Retrochorial hematoma in early pregnancy: causes, symptoms, treatment
The content of the article:
- Reasons for the formation of retrochorial hematoma
- Symptoms
- Diagnostics
-
Treatment
- Drug therapy
- General recommendations
- Evolution of pathology
- Effects
- Video
Retrochorial hematoma during early pregnancy is a fairly common pathological condition, since it is in the first trimester that the probability of detachment of the ovum is highest. This phenomenon is considered as a sign of the threat of termination of pregnancy, and therefore it is better to carry out therapy in a hospital under medical supervision.
Retrochorial hematoma occurs early in pregnancy
The appearance of a hematoma of this type is a partial detachment of the chorionic plate from the underlying decidua. Chorion is the outer shell of the ovum, covered with numerous villi that grow into the inner wall of the uterine surface.
It is the precursor of the placenta, which, until its final formation by the beginning of the second trimester, is responsible for protecting the fetus from internal and external influences.
If the disease is detected at a later date, even with adequate treatment, there is a likelihood of placental insufficiency, hypoxia, intrauterine fetal growth retardation and other severe consequences.
Reasons for the formation of retrochorial hematoma
As a result of the detachment, a subchorial space is formed, in which blood clots accumulate. In about 18% of cases, retrochorial (subchorial, retrocochial) hematoma is the cause of bleeding at the beginning of pregnancy.
It is almost impossible to predict the formation of a subchorial hematoma, as well as to accurately determine the cause of its development. This pathological condition can occur due to many factors, namely:
- physical stress;
- harmful effects of the environment;
- hormonal disorders;
- malformations of the uterus;
- genital infantilism;
- abdominal trauma;
- chronic endometritis;
- infectious and inflammatory diseases of the urogenital zone of various origins;
- autoimmune processes;
- persistent viral and bacterial infection;
- violation of blood clotting;
- stress;
- excessive use of alcohol, tobacco smoking, drug addiction;
- early and late toxicosis;
- fetal malformations;
- external factors: hypothermia, overheating and others.
In many cases, the pathology is noted in patients who underwent medical procedures such as stimulation of ovulation and in vitro fertilization (IVF), and is accompanied by luteal insufficiency of varying degrees. In them, the hematoma becomes a consequence of the immunological conflict between the mother and the fetus due to the activation of immunomodulatory mechanisms mediated by progesterone.
Symptoms
You can suspect a pathological condition by the following symptoms:
- pulling and radiating to the lower back pain in the lower abdomen, reminiscent of premenstrual;
- brownish vaginal discharge;
- constant weakness and fatigue.
One of the main symptoms is lower abdominal pain
It should be borne in mind that these signs are nonspecific and may differ in severity and even be absent altogether. In many cases, the hematoma is detected at random, since its development is not accompanied by pain or discharge. In addition to slight discomfort, a woman may not be bothered by anything, which delays the timely detection of education, and, accordingly, the start of therapy.
Diagnostics
Timely detection is of great importance for the effective treatment of pathology. It is recommended that even with minor discomfort, seek advice from a gynecologist, as this can allow timely application of appropriate measures and avoid negative consequences for both the mother and the fetus.
Pathology is often detected during a routine ultrasound
Diagnosis of retrochorial hematoma is carried out by comparing the data of the clinical examination with the results of ultrasound examination of the pelvic organs. Ultrasound allows you to differentiate the type of education, determine the place of its localization, as well as the state and viability of the embryo.
If a large hematoma is suspected, accompanied by profuse blood loss, a blood test is mandatory, during which anemia is usually detected.
Treatment
The applied therapy, first of all, should be aimed at preventing the growth of a cavity with blood clots. The most dangerous are hematomas that occur before the 9th week of pregnancy, located in the bottom or posterior wall of the uterus, in a volume exceeding 5 cm 3.
In these cases, treatment must be carried out without fail in a hospital under medical supervision, while small formations can dissolve on their own, without requiring auxiliary therapy.
Drug therapy
As medicines can be used:
| A drug | Act |
| Dicinon, Vikasol, Etamsilat | Improves blood clotting |
| No-shpa, Papaverine | Reduce uterine hypertonicity and relax its smooth muscles |
| Vitamin E | Activates the production of hormones that ensure the normal course of pregnancy |
| Ascorutin | Helps stop bleeding, has antioxidant properties, participates in tissue regeneration |
| Valerian extract, Novo-Passit | Have a beneficial effect on the nervous system |
| Magne B6 and other magnesium preparations | Relax the muscles of the uterus |
| Curantil, Actovegin | Improve microcirculation, inhibit platelet aggregation, provide resorption of hematoma |
| Euphyllin, Verapamil, Dibazol | Are prescribed for suspected preeclampsia against the background of retrochorial hematoma as antihypertensive agents |
| Furosemide, Hypochlorothiazide | They have a diuretic effect, are prescribed for severe edematous syndrome |
With continued intrauterine bleeding and an increasing hematoma, both with and without bloody discharge, treatment begins with the appointment of hemostatic agents. The first-line drug in this case is tranexamic acid, which has an anti-inflammatory and hemostatic effect without a pronounced effect on the hemostatic system.
To reduce the hypertonicity of the uterus and relax its smooth muscles, No-shpa is prescribed
After stopping bleeding, it is preferable to use antiplatelet agents that help to normalize blood circulation in the uterus.
Since the development of retrochorial hematoma is influenced by a deficiency of progesterone, it becomes necessary to take medications containing this hormone. In addition to filling the existing deficit, such drugs have an immunomodulatory, anti-inflammatory and tocolytic effect.
Independent selection of any medicines or traditional medicine is not recommended. Only a qualified doctor, taking into account the individual characteristics of the mother's body, can prescribe the most effective treatment that is safe for the developing fetus.
General recommendations
All pregnant patients are advised to:
- compliance with bed rest;
- exclusion from the diet of foods that contribute to gas formation and intestinal obstruction: fried and fatty foods, spices, salt, baked goods, strong coffee and tea;
- the use of a large volume of liquid: pure mineral water, compotes, fruit drinks, kefir;
- exclusion of sexual intercourse.
Evolution of pathology
The evolution of pathology can occur in two ways. Small hematomas are able to resolve on their own over time without causing any adverse consequences. At the same time, pregnancy proceeds normally, and there are no threats to the development of the embryo.
The opposite situation is observed with strong chorionic detachment - there is a high probability of an increase in the volume of formation and separation of the ovum from the decidua, which is accompanied by severe bleeding and leads to spontaneous abortion.
Effects
It is impossible to establish a clear term for how long the hematoma will leave. This process directly depends on the localization of the cavity, its size and the individual characteristics of the mother's body.
Pathology can lead to the development of serious consequences
The appearance of brownish vaginal discharge is considered a positive sign, indicating the release of clotted blood. If you have a reddish discharge, it is important to seek urgent medical attention, as it may indicate the onset of uterine bleeding.
Retrochorial hematoma in severe cases can cause various complications. The most negative consequence for a woman is Couveler's uterus (uteroplacental apoplexy). This is a disease in which necrosis begins due to the soaking of the endometrium with blood. It is usually considered as a direct indication for removal of the uterus.
Video
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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