What irritates a Subchorionic Hematoma?

A subchorionic hematoma is bleeding beneath the chorion membranes that surround a growing baby in the uterus. Expectant mothers, especially those between 10 to 20 weeks of gestation are at higher risk of first trimester bleeding.

Understanding what irritates a subchorionic hematoma is crucial, as it can help in managing the condition more effectively and may also shed light on its connection with complications like preeclampsia. This article will navigate through the factors that may exacerbate a subchorionic hematoma.

Understanding Subchorionic Hematoma

Subchorionic hematomas (SCH) (also called subchorionic hemorrhage or subchorionic bleeding) are a common yet unsettling pregnancy complication. It is generally caused by a partial separation between the chorionic membrane and the walls of the uterus. This separation leads to the accumulation of blood under the chorion membrane. The chorion membrane is a vital structure that connects the mother’s uterine wall to the baby’s amniotic sac. SCH is commonly seen in the first trimester of pregnancy (10 to 20 weeks) and is also the most common cause of vaginal bleeding during pregnancy.

Symptoms and risk factors

The main symptom of SCH is vaginal bleeding in early pregnancy. This can vary from light spotting to heavy bleeding with clots and can cause worry and alarm. However, all cases of SCH do not present noticeable symptoms; some are only discovered during routine ultrasounds. Risk factors that contribute to developing SCH include structural abnormalities of the uterus, previous pelvic infections, trauma, miscarriages, in vitro fertilization (IVF) pregnancies, and high blood pressure.

Complications

Hypertensive disorders, placental abruption, and preterm delivery are several severe complications, associated with SCH.

The management of SCH largely depends on the size of the hematoma and the stage of pregnancy. Common interventions include reduced physical activity, complete bed rest, and avoidance of sexual intercourse. Monitoring through follow-up ultrasounds is also recommended.

Factors that may irritate a subchorionic hematoma

Several factors can put pregnant women at higher risk of subchorionic hematoma (SCH).  A knowledgable understanding of these risk factors is important for both expectant mothers and healthcare providers.

Risk factors include:

• Structural irregularities e.g. an irregular shaped uterus may hinder the normal attachment of the chorionic membrane, leading to an increased chance of bleeding
• A history of uterine infections or trauma can also heighten the risk of developing SCH
• A history of miscarriages and pregnancies achieved through in vitro fertilization (IVF)
• High blood pressure is known to affect blood flow and can exacerbate the severity of SCH

Treatment & management options

• Pregnant individuals diagnosed with subchorionic hematoma are generally advised to avoid strenuous activities, heavy lifting, and excessive exercise
• Reduced activity, no travel and bed rest may be advised. In more severe cases, particularly if bleeding occurs after 24 weeks, hospitalization might be recommended to ensure close monitoring and immediate medical response if needed
• Prescribing blood thinners or treatments containing estrogen and progesterone may be advised to slow or prevent further hemorrhaging. Some patients might even be offered progesterone pessaries that are used by  inserting into the vagina.
• Frequent follow-up ultrasounds to monitor the progress and size of the hematoma

Other important information about your care

• The management of subchorionic hemorrhage involves a team-based approach involving a wide range of healthcare professionals including primary care providers, the department of Obstetrics and Gynecology, midwives, and specialty-trained nurses
• For individuals who are rhesus D (RhD) antigen negative and have experienced bleeding post 12 weeks of pregnancy, an injection of anti-D immune globulin is often administered to prevent complications related to Rh incompatibility
• Regular sonograms are crucial to assess fetal growth and check for signs of preterm labor. Continuous monitoring helps in making timely decisions to safeguard a healthy pregnancy

Conclusion

The complex nature of subchorionic hematoma during pregnancy means a delicate balance is required in managing this condition effectively. Several factors can irritate and potentially worsen a subchorionic hematoma, including unusual uterus structure, a history of uterine conditions, and health issues like high blood pressure. Expectant mothers need to understand these risk factors and the importance of regular monitoring and adjusting activity levels. These are essential steps for expectant mothers and healthcare providers to take to reduce the risks associated with this condition.

Sources

• Subchorionic hematoma – Cleveland Clinic 
• Subchorionic haematoma – NHS