What is Subchorionic Hematoma?
Hematoma is a collection of blood that occur outside the blood vessels, it happens in a particular part of the body like the tissues, muscle and organs.
Chorion is a membrane that develops during pregnancy, it attaches the placenta to the uterus.
Subchorionic Hematoma is the accumulation of blood or clotting between the uterus and behind the placenta. The bleeding usually occurs when small parts of the Chorion separate from the uterus. It happens in 1% of all pregnancies and are associated with miscarriage for almost 44%. Women of all ages and races can be affected by this condition.
For over 25%, Subchorionic Hematoma happens during the first half of pregnancy and became one of the common reasons for ultrasonography during first trimester of the pregnancy. The hematoma commonly ranges from about 1 cm up to greater than 12 cm in size. The hematoma is considered small if it is under 20% to 40% of the size of the sac, and most often regress because it could be absorb by the body or the clot bleed itself out. If the hematoma is large in size it covers 50% or greater the size of the sac. Premature rupture of the membrane and growth restriction will be the risk if remains undetected and continue to progress.
Subchorionic Hematoma in Pregnancy
Subchorionic Hematoma most often appear during the early staged of pregnancy. The outcome also depends on the age of the fetus, and early detection will be the safest for the mother and fetus. During the 1st stage of pregnancy, 25% of all women were affected by vaginal bleeding. At recent, subchorionic hemorrhage caused by marginal placental abortion has found out to be common cause of bleeding in the first 20 weeks of pregnancy. Getting an ultrasound is recommended for those who experience bleeding and abdominal pain.
If Subchorionic hematoma still progress until the later stage of pregnancy, this time medical attention will be a requirement. It might compromise the condition of the fetus inside the mothers womb. The prognosis of Second trimester Subchorionic hematoma is worse compared to patients with hematoma during the first trimester. All pregnant mothers with bleeding during the second trimester must be carefully examined. It increases the risks of miscarriage, stillbirth, preterm labor and premature abruption of placenta (Abruptio Placentae).
Causes of Subchorionic Hematoma
Subchorionic Hematoma is caused separation of uterus (commonly its inner membrane or Endometrium) and the Chorion.
Marginal Placental abortion
- It is most common cause of Subchorionic Hematoma during the first half of the pregnancy. It is a situation in which the blood turns its way behind the chorionic membrane instead flowing behind the placenta. The blood leaks into the cervical canal and causes elevation from the uterine wall. The gestational sac got compress and may lead to premature rupture of membrane and abortion. It is commonly seen in patients with bleeding disorders, threatened abortions, and patients with presence of auto-antibodies, patients receiving anti coagulant drugs and post trauma.
- Some Doctors believed that Subchorionic Hematoma can be the result of separation or tearing of egg cell from the endometrium during the implantation that leads to bleeding within the uterus
Symptoms of Subchorionic Hematoma
In some cases women do not experience any symptoms of Subchorionic hematoma. Clinical evaluation includes maternal age, gravidity, parity, gestational age, presence of pain, presence and amount of bleeding, and pregnancy outcome.
Bleeding affects 25% of all women during the first 3 months of the pregnancy. It is the most common symptoms in the first and second trimester pregnancy. Amount of bleeding may vary ranging from light amount up to heavy flow with presence of blood clots. Some may only experience few amount of brownish blood. During the First trimester small amount of bleeding is mostly experience, but it may continue through heavy bleeding after the first trimester and may increase risk of Preterm labor.
Some pregnant may suffer abdominal pain associated with bleeding, but sometimes it can be painless. Abdominal pain can be mild abdominal cramps or severe abdominal pain.
In some cases, women may not experience any of the symptoms inspite of suffering from Subchorionic Hematoma. In this situation diagnostic procedure is a must have the evidence.
The following procedure is used to identify Subchorionic Hematoma:
Is a Diagnostic method that uses imaging technique to visualize the internal parts of the body like the uterus, placenta and other parts of the reproductive system. Ultasonography is effective imaging modality because it can be performed quickly and has no known risk like radiation.
Using ultrasound, hemorrhages are seen as and anechoic or black area. Some hematoma appears like placenta.
Color Doppler sonography may help in differentiating avascular hematoma from the highly vascular placenta and other premature conditions like miscarriage and ectopic pregnancy. Subchorionic hematoma is generally followed with series of ultrasound.
However, ultrasonography has lower sensitivity for small bleeds since it sensitivity ranges between 25 and 20%. Ultrasound may not also show the presence of hematoma especially when vaginal bleeding is present. Due to flowing of blood in the vaginal canal it will not remain contained in the back of the chorion and gestational sac. If there is no fluid, the ultasound will not be able to perceive it.
Treatment of Subchorionic Hematoma
There is no known therapeutic treatment for Subchorionic Hematoma. But your doctor will give advice on how to manage this condition
Most of the time, doctors will advise to have a lot of bed rest. This allows the body to get enough energy and to prevent more complication. Pelvic rest is also advisable, means no sexual intercourse and using of tampoons. Vaginal exams may also be reduced.
Avoid strenuous physical activity
Pregnant mothers can continue their normal day to day activities as long as they will not engage in any activity that require too much energy and to avoid increase in your heart rate. Increase in heart rate will also increase the blood volume passing through the uterus and will promote bleeding. The examples are lifting heavy things, walking too fast and engaging in sexual intercourse.
Drink a lot of water
This is to maintain her body well hydrated and avoid dehydration. Dehydration causes headache and uterine contractions that can aggravates blood clots. Eight to ten glasses per day is advisable to hydrate the body and lower the possibilities of having uterine contractions.
Joining support groups
Pregnant suffering from Subchorionic Hematoma is encouraged to support groups to promote awareness and to relieve stress and anxiety.
Regular Prenatal check up
Having your regular appointment with your doctor is the greatest prevention in having the risk of othercomplications. All your concerns must be opened with your doctors since they know how to manage all those symptoms.