Subchorionic Hemorrhage

Pregnancy is a delicate stage for every woman. Bleeding may occur, which can be worrisome. Bleeding in any form is a big issue. A subchorionic hemorrhage or also known as subchorionic hematoma is a bleeding that occurs during pregnancy.

What is it and why do subchorionic hematomas occur?

It is the accumulation of blood within the fold of the outer fetal membrane situated right next to the placenta (chorion) or between the placenta and the uterus.

Subchorionic bleeding usually resolves on its own, but some cases require immediate medical attention, especially in women with sensitive pregnancy. About 1% of pregnant women experience subchorionic hemorrhage and most of them occur during first trimester. ^{(2, 4, 5, 6)}

 

Image 1: An ultrasound view of what appears to be a huge black hematoma (subchorionic hematoma) right beside the fetus.
Picture Source: www.babyq.com

Photo 2: An ultrasound view of the patient’s abdomen indicating a clot between the chorion and the amnion.
Picture Source: www.obimages.net

Subchorionic Hematoma Symptoms

• Spotting or bleeding, especially during the first trimester
• Subchorionic bleed detected during a routine ultrasound
• Most causes of subchorionic hemorrhage don’t have noticeable signs and symptoms. The patient will not notice it until the doctor performs a routine ultrasound. ^{(1, 4, 5)}

Unusual signs and symptoms that warrant immediate medical attention include the following:

• Heavy and profuse vaginal bleeding, which could lead to miscarriage, uterine rupture, the placenta separates from the uterus, a preterm labor, ectopic pregnancy, and molar pregnancy. An ectopic pregnancy means that the egg fertilizes outside the womb while a molar pregnancy pertains to a mass of tissue in the womb.
• Severe bleeding can also lead to dizziness and abdominal pain. ⁽⁵⁾

Are there any potential risk for subchorionic hematoma pregnancy?

A subchorionic hematoma bleeding usually dissolves on its own. However, a subchorionic hematoma size that is larger than usual does have a serious effect to the mother and the baby’s health. It could lead to placenta separation from the uterine wall, which will increase the chance of miscarriage and even the possibility of pre-term labor.

If you are experiencing bleeding, be it a simple spotting, you need to inform your doctor right away. ^{(7, 8)}

What causes bleeding during pregnancy?

The exact subchorionic hematoma causes are unknown, but some conditions are linked with it. These include the following:

• Fertilized egg’s separation from the uterine wall
• Trauma to the mother’s abdomen
• Side effects of medications
• Blood coagulation problem during pregnancy ^{(9, 10)}

Diagnosis and Treatment

To properly diagnose the condition of the patient, the doctor will consider the symptoms along with an ultrasound scan. Women usually complain of vaginal bleeding on the early stage of pregnancy. The doctor will order an ultrasound, either abdominal or transvaginal to have a perfect view of the location and condition of the fetus.

If you notice that you have vaginal bleeding, you need to call out for help right away. As for the preventive subchorionic hematoma treatment approach, the patient is put on a strict bed rest with no bathroom privilege. She is also strongly advised to avoid sexual intercourse until the condition heals. ^{(7, 8, 9)}

A part of the subchorionic hemorrhage treatment is taking progesterone or dydrogesterone, avoid standing for a long period of time, and avoid performing strenuous exercises. It is also important to have a religious follow up with your doctor. Prenatal care is important.

Any hematomas are not normal and so it is important for the patient to be closely monitored by a health care professional. Some physicians prescribe blood thinners to bleed the clot out. Examples of blood thinners are heparin, aspirin, Coumadin, and lovenox. To aid in the development of pregnancy, hormone therapy in the form of estrogen and progesterone are given to the patient.

Subchorionic hemorrhage miscarriage rate is 1% to 3% and they are caused by large clots. On a lighter note, most pregnancies progress with no complications at all. The hematoma bleeds itself or naturally absorb by the body. ^{(4, 5, 10)}

What to keep in mind?

• Women suffering from subchorionic hemorrhage/hematoma are at greater risk for abruption placenta (separation of the placental from the uterus). It is a dangerous situation requiring immediate medical attention. It could lead to fetal death if not addressed promptly.
• Subchorionic hemorrhage can cause miscarriage. How? The blood clot does have a possibility to release completely from the uterus causing miscarriage. ^{(2, 3)}
• An intermittent vaginal bleeding throughout the pregnancy can be experienced by women suffering from subchorionic hemorrhage. It is caused by a blood clot that is bleeding out. Aside from bleeding, the patient can also experience abdominal cramping.
• Pregnant women should take good care of themselves. It is important to drink plenty of fluids and allow yourself to rest. Do not do any activities that can contract the uterus or irritate the baby inside your womb. ^{(6, 7)}
• A lot of pregnant women are diagnosed with subchorionic hematoma. If you are one of them, then don’t be afraid because you are not alone. There are support groups all over the internet. They gather online and share their experiences. They offer hope and support to women who are going through the same dilemma.
• Be proactive in the treatment and management of your condition. If you feel like something is not right in your body, then you should not hesitate to contact your doctor.

A subchorionic hemorrhage/subchorionic hematoma is less likely harmful in the long term. However, it is important to keep you and your baby’s health monitored throughout your pregnancy. The doctor will have the best view of your hematoma via ultrasound.

The size of the subchorionic hematoma has something to do with the outcome of the treatment. Smaller hematomas have better prognosis. If the hematoma is extremely large, there is a possibility of pregnancy complications such as miscarriage and preterm labor.

The key to success is diagnosing the condition at an early stage. The earlier you seek treatment, the better the outcome. ^{(5, 7, 9, 10)}

References:

1. www.healthline.com
2. emedicine.medscape.com
3. www.newkidscenter.com
4. www.home-remedies-for-you.com
5. www.mdedge.com
6. www.momjunction.com
7. https://en.wikipedia.org
8. howshealth.com
9. www.subchorionichemorrhage.info
10. Manual of Obstetrics edited by Arthur T. Evans