Pregnancy can be a very worrisome time for many women. They often wonder: are they living the right way, are they doing the right things, are they eating the right diet, are they getting the best healthcare? Every little blip, burp, blub or hiccup may be perceived as a cause for concern.
Or it may be just that.
A hiccup.
When a woman experiences vaginal bleeding during pregnancy that could very well send everyone around her into a state of panic. But that doesn’t always have to be the case. Sometimes bleeding could be a symptom of a common issue called subchorionic hemorrhage. So just what is that, and what does that mean for a pregnancy?
What Is Subchorionic Hemorrhage?
When a blood clot is formed as a result of abnormal accumulation of blood under one of the membranes (chorion) that surrounds the embryo inside the uterus, it’s called a subchorionic hematoma. (Hematoma is just a fancy word for bruise.) The resulting bleeding that is seen is called subchorionic hemorrhage (SCH) or subchorionic bleed. It’s a frequent cause of bleeding seen during the first and second trimesters of pregnancy.
In a study of almost 64,000 pregnant women, 1.7 percent were found to have experienced subchorionic hemorrhage. It can be alarming, but it is very rarely a sign of a miscarriage. Some cases may become serious, while many others may not adversely affect the pregnancy at all. Most of these bleeds resolve on their own, and women go on to have completely normal healthy pregnancies.
Women may experience a range of bleeding from light spotting to a heavy flow that may include clots. Other women may experience pelvic pain and cramping. Sometimes the hematoma is only discovered through ultrasound, as there may be no bleeding at all.
What Causes Subchorionic Hemorrhage?
This is one condition that is not completely understood, and researchers aren’t sure why some women experience it, and others do not. It’s possible that SCH causes may stem from the fertilized egg implanting into the uterine wall in an abnormal way. It’s also thought that it could be a result of the placenta dislodging partially or fully from the uterine wall.
Scientists do know that subchorionic hematomas are more likely to occur in pregnancies that are conceived through in vitro fertilization (IVF).
How Is Subchorionic Hemorrhage Diagnosed?
When a woman experiences any vaginal bleeding during pregnancy, she should make a point to consult her doctor. The doctor will perform an examination and may order blood tests. They will also call for an ultrasound to visualize inside the uterus. Once the clot is located, it will be measured. That’s usually all doctors will find. They’ll be able to visualize the clot, itself, but not be able to locate the source of the bleeding under the membranes.
On ultrasound, tissue that is of a soft density or semi-formed like blood that is clotted will appear to be gray in color, usually a mixed variation of several shades of gray. Fluid, like blood that hasn’t clotted, shows up as black. So on ultrasound, the hemorrhage will appear as a ‘lesion’ along the edge of the placenta that is a mixture of grays and blacks, showing pockets of blood that has clotted alongside some that is still fresh or hasn’t clotted yet.
In rare cases, there may be a history of trauma, early-onset preeclampsia, some sort of clotting disturbance in the mother, severe hypertension, or abuse of vasoactive drugs like cocaine or amphetamines. But in most instances, there is no way to know what started it.
What About Treatment For Subchorionic Hemorrhage?
There are no medications that can dissolve clots, but a great many may dissolve on their own. As a precaution, some patients may be put on bed rest and told to avoid sex until the hematoma dissolves.
Complications of Subchorionic Hemorrhage
Overall, women diagnosed with subchorionic hemorrhage are at a slightly increased risk of placental abruption, and preterm delivery. Research on whether or not SCH poses a risk of miscarriage is conflicting, though most cases are not harmful.
Hematomas that are found in the early stages of the first trimester aren’t as worrisome as those discovered later. The location of the hematoma can say a lot. Small ones on the surface of the placenta aren’t as concerning as those that develop under the placenta or behind the fetal membrane. If the clot grows are more worrisome, as they may pull the placenta from the attachment site on the uterus.
This could trigger a waterfall effect. As the placenta pulls away, it can cause the hematoma to grow larger, rupturing the amniotic sac prematurely. That could lead to a spontaneous abortion. Not all cases are problematic, but some in instances, SCH causes an increased risk of a variety of complications like preterm labor, premature rupture of membranes, miscarriage, and placental abruption.
Most of the time, Subchorionic hemorrhage is harmless when the mother works with her doctor to properly diagnose it and follow their recommendations. Quick and early diagnosis can mean a completely healthy pregnancy moving forward.