Doctors prefer to immediately hospitalize pregnant women with this diagnosis to preserve the pregnancy. After all, a retrochorial hematoma is equated to a threat of miscarriage, which means it requires immediate treatment. But if a woman follows medical recommendations and prescriptions, then she has nothing to worry about: only in a small percentage of all cases does this condition cause termination of pregnancy.
What is retrochorial hematoma in the uterus: symptoms
In medicine, a hematoma is an accumulation of liquid or coagulated blood in a cavity. The definition of retrochorial indicates the place where this very cavity with blood is formed. In this case, this is the gap created between the uterus and the chorion due to rejection of the fertilized egg. That is, this type of hematoma occurs only in pregnant women (the chorion is the membranes of the embryo from which the placenta gradually forms).
Mostly retrochorial hematoma in the uterus occurs in the early stages of pregnancy, up to 16 weeks. Then a full-fledged placenta is formed, and if it begins to separate, then this condition is called placental abruption.
Suspicion of the formation of a retrochorial hematoma should arise when nagging pain in the lower abdomen appears in the early stages, possibly radiating to the back. This sign should be a reason to consult a doctor. If bloody, bright red discharge appears, you should urgently go to the hospital. They indicate the opening of new bleeding with an increased risk of detachment of the ovum and miscarriage. Particularly dangerous in this case are such signs that accompany bloody discharge, such as cramping pain, a sharp drop in blood pressure.
The value of diagnostic methods is especially important when a retrochorial hematoma in the uterus occurs without discharge or other signs. And if there is no discharge, but a bruise is detected, then this indicates an early stage of pathology formation, that is, the hematoma can still develop further, increasing in size. A retrochorial hematoma without discharge is often located at the fundus of the uterus, that is, at its highest point, which complicates diagnosis without the use of ultrasound.
Retrochorial hematoma during pregnancy: causes
Despite the fact that chorion detachment occurs in almost many pregnant women, doctors still cannot find a way to determine the exact cause of this pathology. However, they identified a number of factors that can lead to hematoma formation:
- hormonal changes in a woman’s body;
- stress, nervous shock;
- physical exercise;
- injuries, bruises in the abdominal area and other mechanical impacts;
- bad habits of a pregnant woman;
- severe toxicosis;
- anatomical features in the structure and pathology in the development of the uterus and cervix;
- inflammatory and pathological processes in the uterus (in particular endometriosis, fibroids);
- infections and inflammations in the urinary tract;
- disorders in the blood coagulation system;
- cardiovascular pathologies;
- other diseases (diabetes mellitus, lupus erythematosus and others);
- abnormalities in embryo development;
- negative impact of the environment and professional activities (noise, vibration, polluted air).
Any of these factors can provoke chorionic detachment with the threat of miscarriage. But regardless of what exactly caused the formation of the hematoma, the condition requires some kind of correction, and often even the use of drug therapy.
Retrochorial hematoma during pregnancy: treatment
At the first suspicion of chorion detachment, the pregnant woman is prescribed absolute physical and sexual rest. This means that sex is completely excluded, even oral, so as not to tone the uterus during orgasm. A woman should remain in bed and exclude any physical and emotional stress. That is why it would be more reliable to hospitalize her, so that there is no temptation to do household chores. But in principle, if the size of the retrochorial hematoma is small and there is no bright bleeding, treatment can be carried out at home. The main thing is to follow all medical prescriptions.
Hospitalization is mandatory if the retrochorial hematoma during pregnancy is very large - over 60 cm 3 or 20 ml, or more than 40% of the size of the embryo.
As a rule, treatment is not limited to rest alone. Medicines are almost always prescribed, but their selection, combination, dosage and method of administration differ in each individual case! Therefore, none of them should be taken on your own initiative without consulting a doctor.
Depending on the indications (size and stage of development of the hematoma, accompanying signs, presence or absence of concomitant diseases, well-being and health status of the woman), the following groups of drugs can be used in the treatment of retrochorial hematoma:
- analgesics, antispasmodics - to relieve uterine tone and eliminate pain: No-shpa, Magne B6, Papaverine suppositories, Viburkol;
- sedatives - if a pregnant woman is worried or exposed to stress: valerian, motherwort, peony tincture, Novopassit;
- improving uteroplacental blood flow - Actovegin, Curantil;
- hemostatics - to stop the growth of hematoma: Dicynon (Etamzilat), Ascorutin, Tranexam, Vikasol;
- mineral and vitamin preparations - to maintain health and pregnancy: in particular folic acid, vitamins A and E, magnesium;
- hormonal - to restore normal levels of hormones in the blood: Duphaston, Utrozhestan.
Homeopathy and traditional medicine are also actively used, but such treatment should also be prescribed only by a qualified specialist and carried out under his supervision.
Typically, a retrochorial hematoma resolves within 2-5 weeks if the pregnant woman follows all instructions and recommendations.
Retrochorial hematoma during pregnancy: consequences
We have already said that chorion detachment is equivalent to the threat of miscarriage. That is, in some cases - if the necessary measures are not taken or treatment begins too late - termination of pregnancy is possible.
In exceptional cases, the consequences of a hematoma, doctors believe, may be fading of pregnancy, development of intrauterine hypoxia, slow growth of the embryo
But in the vast majority of cases, retrochorial hematoma is successfully cured and does not have negative consequences for the development of the fetus and pregnancy. Only if a placental abruption occurs in the later stages can a woman be given a caesarean section, which is usually performed at approximately 38 weeks.
So, you shouldn’t worry too much about such a nuisance, but you certainly need treatment: the prognosis and outcome of pregnancy depend on this. Pregnant women who have been diagnosed with retrochorial hematoma are under close medical supervision until the end of the term (especially during the most dangerous periods), and therefore there is no reason to worry.
Especially for - Ekaterina Vlasenko
In the initial stage of pregnancy, when the fetus has not yet fully formed, it is not surrounded by the placenta, but by the chorion - the embryo of the placenta. In the future, if development proceeds as expected and without complications, then the chorion becomes the placenta, creating protection for the child and a connection between mother and fetus throughout pregnancy.
Retrochorial hematoma is formed as a result of pathology of the development of the chorion, various injuries, which can lead to termination of pregnancy or various pathologies during the development of the embryo.
What is chorion?
After fertilization, the egg descends into the uterus, attaches to one of the walls and a protective membrane, the chorion, is formed around the embryo. She draws the line between the embryo and the walls of the uterus. It is formed 7-12 days from the moment of conception.
The inner surface is smooth, and the outer surface (which touches the walls of the uterus) has outgrowths and villi that penetrate the uterine walls. At the end of the 1st trimester, the chorion is reformed into the placenta.
Like the placenta itself, the chorion performs protective functions, breathing, feeding the embryo, releasing substances it does not need outside the amniotic sac, promoting adequate development and growth of the fetus.
How does a retrochorial hematoma form?
When the chorion is rejected or separated from the uterine walls. In this case, the blood that comes out of damaged vessels and capillaries remains between the chorion and the uterus.
Factors contributing to chorion separation:
Retrochorial hematoma - stages of development
Hemorrhage can also occur due to strong growth of the villi of the upper layer of the chorion into the uterus. Vessels or capillaries may be injured, leading to retrochorial hematoma.
With blood clotting disorders, retrochorial hematoma grows rapidly during pregnancy and can pose a threat to the woman’s life due to massive blood loss.
Symptoms
There are three degrees of severity:
Lightweight
The hematoma is relatively small in size and it is impossible to notice it on your own, only with the help of instrumental diagnostic methods. It does not harm the woman or the fetus in any way, has no symptoms and soon goes away on its own. There may be spotting from the vagina during bowel movements. Typically they are brown or dark brown in color.
Average
As a rule, a woman notices bloody discharge from the vagina. Their number is small. They may be brown if the bleeding is stopped and resolves on its own. If the discharge is clearly red, it means that the hematoma is growing and the bleeding does not stop on its own. There may be nagging pain in the pelvic area. In this case, be sure to immediately consult a doctor.
Heavy
There is copious bleeding. In this case, a woman may have intense nagging pain in the abdomen, dizziness, weakness, and pallor. The strength of the symptomatic picture in severe retrochorial hematoma directly depends on its size. Severe hemorrhage entails a decrease in pressure, cramping pain and even loss of consciousness.
Diagnostics
A mild retrochorial hematoma of the uterus is detected on an ultrasound examination, which is done routinely. If a woman goes to the doctor with complaints about symptoms, she is also prescribed an ultrasound examination and examination by a gynecologist, laboratory diagnostics (clinical blood test).
Retrochorial hematoma - ultrasound diagnosis
Ultrasound diagnostics allows us to identify pathologies such as:
- Thickening of the uterine wall, which indicates hypertonicity. If the examination is carried out with a vaginal sensor, then the examination must be repeated in a different way, through the anterior abdominal wall (since the uterus can react to the touch of the sensor). If hypertronus is preserved, this may indicate a threat of miscarriage, since the reaction of the uterine walls to the sensor is short-lived.
- Retrochorial hematoma. And also accurately determine the area of origin and the amount of blood, where the fertilized egg is located, its size.
- Pathologies of the ovum. For example, a change in shape under the influence of the walls of the uterus.
Laboratory research methods that must be prescribed to the patient:
- General analysis of urine and blood;
- Bacteriological smear of the uterus for flora;
- Blood chemistry;
- Determination of the amount of hormones in the blood;
- Determination of blood clotting;
- Taking smears for sexually transmitted infections.
Treatment of retrochorial hematoma
The very first thing that the obstetrician-gynecologist prescribes to the patient is bed rest, during which the legs should be elevated to normalize blood circulation. This position will also allow you to empty the hematoma if it is located on the fundus of the uterus.
Various antispasmodic drugs are used to reduce the tone of the uterus: no-spa, papaverine. If it is necessary to adjust hormone levels, the doctor prescribes medications strictly individually and calculates the dose taken. When the hematoma grows, hemostatic agents are used: vikasol, sodium etamsylate.
If a woman’s mental state is not calm, then she is prescribed weak sedatives, such as motherwort and valerian root. It is important to be in a calm emotional state, as complications may arise.
Retrochorial hematoma - the drug Duphaston allows you to maintain pregnancy
In addition to drug therapy, a diet is prescribed in which the patient cannot consume foods that increase intestinal motility and gas formation: legumes, cabbage, coffee, fiber. The uterus should be in a relaxed, calm state to prevent recurrence of hemorrhage.
Physical activity, sex, and emotional experiences are completely prohibited. A woman should be completely at rest.
What can be the consequences of retrochorial hematoma?
The larger the hematoma, the higher the likelihood of miscarriage. Small hematomas do not pose any threat to further pregnancy and fetal development.
If its size exceeds 40% of the mass of the ovum, then this is a very unfavorable diagnostic sign.
The most likely thing that can happen with this pathology is spontaneous abortion. Other complications are not so likely, but occur nonetheless. These are complications such as: frozen pregnancy, chronic hypoxia of the embryo throughout the entire gestation period and delayed fetal development.
Conclusion
The most important thing during pregnancy is to comply with all the instructions of the obstetrician-gynecologist, attend routine examinations, undergo timely tests, and monitor your condition. Any change in the mother’s condition gives her the right to consult a doctor in order to exclude any pathology in the development of the embryo.
Keeping a woman in emotional peace, lack of physical activity and monitoring her health will reduce the chances of retrochorial hematoma and possible pregnancy complications.
About 97% of pregnant women, with proper treatment of retrochorial hematoma and following doctor's recommendations, carry a healthy fetus to term and give birth to a healthy baby.
Chorion is the name of a thin, but elastic and durable film that protects the fertilized egg, and subsequently the embryo. It is formed from the first days of conception. Further, with the further development of the embryo against the background of normal fetal development, this film is transformed into the placenta. But there are situations when a developmental failure occurs, leading to the separation of the embryonic egg from the chorion. The gap that appears begins to fill with blood. It is this pathological change that doctors call retrochorial hematoma during pregnancy. This is a very dangerous pathological deviation that can lead to a woman losing her unborn baby.
Causes of retrochorial hematoma during pregnancy
In order to get one or another disturbance from the normal course of pregnancy, there must be a source that provoked the pathological deviation in question. To date, this problem has not yet been fully studied, and it has not yet been possible to fully identify all the sources that provoke the appearance of the pathological change in question. But many causes of retrochorial hematoma during pregnancy have still been established.
From this we can conclude that there are a lot of sources that can provoke the development of retrochorial hematoma during pregnancy, but the likelihood of its occurrence can still be reduced. This is possible if a woman removes those provoking factors that she is able to fully influence.
Symptoms of retrochorial hematoma during pregnancy
The pathological change in question is the accumulation of a blood clot, which is formed during the process of peeling off the uterine wall from the embryonic membrane in the emerging gap. This disease is very dangerous. When diagnosing a retrochorial hematoma during pregnancy, it is necessary to immediately begin to stop this process, because such appearance of signs of this pathology indicates a threat of miscarriage (termination of pregnancy).
Symptoms of retrochorial hematoma during pregnancy largely depend on the level of neglect and severity of the disease. If a woman’s pathological disorders are a mild form of pathology, then she may not even be aware of the presence of this problem. This form of retrochorial hematoma can only be diagnosed by ultrasound examination. This clinical picture is observed because the blood clots that appear are not shed due to the chorionic villi, which keep them in a limited space.
The average degree of development of the disease already has its own symptoms, which begin to bring discomfort to the expectant mother:
- She develops a nagging pain in the lower abdomen and lumbar region.
- A brownish discharge appears from the genitals.
But if the color of the discharge is brown, then specialists are in no hurry to worry; they simply take such a patient under more careful control. The brown color of the discharge can only indicate that the internal hematoma is simply beginning to resolve on its own.
But if bleeding occurs, you need to sound the alarm. There are serious reasons for concern. The appearance of red or scarlet blood indicates that there is intrauterine bleeding in the woman’s body. And since it does not stop, the specialist concludes that the hematoma is expanding and the process of chorion detachment is progressing, which will invariably lead, if urgent and adequate measures are not taken, to termination of pregnancy.
Symptoms of severe retrochorial hematoma during pregnancy:
- The nagging pain in the lower abdomen develops into cramping attacks.
- There is a sharp decrease in blood pressure.
- Large amounts of bleeding.
- There are cases when a pregnant woman lost consciousness.
In such a situation, it is necessary to urgently call an ambulance. Such a woman is subject to immediate hospitalization.
Consequences of retrochorial hematoma during pregnancy
If the pathological processes are mild, then you should not worry too much. A woman’s body is able to cope with the problem on its own. The consequences of retrochorial hematoma during pregnancy directly depend on the size characteristics of the neoplasm.
The greatest danger is posed by bruises that have a volume of more than 20 ml, as well as those that cover the area of a fertilized egg, or an already developing embryo, by at least 40%.
This clinical picture causes inhibition of the normal development of the fetus, and also increases the risk of an increase in the process of detachment, which invariably provokes termination of pregnancy.
But immediately, when such symptoms appear, a woman should not panic. If a pregnant woman receives timely assistance, then therapy for retrochorial hematoma during pregnancy proceeds favorably. Even if the bleeding was extensive, the likelihood of a successful outcome is quite high.
When the pathology in question is diagnosed and treated in a timely manner, a woman is quite capable of giving birth on her own if there are no other contraindications in her medical history. However, before a successful delivery, such patients undergo a number of additional examinations and are, until the moment of birth, under the close supervision of an obstetrician-gynecologist.
But there are cases when bleeding and bloody clots in the uterine cavity occurred during the prenatal period, then the obstetrician-gynecologist may prevent the pregnant woman from giving birth by prescribing a cesarean section, which is performed in conjunction with amniotomy (surgical opening of the fetal bladder).
With retrochorial hematoma, miscarriages are reported in isolated cases. This result is usually more likely if a woman registers her pregnancy very late, as well as if medical care is not provided to her in a timely manner when the pregnant woman experiences uterine bleeding.
Diagnosis of retrochorial hematoma during pregnancy
If a specialist suspects the pathology in question in a woman, then the diagnosis of retrochorial hematoma during pregnancy is represented by the only available method - ultrasound.
A specialist can assume the presence of this disease based on certain characteristics:
- One of the walls of the uterus is thicker than the others. This is the result of the presence of hypertonicity in a given place, which invariably indicates a high probability of termination of pregnancy.
- The presence of blood clots in the formed layer between the wall of the female organ and the chorion. Thanks to this indicator, the specialist is able to assess the duration of the hemorrhage, its ability to progress and its location.
- On the screen of the ultrasound machine, the deformation of the uterine contour is clearly visible. This is observed due to the fact that protrusion of contracted muscle tissue occurs, which rises above other structures.
- The configuration of the fertilized egg has also changed. The outline of the embryo is different from the normal shape of a healthy fetus. It looks more like a slightly elongated drop or has a boat shape.
Dimensions of retrochorial hematoma during pregnancy
There is probably no need to explain why this pathology is dangerous? Its most severe result may be the loss of a woman’s child, that is, a retrochorial hematoma can provoke a miscarriage.
The final outcome largely depends on the size of the retrochorial hematoma during pregnancy. If its parameters do not reach 20 ml, then monitoring the pregnant woman’s condition by a doctor will not be superfluous; therapy for the pathology is also necessary, but such hematomas do not bring much concern or negative consequences.
If the volume of hemorrhage is significantly greater, as well as in the case when the hematoma covers more than 40% of the surface of the separation of the chorion membrane and the uterine wall, the likelihood of losing the baby becomes more real. With the development of such a situation, the coccyx-parietal size of the embryo is inhibited, sometimes lagging behind accepted norms for up to ten days, which is also an unfavorable indicator of the course of pregnancy.
But even with successful therapy to relieve retrochorial hematoma during pregnancy, the threat of a negative situation for the fetus is not exhausted. In pregnant women who have suffered the pathology in question, gynecologists subsequently observe the formation of placental insufficiency much more often, that is, it begins to “age” much faster than is allowed by the natural course of pregnancy. Against this background, the fetus receives an insufficient amount of nutrition, which leads to its hypoxia, and as a result, such a baby comes into this world with less weight.
But it should still be recalled that the scenario for the development of pathological changes largely depends on the volume of the hematoma, its location, and the timeliness of providing adequate medical care. Nevertheless, the level of modern medicine makes it possible to bring the vast majority of cases to a favorable outcome for both the woman and her unborn baby.
Treatment of retrochorial hematoma during pregnancy
All modern techniques come down to solving two problems: blocking the growth of hemorrhage, as well as its rapid resorption. But, in addition to therapeutic treatment, it is very important for a successful outcome that the woman herself follows the recommendations that the attending physician gave her, and also leads a healthy lifestyle.
After the diagnosis has been established, treatment of retrochorial hematoma during pregnancy begins with the woman being hospitalized without fail. Such a patient needs bed rest and complete physical and emotional rest, which is difficult to achieve at home. Only in exceptional cases can a specialist prescribe therapy at home, but only if the retrochorial hematoma is a mild form. Even in such a situation, the pregnant woman must be under the constant supervision of a doctor.
In such a situation, a woman should exclude any hard work, and it is also necessary to refrain from sexual intercourse during the period of treatment. The requirements of this period include a review of a woman’s diet. The food that gets on her table should not provoke the development of constipation, and also exclude food that contributes to increased gas formation in the digestive tract. Prohibited foods include: beans, soybeans, beans and other legumes, as well as coffee, carbonated drinks and strong tea. During this period, it is better to take more liquid food.
In terms of medication, a pregnant woman must receive complex therapy. She is prescribed vitamin E, which allows her to activate the synthesis of necessary hormones, which improves the situation with hormonal balance and promotes the resorption of the hematoma.
This medicine is taken orally with sufficient liquid. The capsule is administered whole during a meal or immediately after finishing it. One capsule per day is enough to get a therapeutic effect. The duration of treatment therapy is determined by the treating doctor.
A contraindication to the use of this medicine is individual hypersensitivity to its component composition. This drug should also be prescribed with extreme caution if a woman’s tests show a low prothrombin time.
Folic acid is also required in the treatment protocol, which is basic for the normal course of pregnancy and the necessary development of the fetus. This drug takes part in DNA synthesis.
The drug is administered orally after meals. The recommended starting dosage of the drug is 1–2 mg one to three times a day, which corresponds to one to two tablets. The maximum daily amount of the drug should not exceed 4 mg during pregnancy, which corresponds to four tablets, and during lactation - 3 mg (three tablets, respectively). The duration of treatment with folic acid is usually from 20 to 30 days.
Folic acid is not recommended if the woman has a history of allergic reactions, especially to folic acid. A pregnant woman must be prescribed sedatives, since negative emotions hinder the achievement of an effective result. For example, a doctor may prescribe magnesium sulfate, valerian extract or Novo-passit, which is drunk 5 ml three times a day; if there is no measuring cup, it can be replaced with a teaspoon, which just holds this amount of the drug .
If medically necessary, the dosage can be doubled. If a pregnant woman experiences excessive lethargy, the drug is administered on a dosage schedule in which ¼ of the dose is taken in the morning and at lunchtime, and the remaining half of the daily dosage is left in the evening and taken immediately before going to bed.
The medicine is allowed to be taken in the released concentration, and can also be added to drinks. If Novo-passit provokes the development of a disorder in the digestion of food, it is better to take it together with food.
Novo-passit should not be prescribed if the patient has a history of muscle weakness, or if there is an individual intolerance to the components of the drug.
But the basis of drug therapy is drugs that work to improve the quality of blood clotting. An obstetrician-gynecologist can prescribe tranexamic acid, dicinone, prophylactic S, vikasol, ascorutin, rutascorbine. The vitamin preparation Ascorutin is taken one tablet three times throughout the day, the preventive dosage is one tablet twice a day. Duration of treatment is three to four weeks.
A contraindication to taking ascorutin is the woman’s increased intolerance to the components of the drug, including vitamins P and C. This medication should also not be taken if the woman has a history of diabetes, gout, kidney stones, or thrombophlebitis.
To relieve spasmodic pain, the doctor introduces antispasmodics into the treatment protocol, for example, suppositories with papaverine, viburkol, drotaverine, no-spa.
An antispasmodic drug that relaxes the smooth muscles of blood vessels, as well as other internal organs - No-spa. This medicine is taken orally at a dosage of 40–80 mg two to three times a day, or a 2% solution into a vein (administered very slowly), 2–4 ml. Quite rare, but intra-arterial administration of the drug is also allowed.
The drug in question should not be prescribed if a pregnant woman suffers from increased intraocular pressure (glaucoma), as well as in case of individual intolerance to the drug. Included in the treatment protocol for retrochorial hematoma during pregnancy is a drug that is designed to relax the muscles of the uterus. This is Magne B6, a vitamin that is taken with food. To do this, the contents of three to four ampoules are introduced into half a glass of clean water at room temperature. This amount of the drug is divided into two to three daily doses. The maximum daily dosage should not exceed four ampoules. Contraindications for administering Magne B6 include hypersensitivity to any component of the drug, as well as severe renal failure with creatinine clearance less than 30 ml/min. Medicines based on female sex hormones and their synthetic analogues, such as utrozhestan or duphaston, are also introduced.
Duphaston is taken orally with a starting dosage of 40 mg once, after which 10 mg are started to be administered into the woman’s body every eight hours. This dosage schedule is maintained for a week. Then the amount of administered medication is gradually reduced.
Duphaston is contraindicated if the pregnant woman is hypersensitive to dydrogesterone or other components of the drug, as well as with certain liver diseases.
Medicines that improve uteroplacental permeability are also introduced. The pharmacodynamics of such drugs as chimes and actovegin allow us to solve this problem.
The angioprotective drug curantil is prescribed in a dosage of 0.075 to 0.225 g, divided into three to six doses. Upon obtaining therapeutic effectiveness, the administered amount of the drug is reduced to 0.025 - 0.050 g. The maximum permissible daily amount of administered chimes is 0.6 g.
Chimes is contraindicated if the woman has a history of individual intolerance to dipyridamole or other components of the drug, as well as with subaortic stenosis, renal and/or cardiac dysfunction, which is in the terminal stage.
Homeopathic medicines are also used in the treatment of retrochorial hematoma during pregnancy: sulodexide or Wobenzym.
Sulodexide is administered orally between meals, and intramuscular and intravenous administration is also acceptable. The medicine should not be prescribed if the pregnant woman suffers from hemorrhagic diathesis, as well as in case of hypersensitivity to the components of the medicine.
After drug treatment is completed, the attending physician must prescribe a control ultrasound examination. Its results make it possible to evaluate the effectiveness of the therapy and, if necessary, adjust the treatment or cancel it.
Prevention of retrochorial hematoma during pregnancy
Analyzing the already known reasons that can provoke the pathology in question, we can conclude that the appearance of some sources can be completely avoided if a woman is more attentive to her body and tunes in to a healthy lifestyle. Prevention of retrochorial hematoma during pregnancy is a comprehensive measure to prevent the development of the disease or reduce the risk of its manifestation.
Such events include:
- Remove negative habits from your life: alcohol, drugs, nicotine.
- When a viral or infectious disease of any origin appears, it is necessary to carry out timely and complete treatment, avoiding relapses.
Prognosis of retrochorial hematoma during pregnancy
The answer to this question largely depends on the size of the hematoma. If its parameters are less than 20 ml, the prognosis of retrochorial hematoma during pregnancy is favorable. The pathology can resolve on its own or requires minor medical intervention.
If the hemorrhage occupies more than 40% of the surface area between the chorionic membrane and the uterine wall or the volume of the hematoma is more than 20 ml, the likelihood of losing the baby becomes more real. In order to achieve a positive result in such a situation, a pregnant woman, at the first signs of pathological changes, must notify her obstetrician-gynecologist, who, after assessing the clinical picture, prescribe an additional examination and write out the necessary recommendations. This approach to therapeutic treatment is a guarantee of health for both the expectant mother and her baby.
The expectant mother must clearly understand that any pathological symptoms should not be ignored, because seemingly minor discomfort can develop into very dangerous pathologies, for example, such as retrochorial hematoma during pregnancy, which, without proper therapy and ignoring its symptoms, can lead to spontaneous abortion. And, simply put, a woman can lose her baby. Therefore, in order to prevent this, you need to be more attentive to your body, and if it signals with various symptoms, then you should not brush aside its signals. After all, timely detection of the problem and initiation of therapy will allow you to quickly stop the bleeding, block the growth of the hematoma and lead to its resorption. After undergoing treatment, up to 98% of pregnant women go to term without any problems and give birth to a healthy child on time.
The term means one of the signs of complications during pregnancy, as a result of which blood accumulates behind the chorion (future placenta) when the fertilized egg moves away from it.
In other words - when rejected, the fertilized egg forms a cavity filled with blood, which is called a hematoma.
Manifests brownish discharge, nagging abdominal pain and discomfort. In the early stages it may not show itself at all.
The first case, despite the anxiety of pregnant women, is considered more successful: evacuation of blood clots is an indicator of positive dynamics.
The most dangerous clinical manifestation- bloody issues. If there is a drop in blood pressure and severe pain, then such symptoms may lead to premature termination of pregnancy.
Constant monitoring with ultrasound and level checking is required.
Hematoma– quite common among expectant mothers. It is impossible to foresee and insure against it.
Causes
Causes retrochorial hematoma:
- physical exercise;
- harmful effects of the environment (vibration, noise, etc.);
- hormonal imbalances;
- malformations of the uterus;
- inflammatory and infectious diseases of the genitourinary system;
- autoimmune processes;
- chronic endometritis;
- pathologies of the body's coagulation system;
- genital infantilism.
What is the treatment?
It is acceptable to carry out treatment at home, but under the constant supervision of a doctor. The sooner a hematoma is detected, the better. The most important- don't let it grow.
A timely reaction and adequate medical prescriptions can eliminate possible serious consequences. As a rule, only 2-3% of cases end in termination of pregnancy.
Prescriptions from obstetricians and gynecologists usually include the following: bed rest, lack of anxiety, physical activity and, of course, sexual activity.
Sometimes it is advised to place a pillow under the pelvic area to facilitate the outflow of blood. Required condition– a diet that promotes the normal functioning of the digestive system.
Or excessive gas formation can create additional effects on the uterus.
Drugs that are used during therapy:
- improve blood clotting: , Ascorutin, Vikasol, ;
- antispasmodics:, Viburkol or other suppositories with Papaverine;
- relaxes the uterine muscles: ;
- calming: extract, ;
- improving placental perfusion: And ;
- hormonal: Dydrogesterone (
Every third pregnant woman experiences this from her own experience. This is one of the most common pathologies of early pregnancy. Is this condition dangerous, why does it develop, and whether the hematoma needs to be treated will be discussed in this article.
What it is?
Retrochorial hematoma during pregnancy is an insidious and dangerous pathology, which can have very sad consequences for the mother and child. A hematoma is a hemorrhage or bruise. To understand where and how this bruise forms during pregnancy, you need to understand how the fertilized egg attaches to the uterine cavity.
8-10 days after ovulation, the fertilized egg, after a long journey through the fallopian tube, enters the uterine cavity. Its task is to implant itself, to gain a foothold. Special enzymes that produce membranes help literally dissolve the epithelial layer of the uterus, penetrate and grow tightly into it.
The place of attachment of the chorion is a close vascular connection between the fertilized egg with the embryo growing in it and the wall of the uterus, which becomes looser before implantation under the influence of the hormone progesterone. The vascular network provides the fetus with nutrition and access to oxygen with maternal blood.
The chorion subsequently changes and becomes a young placenta. But this happens only by 12-14 weeks of pregnancy. Until the end of the first trimester, the placenta as such does not exist, there is only the chorion - its predecessor.
Any, even minor, detachment of the fertilized egg from the wall of the uterus causes ruptures of blood vessels from the vascular network. Blood leaks from damaged vessels and accumulates between the fertilized egg and the wall of the uterus. This is a hematoma.
Since we are talking about the chorion, the hematoma is called retrochorial. Thus, pathology occurs only in the early stages of pregnancy. If abruption occurs later, when the placenta is formed, the hematoma is called retroplacental.
The danger of such a detachment is that the hematoma will not go away on its own. If there is no outlet for the accumulated blood, then the hematoma will increase, and more and more sections of the chorion will be involved in the detachment until the fertilized egg loses contact with the uterine wall over a large area or moves away from it completely. For the embryo, departure means death, since it will no longer receive the necessary nutrients and oxygen. In a pregnant woman’s body, the chorion, damaged and deprived of blood supply, will stop producing the hormone hCG necessary for bearing a baby, and this will lead to spontaneous miscarriage in the early stages.
The mechanisms of hematoma occurrence are not completely clear to modern medicine, but statistics exist, and they are far from reassuring: the diagnosis of “retrochorial hematoma” is made in approximately 35-40% of pregnant women.
This does not mean that all pregnancies end in miscarriage, since the mere presence of such a hematoma does not necessarily lead to the cessation of fetal life.
Causes
The reasons can be very different, and it is not always possible to detect the true cause in a particular woman, because doctors tend to believe that several negative factors are usually “to blame” for the formation of a hematoma. The most likely of them are several reasons.
- Hormonal imbalances. If pregnancy occurs due to insufficient levels of progesterone, if a woman has other hormonal pathologies or thyroid dysfunction, then it is very likely that in the very early stages of pregnancy the endometrium of the uterus will not be ideally ready for implantation. The risk of developing partial or complete detachment increases. Hormonal causes are one of the most common; they accompany early miscarriages in approximately 15% of pregnant women.
- Stress. A disruption of the close relationship between the chorion and the endometrium of the uterus can occur due to severe stress, anxiety, and emotional shock, since the stress hormones produced during this process block the production of female sex hormones. In addition, stress causes fluctuations in blood pressure levels, and abruption may occur due to them.
- Early toxicosis. If toxicosis appears early and is very strong, the woman’s functioning of all organs and systems, including the cardiovascular, nervous, and endocrine systems, is disrupted. Due to complex disorders associated with changes in blood composition and viscosity, detachment may occur.
- Bad habits. Smoking and alcoholic beverages, if a woman continues to consume them during pregnancy, have a detrimental effect on the condition of blood vessels and pressure. Early chorion detachment in this case is associated precisely with the fragility and vulnerability of blood vessels, which is characteristic of all women who smoke and drink.
- Gynecological diseases and complicated anamnesis. Quite often, detachment of the chorion from the wall of the uterus occurs in women who, even before pregnancy, had problems with reproductive health - uterine fibroids, endometriosis, often had abortions or have postoperative scars on the uterus.
- Autoimmune processes. It is relatively rare, but it happens that a woman’s immunity cannot adapt to pregnancy and produces specific antibodies to her own cells and the cells of the embryo. Then rejection occurs due to the action of immune processes. This is the most complex reason, which is very difficult to correct.
- Fetal pathologies. At a short period of time, a woman may not yet know about the chromosomal or structural abnormalities that exist in the child, but nature already knows this for sure; the fertilized egg is sometimes rejected due to the impossibility of further development of the fetus. It is usually not possible to stop such detachment.
- External negative influences. A woman’s body can be affected by working in hazardous industries, with paints, varnishes, and toxic substances. Both household chemicals and radioactive radiation are dangerous. And also increased risks are created by vibration, shaking, strong physical activity, and jumping.
In addition, taking medications without a doctor’s permission, chronic diseases of the heart, kidneys, liver and urinary system can affect the integrity of the contact between the chorion and the wall of the uterus. Sometimes the cause of detachment is not obvious, and it is almost impossible to establish it.
Symptoms
Most often, retrochorial hematoma is manifested by aching pain in the lower abdomen and lower back (as during menstruation), unusual discharge from the genital tract. The discharge contains blood and can be bloody, pink, bloody, orange, and others. The abundance of discharge depends on the degree of detachment and the size of the hematoma, as well as the presence of blood exiting the damaged vessels into the vagina.
If the hematoma is closed, there is no way out, the pathology proceeds without discharge, but with aching and nagging pain. The presence of scarlet blood on a panty liner indicates that the detachment has just begun, the blood has not yet dried, it is fresh. Brown discharge indicates that the detachment occurred earlier, and now the process of congealed blood coming out and the hematoma resolving has begun.
Brown discharge is considered the most favorable sign. The more abundant they are, the better the prognosis - the hematoma resolves, the detachment has stopped.
If the scarlet discharge continues and the pain becomes stronger, it is likely that the separation of the fertilized egg from the uterine wall continues. At the same time, the pain intensifies, it becomes cramping and constant. Due to changes in hormonal levels, a woman begins to experience severe anxiety, worry and even fear. The heart rate becomes more frequent and the blood pressure becomes lower. The woman begins to feel severe weakness and malaise.
If the chorion is located in the fundus of the uterus (in the highest and widest part), then there may be no symptoms. And the expectant mother can only find out about a possible detachment during the next ultrasound or when it is too late to do anything - if the fertilized egg detaches completely and a miscarriage begins.
Retrochorial hematoma is considered one of the main causes of threatened miscarriage in the early stages of pregnancy. This is bad news. But there is also a good one - up to 95% of all cases of such chorion detachment end quite successfully- the pregnancy is preserved, the child grows and develops further, this incident does not affect his condition in any way.
Diagnostics
Determining retrochorial hematoma during pregnancy does not cause any great difficulties. If there are symptoms, then a preliminary diagnosis is made based on clinical signs; if there are no symptoms, then the hematoma can only be detected by ultrasound scanning. The doctor will refer you for an ultrasound in any case if he has even the slightest suspicion of chorionic detachment.
The risk group is women who have previously suffered from chorion or placental abruption, who are carrying twins or triplets, mothers of many children whose uterine walls have already lost their natural elasticity, women with a complicated medical history, as well as those who became pregnant after a long period of infertility on their own or through IVF.
Ultrasound is performed intravaginally, this allows not only to assess the presence or absence of a hematoma, determine its exact location and size, but also to examine the cervix and assess the condition of the internal pharynx. If the detachment is large and the pharynx opens slightly, they talk about a miscarriage that has begun, but if fragments of the fertilized egg have already begun to leave the uterine cavity, they talk about a miscarriage that has taken place.
With a retrochorial hematoma, the cavity filled with blood is defined as a darkened echogenic area; the fertilized egg itself may have an irregular shape and be deformed.
How to treat?
If the doctor suggests hospitalization, you should not refuse it - detachment is a serious matter, and they suggest going to the hospital only in case of a fairly serious detachment. A small hematoma can be treated at home.
A pregnant woman will be sent to the hospital if she has severe pain, bright scarlet blood is released from the genital tract, blood pressure is reduced, and there is a general deterioration in her condition. And they also send women to the hospital whose hematoma is quite large, and the blood has no way out (no discharge).
The accumulation of blood between the chorion and the uterus in an amount of more than 20 milliliters is considered dangerous. With small pink or brown discharge, a woman may well be allowed to be treated at home.
The main goal of treatment is resorption of the hematoma. In order to prevent the smooth muscles of the uterus from becoming toned and thereby increasing detachment, antispasmodic drugs are prescribed: “No-shpa”, “Papaverine”. To improve blood circulation, general systemic drugs “Actovegin”, “Curantil” are used, and to stop bleeding if it increases, hemostatics are used, for example, “Ditsinon”, “Vikasol”.
If detachment occurs due to hormonal deficiency, progesterone drugs are prescribed - Utrozhestan, Duphaston and others in an individual dosage, which the doctor selects based on a blood test for the hormonal profile. Particular attention is paid to vitamins; they are indicated for all pregnant women at risk of miscarriage. To eliminate the symptoms of stress and uterine tone, Magne B 6 is recommended.
A woman is recommended to use products containing iron to eliminate the symptoms of anemia, if any, as well as to prevent anemia, which can intensify and aggravate the detachment. For a woman, even with a small retrochorial hematoma, bed rest or semi-bed rest is recommended; in a lying position, it is best to place a cushion under the lower back.
But you should also avoid visiting bathhouses and saunas, and do not swim in a hot bath. Hygienic procedures should be limited to a warm shower; any overheating of the body threatens to result in the development of uterine bleeding and loss of pregnancy.
It is important to avoid constipation, since excessive straining during bowel movements can lead to undesirable consequences. If constipation does occur, you should find out from your doctor which mild laxative you can use in early pregnancy.
If you do not follow the recommendations, it is possible that a miscarriage will still occur. There is also a possibility that even if the pregnancy continues, placental abruption may occur at a later date, and this is the most dangerous.
