Subchorionic Haemorrhage

Subchorionic Hematoma

Some women experience bleeding during pregnancy. This is not uncommon, but it’s necessary to delve deeper to rule out any complications to the pregnancy.



What Is Subchorionic Hematoma?

Chorion is the outer fetal membrane. This membrane is placed between the uterus and the placenta. If the placenta gets detached from the site of implantation, the chorionic membranes form a sac between the placenta and the uterus. These movements result in bleeding and blood gets collected in the chorion, resulting in a subchorionic hematoma, also called subchorionic bleeding.





A sub-chorionic haemorrhage can have variable sizes from small to large clots. The smaller ones are more prevalent and result in spotting while the larger ones lead to excessive bleeding. Usually, sub-chorionic haemorrhage resolves naturally and you can still have a healthy pregnancy.

How Common Is Subchorionic Hematoma?

This condition is detected through ultrasound, during the first trimester of pregnancy. Around 25 of every 100 women experience vaginal bleeding during the first half of pregnancy. Women who have undergone IVF are more prone to subchorionic hematoma.




How Is Subchorionic Hematoma Different From Spotting?

Subchorionic haemorrhage shouldn’t be mistaken for spotting. When you notice just a few spots of blood on your undergarment, it’s spotting. However, subchorionic hematoma results in both bleeding and spotting. It may necessitate panty liners. The bleeding may also be accompanied by severe abdominal pain and dizziness.

Causes

Why subchorionic haemorrhage happens is still unknown. Here are the possible triggers:





  • A concern with the egg implantation process where the egg gets implanted in the uterus lining may lead to cramping pain and bleeding
  • The expecting mother’s abdomen getting subjected to extreme trauma
  • Blood coagulation
  • Excessive intake of drugs during early pregnancy
  • Scarring from dilation and curettage (D&C) procedure or miscarriage
  • The expecting mother’s age being above 35 years

Can Subchorionic Hematoma Harm the Baby?

In most cases, subchorionic hematoma resolves on its own. Subchorionic hematoma towards the end of the first trimester or early second trimester can fractionally tear away the developing placenta from its site of attachment. Large hematomas can tear away up to 40% of the placenta from the endometrium, and can grow larger in size, thereby applying pressure on the gestational area and rupture the membrane and lead to abortion. Subchorionic hematomas occurring beneath or, at the edge of the placenta or, behind an isolated area of the foetal membrane can be a cause of concern. Large intrauterine hematomas can restrict the growth of the foetus and also hamper the mother’s health.

Symptoms

Small clots usually don’t show any symptoms and can be detected only by ultrasound. Noticeable symptoms include:




  • Spotting
  • Vaginal bleeding with or without mild cramping

Diagnosis

Either a transvaginal or abdominal scan is done to determine the size and position of the clot, the actual amount of bleeding and the site of the collection of the blood. It also shows whether the extent of damage to placenta. From appearance, it seems as though a second placenta is present. With the help of the images of the bones, a regular sonography appears blackish. Post identification of the blood clots, the sub-chorionic haemorrhage can get diagnosed.

Whether the clots are resolving naturally or continue to grow further may be determined with the help of follow up ultrasounds.





Risks & Complications

  • The placenta can get detached from the uterine wall, posing the risk of preterm birth or miscarriage.
  • There’s also a risk of miscarriage.
  • In addition to other complications during pregnancy, subchorionic haemorrhage can pose a risk to the life of the foetus.

Treatment

  • Take bed rest.
  • Refrain from sexual intercourse.
  • Refrain from lifting heavy weights, and standing for long hours.
  • Opt for progesterone or oestrogen therapy. Dydrogesterone is an artificial progesterone hormone which can be taken orally to treat subchorionic haemorrhage.
  • Blood thinners such as Lovenox (inj), aspirin, Heparin (inj) and Coumadin are often prescribed to remove the clots.
  • Consume adequate water to prevent dehydration.
  • Eat small meals at regular intervals to prevent hunger cramps.
  • Increase the intake of fibre and water to prevent constipation.
  • Go for ultrasound check-ups regularly.

When Should You Visit a Doctor?

Subchorionic haemorrhage has mild symptoms, which, sometimes, go unnoticed. We suggest that you visit a gynaecologist twice a week during the first trimester. If there is bleeding or spotting, consult your doctor to identify and address the issue immediately.

Subchorionic haemorrhage can prove to be fatal to your baby, if not diagnosed on time. In case you experience bleeding during pregnancy, consult a gynaecologist, and take the necessary precautions.