0) 24 (12.8) 6 (3.3)
Johns* (2003)
15
51 NA NA 5 (9.8) 1 (2.0) NA
Sharma (2003)
28
129 NA 7 (5.4) 24 (18.6) NA NA
IUH, intrauterine hematoma; SA, spontaneous abortion; PTD, preterm delivery; Pl Ab, placental abruption; PM, perinatal mortality; NA, not
applicable.
* Controlled study.

Presented at Tenth International Congress, The Fetus as a Patient, Brijuni, Croatia, 1994.
343 VOL. 105, NO. 2, FEBRUARY 2005 Maso et al Intrauterine Hematoma
5. Pearlstone MM, Baxi LV. Subchorionic hematoma: a
review. Obstet Gynecol Surv 1993;48:658.
6. Mantoni M, Pedersen JF. Intrauterine hematoma: an ultra-
sonic study of threatened abortion. Br J Obstet Gynaecol
1981;88:4751.
7. Seki H, Kuromaki K, Takeda S, Kinoshita K. Persistent
subchorionic hematoma with clinical symptoms until
delivery. Int J Gynaecol Obstet 1998;63:1238.
8. BorlumKG, Thomsen A, Clausen I, Eriksen G. Long term
prognosis of pregnancies with intrauterine hematomas.
Obstet Gynecol 1989;74:2313.
9. Dickey RP, Olar TT, Curole DN, Taylor SN, Matulich
EM. Relationship of rst-trimester subchorionic bleeding
detected by color doppler ultrasound to subchorionic uid,
clinical bleeding, and pregnancy outcome. Obstet Gynecol
1992;80:41520.
10. Bennett GL, Bromley B, Lieberman E, Benacerraf BR.
Subchorionic hemorrhage in rst trimester pregnancies:
prediction of pregnancy outcome with sonography. Radi-
ology 1996;200:8036.
11. Sauerbrei EE, Pham DH. Placental abruption and subcho-
rionic hemorrhage in the rst half of pregnancy: US
appearance and clinical outcome. Radiology 1986;160:
10912.
12. Abu-Yousef MM, Bleicher JJ, Williamson RA, Weiner CP.
Subchorionic hemorrhage: sonographic diagnosis and
clinical signicance. AJR Am J Roentgenol 1987;149:
73740.
13. Mandruzzato GP, DOttavio G, Rustico MA, Fontana A,
Bogatti P. The intrauterine hematoma: diagnostic and
clinical aspects. J Clin Ultrasound 1989;17:50310.
14. Tower CL, Regan L. Intrauterine haematomas in a recur-
rent miscarriage population. Hum Reprod 2001;16:
20057.
15. Johns J, Hyett J, Jauniaux E. Obstetric outcome after
threatened miscarriage with and without a hematoma on
ultrasound. Obstet Gynecol 2003;102:4837.
16. Falco P, Milano V, Pilu G, David C, Grisolia N, Rizzo N,
et al. Sonography of pregnancies with rst trimester bleed-
ing and viable embryo: a study of prognostic indicators by
logistic regression analysis. Ultrasound Obstet Gynecol
1996;7:1659.
17. Ball RH, Ade CM, Schoenborn JA, Crane JP. The clinical
signicance of ultrasonographically detected subchorionic
hemorrhages. Am J Obstet Gynecol 1996;174:9961002.
18. Nagy S, Bush M, Stone J, Lapinski RH, Gardo S. Clinical
signicance of subchorionic and retroplacental hematomas
detected in the rst trimester of pregnancy. Obstet
Gynecol 2003;102:94100.
19. Stabile I, Campbell S, Grudzinskas JG. Ultrasonic assess-
ment of complications during rst trimester of pregnancy.
Lancet 1987;2:123740.
20. Makrydimas G, Daskalakis A, Souka AP, Kavalakis Y,
Michalas S. Fetal loss following ultrasound diagnosis of a
live fetus at 610 weeks of gestation. Ultrasound Obstet
Gynecol 2003;22:36872.
21. Kupesic S, Kurjak A, Chervenak FA. Doppler studies of
subchorionic hematomas in early pregnancy. In: Cherve-
nak FA, Kurjak A, editors. Current perspectives on the
fetus as a patient. New York (NY): The Parthenon Pub-
lishing Group; 1996. p. 338.
22. Goldstein SR, SubramanyamBR, Raghavendra BN, Horii
SC, Hilton S. Subchorionic bleeding in threatened abor-
tion: sonographic ndings and signicance. AJR Am J
Roentgenol 1983;141:9758.
23. Pedersen JF, Mantoni M. Prevalence and signicance of
subchorionic hemorrhage in threatened abortion: a sono-
graphic study. AJR Am J Roentgenol 1990;154:5357.
24. Jouppila P. Clinical consequences after ultrasonic diagno-
sis of intrauterine hematoma in threatened abortion. J Clin
Ultrasound 1985;13:10711.
25. Nyberg DA, Mack LA, Benedetti TJ, Cyr DR, Schumann
WP. Placental abruption and placental hemorrhage: cor-
relation of sonographic ndings with fetal outcome. Radi-
ology 1987;164:35761.
26. Bloch C, Altchek A, Levy-Ravtech M. Sonography in
early pregnancy: the signicance of subchorionic hemor-
rhage. Mt Sinai J Med 1989;56:2902.
27. Ylostalo P, Ammala P, Seppala P. Intrauterine haematoma
and placental protein 5 in patients with uterine bleeding
during pregnancy. Br J Obstet Gynaecol 1984;91:3536.
28. Sharma G, Kalish RB, Chasen ST. Prognostic factors
associated with antenatal subchorionic echolucencies.
Am J Obstet Gynecol 2003;189:9946.
29. Williams MA, Mittendorf R, Leiberman E, Monson RR.
Adverse outcome of pregnancy associated with rst trimes-
ter vaginal bleeding. Obstet Gynecol 1991;78:148.
30. Salaa CM, Lopez-zeno JA, Sherer DM, Whittington SS,
Minior VK, Vintzileos AM. Histologic evidence of old
intrauterine bleeding is more frequent in prematurity.
Am J Obstet Gynecol 1995;173:106570.
31. Laurini RN. Abruptio placentae: from early pregnancy to
term. In: Chervenak FA, Kurjak A, editors. Current per-
spectives on the fetus as a patient. New York (NY): The
Parthenon Publishing Group; 1996. p. 43344.
Address reprint requests to: Dr. Andrea Sartore, Department
of Obstetrics and Gynecology, IRCCS Burlo Garofolo, Uni-
versity of Trieste, Via dellIstria 65/134137, Trieste, Italy;
e-mail: sartore@burlo.trieste.it.
Received May 31, 2004. Received in revised form July 31, 2004.
Accepted October 14, 2004.
344 Maso et al Intrauterine Hematoma OBSTETRICS & GYNECOLOGY