Decades ago, when a woman presented with early trimester bleeding, doctors assumed it was an impending miscarriage. They had no other information to go on. Now with the help of ultrasound technology, doctors are able to make a more definitive diagnosis.
SCH or Subchorionic Hematoma is a gathering of blood between the membranes of the placenta and the uterus. A more technical name is the chorion. Some doctors will also just refer to it as a blood clot.
Causes of Subchorionic Hematoma
There is no known cause for a SCH but many researchers speculate that during egg implantation, the egg slightly separates or tears from the uterus, causing a bleed. There is nothing a woman did or could have done to cause or prevent them. SCH occurs to pregnant women of all ages and races.
Diagnosing Subchorionic Hematoma
Diagnosing a SCH is based on its symptoms and visualization via ultrasound scan. Many women visit the doctor or emergency department with the chief complaint of vaginal bleeding during early pregnancy. An ultrasound, either transvaginal or abdominal, would more than likely be carried out. During the ultrasound scan, the doctor or radiologist will locate the fetus and assess its current condition. Identifying a SCH by an untrained eye is difficult. The clot appears as a black mass within the uterus. It almost appears as if another placenta is present. Ordinary ultrasound images appear blackish with visuals of bone. After a visual of the blood clot is made, and it appears a woman is not having a miscarriage, the diagnosis of SCH is made.
Having a diagnosis of SCH instead of a miscarriage is probably a relief, but having SCH comes with its own concerns.
Treatment of Subchorionic Hematoma
There is no formal treatment for this blood clot, but each doctor is different. Some suggest that you can continue with your everyday activities while others may suggest taking it easy. Some physicians even suggest refraining from sexual intercourse throughout pregnancy and bed rest. Surgery is not an option. Straining and heavy lifting should be avoided, but this is also suggested in normal pregnancy.
Some doctors prefer a ‘wait and see’ approach while others choose to use medications. Blood thinners such as: aspirin, Lovenox (inj), Coumadin and Heparin (inj) are used in attempts to ‘bleed’ the clot out. Estrogen and Progesterone therapy is also sometimes used to aid in the development of the pregnancy.
The current statistics for pregnancy loss with a SCH is 1-3%. This low percentage is related to large clots. Most pregnancies progress with no further complications. Most clots resolve on their own by 20 weeks of pregnancy. The clot either bleeds itself out or the body absorbs it.
Women with SCH are at greater risk for placental abruption or abruptio placenta. Placental abruption is when the placenta tears away from the uterus. This is an extreme pregnancy complication that requires immediate medical attention. If the placenta separates from the uterine wall, the health of the fetus is in danger.
SCH is a risk early in pregnancy, because the clot itself can cause a miscarriage. The clot can release completely from the uterus and cause the fetus and placenta to miscarry.
Women with SCH may experience intermittent periods of vaginal bleeding throughout their pregnancy. This experience would more than likely be a result of the clot ‘bleeding out.’ Blood is an irritant to the uterus and cramping may be accompanied with the bleeding. While seeing blood while pregnant can be very scary, it is very common with SCH. Tampons and sexual intercourse are not generally recommended during bleeding/spotting periods.
Allow yourself adequate rest and plenty of fluids. Dehydration can also cause the uterus to contract-irritating your baby and the clot.
If you’ve been diagnosed with SCH, you’re not alone. Support groups have been popping up all over the internet in recent years. Women from all across the globe have been gathering through the World Wide Web to share their experiences and offer hope to others going through the exact same thing.
If you’re ever in doubt about your condition, you should never hesitate to contact your doctor. Information gathered here should only be used as a reference and not a substitute for actual medical care.
© Rebecca Pillar 2007