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Comments: Patient has heavy bleeding. US exam show viable fetal pole. Please look carefully at the image and explain why it is bleeding. What cause it? What are the consequences?
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12 comments:
I think I see a subchorionic hemorrhage anterior to the GS. This is "the most common sonographic abnormality in the presence of a live embryo. Vaginal bleeding affects 25% of all women during the first half of pregnancy".
http://emedicine.medscape.com/article/404971-overview
There are lots of cause of vaginal bleeding at the first trimester.It looks like subchorionic hemorrhage or hematoma to me as well.
Subchorionic hemorrhages are often seen during first trimester ultrasound. While it is considered to be an abnormality, it is seen in many pregnancies and often is of no consequence. In addition,
Most subchorionic hemorrhages are small and will not have an effect on the pregnancy. They generally clear up by the second trimester.
Using ultrasound, subchorionic hemorrhages are usually seen as an anechoic (black) area. Some hematomas may look the same as the placenta (isoechoic) and may not be seen. Larger hematomas are more likely to contribute to a poor outcome and may cause bleeding throughout the duration of the pregnancy.
http://www.suite101.com/content/subchorionic-hemorrhage-a143383
The treatment options for subchorionic hemorrhage are blood thinners to dissolve the blood clot, bedrest and refraining from lifting up heavy stuff
"The current statistics for pregnancy loss with a subchorionic hemmorrhage (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."
http://www.justmommies.com/articles/subchorionic-hematoma.shtml
Hi, Zenya
Subchorionic hemorrhage can be one of the risk factors in early pregnacy, however, there is no specific treatment to cure it. Most SCH are cured spontaneously, and every doctor suggests different treatments for patients depending on patients' condition.
Hye
Another serious consideration of 1st trimester bleeding is an ectopic pregnancy. I agree with Abby that this is a subchorionic hematoma. The outcome of the fetus depends on the size of the hematoma, the mother's age, and the fetus's gestational age. The subchorionic hemorrhage/hematoma collects between the uterine wall and the chorionic membrane and may leak through the cervical canal. Later in the first trimester and early second trimester, the subchorionic hematoma may partially strip the developing placenta away from its attachment site. Therefore, the prognosis of patients with this type of hematoma is worse than the prognosis of patients with hematoma early in first trimester.
http://emedicine.medscape.com/article/404971-overview
Zouliath said
According to the patient history and the pictures it is a subchorionic hemorrhage, but we still need to r/o ectopic pregnancy because it is also frequent source of pain in the first trimester pregnancy.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.
I agree with each of the blogger responses and I would add that if the OB physician or perinatologist is suspicious of fetal loss a cerclage is performed to save the fetus and the mother would be put on bed rest and lifting weight restrictions. Chorionic bleeds could be caused from stress or too much activity and lifting heavy objects.
I would have to agree with the anterior subchorionic/implantation bleed. This is extremely common and can resolve without negative implications. This is probably incorrect, but the baby appears to be a little small for 10 and half weeks....
You all did a great job! It is really a subchorionic bleed in the first trimester of pregnancy. Patient had to come for the F/U and it resolved.
do you know that a woman with a subchorionic hematoma can have bleeding of varying quantities, ranging from light spotting to a heavy flow with clots, or she may have no outward symptoms at all. The bleeding can be painless, or there may be mild abdominal cramping.
Subchorionic Hemorrhage is bleeding behind the placenta, often caused by a clot. In most cases, this clot will dissolve away, resolving the problem and allowing the pregnancy to progress normally. It may take several weeks for this clot to dissolve. Treatment for a Subchorionic hemorrhage is typically bed rest.
Rarely, the clot dissects between the placenta and the attachment to mother. This may lead to placental abruption. Risk factors that may increase the chance of experiencing this include high blood pressure, smoking and cocaine use. Symptoms may include:
- contractions that don't stop
- pain in the uterus
- tenderness in the abdomen over the uterus
- vaginal bleeding
If you experience these symptoms, you should contact your physician immediately. Treatment of placental abruption will vary according to your particular state. If the separation of the placenta is small, the baby isn't in distress, and your condition is stable, you may be able to go home and continue the pregnancy with frequent checkups. If the separation is moderate to severe but the baby is not in distress and your condition is stable, the doctor may induce labor and perform a vaginal delivery. If the baby is in distress or if you are losing a lot of blood, the doctor will most likely deliver the baby immediately by cesarean section.
http://www.amazingpregnancy.com/pregnancy-articles/191.html
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