Bleeding during pregnancy is a cause of great concern and worry. Vaginal bleeding complicates around 20-25% of all pregnancies. There are many causes of bleeding during pregnancy, sub chorionic hematoma being one of them.
Bleeding in the sub chorionic space occurs when the placenta detaches from the original site of implantation. This forms a sub chorionic haemorrhage or hematoma. The membranes are lifted apart and a space is created between the placenta and uterus. Small clots cause less complications and larger ones may cause heavy bleeding.
Other causes of bleeding during pregnancy
Cause- Cause of formation of hematoma is not fully understood.
Placenta dislodges fully or partially from the uterine wall
Fertilised egg implants in the uterus in abnormal manner
More in pregnancy conceived via IVF or frozen thawed embryo transfer
Blood coagulation disorders
Scars from previous dilatation and curettage
Mother’s age >35 years
Bleeding- It could be spotting to heavy bleeding with clots or no bleeding at all( hematoma diagnosed on routine scan)
Diagnosis- It can be made by a simple ultrasound examination. The progress can also be monitored by ultrasound for the increase or decrease in size and resolution of the same. It is seen as hypoechoic or anechoic crescent shaped area.
Treatment- Consists of drugs to prevent miscarriage.
Avoid heavy work
Avoid inter course
Progesterone support in oral, injectable or vaginal form
Stay well hydrated to prevent constipation and straining at stool
Regular small meals with fibre
Complications- Most small hematomas are not harmful and resolve on their own. We just need to monitor them and you may have a normal healthy term baby. Large clots are related to risks.
If >30% placenta is dislodged it causes clot to grow fast leading to spontaneous abortion.
Increased risk of miscarriage, preterm labour, placental abruption and preterm rupture of membranes is there.
Conclusion- Sub chorionic clot in patients during first trimester increases the risk of miscarriage and other complications, but presence of clot does not always increase adverse pregnancy outcome. Close monitoring and treatment of pregnancy can have good outcome and result in healthy baby.