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• W2010705809 abstract "Subchorionic hematoma or hemorrhage (SCH), in which vaginal bleeding is observed in the first or second trimester, can cause miscarriage or premature delivery. However, the differentiation of a subchorionic hematoma from the placenta can be difficult. We report a case in which we were able to clearly differentiate a hematoma from the placenta using elastography in a case of suspected placenta previa that was diagnosed with subchorionic hematoma in early mid-trimester. A 36-year-old woman who had undergone a previous Cesarean section experienced vaginal bleeding at 12 weeks' gestation. She was diagnosed with SCH and was transferred to our hospital. A diagnosis of placenta previa was made on transvaginal ultrasound examination. An Acuson S2000 ultrasound machine (Siemens AG, Germany) equipped with a 3.75-MHz transvaginal probe (EC9-4) was used to perform elastography at 29 + 2 weeks' gestation, revealing a hematoma that was visualized as a structure with a stiffness that clearly differed from that of the placenta (Figure 1). The appearance of the placental tissue and hematoma was uniform on transvaginal ultrasound using B-mode imaging. Macroscopic examination of the placenta following delivery showed a green residual hematoma in the placental periphery. Transvaginal B-mode ultrasound image (a) and elastography images (b, c) of suspected placenta previa at 29 + 2 weeks' gestation. On elastography, the area suspected of being placenta previa on B-mode ultrasound was partially red and depicted as more rigid tissue (arrowheads) than that of the surrounding placenta. The internal uterine orifice was closed as a result of this tissue. On conventional ultrasound, the diagnosis of SCH is made based on the presence of an anechoic area1. However, the echogenicity of this initially anechoic area can increase greatly over time2. The use of high-resolution transvaginal sonography can facilitate the diagnosis3, but it is still sometimes difficult to differentiate an SCH from the placenta4-7. The differential diagnosis of SCH includes chorioangioma and normal placenta4. Chorioangioma can be diagnosed using B-mode and/or Doppler ultrasound8, but the differentiation of an SCH from normal placental tissue depends on the timing of the examination. SCHs are often contiguous with the placenta at its periphery9, and so can appear to form part of the placenta when the hematoma presents the same level of echogenicity. In cases in which an SCH is located close to the uterine os, it may be mistaken for placenta previa. In such cases, the painless, sporadic and irregular vaginal bleeding that is characteristic of SCH will be interpreted as warning bleeding for placenta previa, with the inevitable consequence of early Cesarean section. Consequently, differentiating an SCH located near the uterine os from the placenta is crucial from the standpoint of management. Our case suggests that elastography might be a useful approach for differentiating SCH from the placenta. Retrospective diagnosis of SCH using magnetic resonance imaging (MRI) has been previously reported10, 11. Retrospective investigation of MRI findings in the present case revealed a hyperintense area that coincided with the site of the SCH as observed on elastography. However, the finding was indistinct and could barely be observed even after increasing the contrast (Figure 2). Magnetic resonance (MR) images of suspected placenta previa at 26 + 3 weeks' gestation. In (a) the box indicates the area around the internal uterine orifice, which is enlarged in (b) with contrast increased. The subchorionic hematoma appears as hyperintense (arrowheads). Elastography has been established as a method for the quantitative evaluation of tissue stiffness. In terms of imaging findings in this case, the color of the placenta and the hematoma clearly differed, with the hematoma depicted as stiffer tissue than the placenta. In the case of SCH, the area depicted as anechoic in the early stage of onset presumably increases in stiffness as the pregnancy progresses. In conclusion, the findings in this case suggest that the differential diagnosis of SCH and placenta previa may be possible using elastography. We hypothesize that in the future it will be possible to use elastography to differentiate other placental abnormalities, such as placental infarction and partial placental separation. M. Ogawa*, D. Nagao , K. Mori , M. Sato , A. Sato , D. Shimizu , Y. Terada , * Perinatal Care Center, Akita University Hospital, Akita, Japan, Department of Obstetrics and Gynecology, Akita University Hospital, Akita, Japan" @default.
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• W2010705809 date "2011-12-23" @default.
• W2010705809 modified "2023-10-18" @default.
• W2010705809 title "Elastography for differentiation of subchorionic hematoma and placenta previa" @default.
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• W2010705809 doi "https://doi.org/10.1002/uog.9084" @default.
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