Retrochorial hematoma in pregnancy

Chorion is the name of a thin, but elastic and strong, film that protects the resulting fertilization of the egg, and subsequently the fetus. It is formed from the first days of conception. Further, with further development of the embryo against a background of normal development of the fetus, this film is transformed into a placenta. But there are situations when the development fails, leading to the separation of the embryo from the chorion. The emerging gap begins to fill with blood. It is this pathological change that is called medics - retrochorional hematoma in pregnancy. This is a very dangerous pathological deviation, which can lead to the loss of a woman of her unborn baby.

The causes of retrochorial hematoma in pregnancy

To get this or that violation from the normal course of pregnancy, there must be a source that provoked the pathological deviation in question. To date, this problem has not been fully understood yet, and it has not yet been possible to fully identify all sources that provoke the appearance of the pathological change under consideration. But many causes of retrochorial haematomas are still established during pregnancy.

Analyzing the list below, for yourself you can determine the opinion that the appearance of a certain number of sources can be fully protected if the woman is more attentive to her body and adjusts to the right way of life, although some of the sources listed below do not obey the will and desire of the representative the fair sex.

• Congenital pathology in the formation of female genital organs, including uterus.
• Underdevelopment of female genitalia or as it is also called infantilism. This term indicates that an adult of a weaker sex who has reached reproductive age, a gynecologist observes one or more criteria that are characteristic of young children or teenagers.
• Diseases affecting the endocrine system can lead to hormonal imbalance, which can become the primary source of retrochoric hematoma in pregnancy. And if you consider that pregnancy is also a stress for the female body, the hormonal imbalance can only increase.
• Provoke the detachment of the chorion can and active physical work, increased stress. It is for this reason that a woman who has learned about her "interesting position" should not be lifted by weights. Neglect of these recommendations can lead to complications of pregnancy, the threat of miscarriage or the vices with which the baby is born.
• Endometritis of a chronic nature is the inflammation of the inner layer of the uterus, which occurs under the influence of an invasive infection.
• Fetal malformations of the fetus.
• Infectious diseases and inflammatory processes affecting the genitourinary system of the female body. If there are first signs of infection, it is necessary to immediately seek advice from a specialist and undergo clinical therapy, preventing the passage of pathological lesions into a chronic condition.
• To provoke the development of retrochoric hematoma during pregnancy are capable of harmful conditions in which the future mother works. It can be a constant vibration; high dustiness of the room; monotonous, uninterrupted noise.
• Constant stress, emotional overload.
• The cause of the pathological disorder may be the resulting injury.
• Diseases of an autoimmune nature. This pathology develops when the human immune system fails and the body begins to synthesize antibodies that begin to "fight" not with the invading pathogenic flora and parasitic microorganisms, but with the cellular structures of their body. In this case, as a rule, the cells that are being destroyed are completely healthy.
• Psychological shocks.
• Presence in the anamnesis of a pregnant benign or malignant neoplasm.
• Myoma of the uterus.
• Problems with blood and blood coagulability.
• A severe manifestation of toxicosis should be the reason for an immediate reference to a specialist.
• Harmful habits that suffer from a future mother: drugs, alcoholism, nicotine.
• Overweight, obesity.

Hence it can be concluded that there are a lot of sources capable of provoking the development of retrochoric hematoma during pregnancy, but the likelihood of its occurrence can still be reduced. It is possible, if a woman removes those provoking factors, which she is able to fully influence.

Symptoms of retrochorial hematoma in pregnancy

The pathological change under consideration is a cumulation of the blood clot that forms during the peeling of the uterine wall from the embryonic membrane in the emerging gap. This disease is very dangerous. When diagnosing retrochoric hematoma in pregnancy, it is necessary to immediately begin to stop this process, because such appearance of the signs of this pathology indicates the emergence of a threat of miscarriage (abortion).

Symptoms of retrochoric hematoma in pregnancy largely depend on the level of neglect and severity of the disease. If a woman has pathological disorders represented by a mild form of pathology, she may not even suspect the presence of this problem. Such a form of retrochoric hematoma can be diagnosed only during an ultrasound examination. This clinical picture is observed because the emerging blood clots do not pour out due to villi chorion, which keep them in a limited space.

The average degree of the disease already has its own symptomatology, which starts the future mother to bring discomfort:

• She has a drawing pain in the lower abdomen and in the lumbar region.
• From the genital organs appear a brownish tinge.

But if the color of the discharge is brown, then the specialists are not in a hurry to worry, just such a patient is taken under closer control. The brown color of the secretions can only say that the internal hematoma simply dissolves on its own.

But in case of the appearance of blood discharge it is necessary to sound an alarm. There are serious reasons for concern. The appearance of red or scarlet blood suggests that the woman has intrauterine bleeding. And since it does not stop, the specialist draws a conclusion about the enlargement of the hematoma and the progression of the chorion detachment process, which will invariably lead, if not to take urgent adequate measures, to the termination of pregnancy.

Symptomatic of severe form of retrochoric hematoma during pregnancy:

• Drawing pain in the lower abdomen grows into cramping attacks.
• A sharp drop in blood pressure is observed.
• Large amounts of bleeding.
• There are cases when the pregnant woman has 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 in pregnancy

If pathological processes take place in mild form, then you should not worry. The woman's body is able to cope with the problem on her own. The consequences of retrochoric hematoma in pregnancy directly depend on the dimensional characteristics of the tumor.

The greatest danger is bruising, which has volume indicators of more than 20 ml, as well as those that cover the area of a fertilized egg, or already developing embryo, by at least 40%.

This clinical picture causes oppression of normal fetal development, as well as increases the risk of increasing the detachment process, which invariably provokes abortion.

But at once, at occurrence of a similar symptomatology, the woman should not panic. If the pregnant woman is provided with timely help, then the therapy of retrochoric hematoma during pregnancy is favorable. Even if the bleeding was extensive, the probability of a successful outcome is large enough.

When diagnosing the pathology in question and timely effective treatment, a woman is fully capable of giving birth alone, unless there are other contraindications in her anamnesis. However, prior to safe delivery, such patients undergo a number of additional examinations, and are, until the time of delivery, under close supervision of the obstetrician-gynecologist.

But there are cases when bleeding and bloody clots in the uterine cavity arose in the prenatal period, then the obstetrician-gynecologist can prevent the pregnant woman from giving birth by appointing a cesarean section that is performed in conjunction with amniotomy (surgical opening of the bladder).

With retrochoric hematoma, miscarriages are noted in isolated cases. Such a result is usually more likely if the woman became very late on pregnancy records, as well as in the case of untimely medical care when pregnant uterine bleeding occurs.

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Diagnosis of retrochorial hematoma in pregnancy

If an expert suspected a woman of this pathology, then the diagnosis of retrochoric hematoma in pregnancy is represented by the only available method - ultrasound.

The expert can presume the presence of this disease according to certain characteristics:

• One of the walls of the uterus is thicker than the rest. This is the result of the presence in this place of hypertonicity, which invariably indicates a high probability of termination of pregnancy.
• Presence of blood clots in the formed interlayer between the wall of the female organ and the chorion. Thanks to this indicator, a specialist is able to assess the duration of a hemorrhage, its ability to progress and the location of localization.
• On the screen of the ultrasound machine, the deformation of the mother circuit is clearly discernible. This is due to the fact that protrusions of contracted muscle tissue occur, which rise above the rest of the structures.
• Changed and the configuration of the fetal egg. The outline of the embryo is different from the normal shape of a healthy embryo. It is more like a slightly elongated drop or has the shape of a boat.

Dimensions of retrochoric hematoma in pregnancy

Probably, there is no need to explain, what is this pathology dangerous? The most severe result of it can be a woman's loss of her child, that is, a retrochoric hematoma can provoke a miscarriage.

The final outcome largely depends on what the size of the retrochorial hematoma is in pregnancy. If its parameters do not reach 20 ml, then the doctor's control of the condition of the pregnant woman will not be superfluous, and therapy of pathology is necessary, but such hematomas do not bring particular anxiety and negative consequences.

If the amount of hemorrhage is much larger, and if the hematoma covers more than 40% of the surface of separation of the chorion and the uterine wall, the probability of losing the baby becomes more real. When this situation develops, the coccygeal - parietal embryo size is inhibited, sometimes, falling behind the accepted norms to ten days, which is also an unfavorable indicator of the course of pregnancy.

But even with successful therapy of relief of retrochoric hematoma in pregnancy, the threat of a negative situation for the fetus is not exhausted. In pregnant women who have undergone this pathology, gynecologists in the future are much more likely to observe the formation of placental insufficiency, that is, it begins to "age" much faster than it is allowed by the natural course of pregnancy. Against this background, the fetus receives an insufficient amount of food, which leads to its hypoxia, and as a result, this baby comes to this light with less weight.

But it should nevertheless be recalled that the scenario for the development of pathological changes largely depends on the volume of the hematoma, the location of its localization, and the timeliness of the provision of adequate medical care. Nevertheless, the level of modern medicine allows you to bring the vast majority of cases to a favorable outcome for both the woman and her unborn baby.

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Treatment of retrochoric hematoma in pregnancy

All modern techniques are reduced to solving two problems: blocking the growth of hemorrhage, as well as to its rapid resorption. But, apart from therapeutic treatment, it is very important for a successful outcome, so that the woman herself complies with the recommendations given to her by the attending physician, and she also led a healthy lifestyle.

After the diagnosis, treatment of retrochoric hematoma in pregnancy, begins with the fact that a woman is mandatory hospitalized. This patient needs a bed rest and full of both physical and emotional rest, which is problematic at home. Only in exceptional cases, a specialist can go for the appointment of therapy at home, but only if the retrochoric hematoma is represented by an easy form of leakage. Even in such a situation, the pregnant woman must be under constant doctor control.

In such a situation a woman should exclude any hard work, and also it is necessary to refuse for the period of treatment from sexual contacts. The requirements of this period include the revision of the diet of a woman. Foods falling on her table should not provoke the development of constipation, as well as exclude food, which contributes to increased gas formation in the digestive tract. To forbidden food include: beans, soybeans, beans and other beans, as well as coffee, carbonated drinks and strong tea. In such a period it is better to take more liquid food.

There is a recommendation that pregnant women who received the diagnosis in question, for better outflow of blood in the uterus, as well as to prevent its stagnation, it will be useful to put a small ottoman under the pelvis.

In the medical plan, the pregnant woman necessarily receives complex therapy. She is assigned vitamin E (Vitamin E), which allows to activate the synthesis of necessary hormones, which improves the situation with the hormonal balance, promotes resorption of the hematoma.

This drug is taken orally with a sufficient amount of liquid. The capsule is entered whole during or just after the meal. One capsule per day is enough to get a therapeutic effect. The duration of treatment is established by the treating doctor.

Contraindication to the use of this drug is an individual hypersensitivity to its component composition. And also with special caution should prescribe this drug, if the analysis of women shows a low prothrombin time.

Obligatory in the protocol of treatment and folic acid, which is the basis for the normal course of pregnancy and the necessary development of the fetus. This drug is involved in the synthesis of DNA.

The drug is administered orally after meals. The recommended starting dosage of the drug is 1 to 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 in pregnancy, which corresponds to four tablets, and in the lactation period - 3 mg (three tablets, respectively). The duration of treatment with folic acid is usually from 20 to 30 days.

Folic acid is not recommended for admission if a woman's history has a tendency to allergic reactions, especially folic acid. Necessarily pregnant are prescribed sedatives, because negative emotions inhibit obtaining an effective result. For example, a doctor can prescribe magnesium sulfate, valerian extract or Novo-passit, which is drunk 5 ml three times throughout the day, if there is no measuring cup, it can be replaced with a teaspoon, in which just this amount of the drug is placed .

In case of medical necessity, the dosage can be doubled. If the pregnant woman has excessive inhibition, the drug is administered in such a schedule, when ¼ part is taken in the morning and at lunch time, and the remaining half of the daily dosage remains for the evening and is taken immediately before going to bed.

The medicine is allowed to be taken in the released concentration, and can also be added to the drinks. If Novo-Passit provokes the development of a digestive disorder, it is better to take it with food.

Novo-Passit should not be prescribed if there is a muscle weakness in the patient's history, and there is also an individual intolerance to the constituents of the medicine.

But the basis of drug therapy is made up of drugs that work to improve the quality of blood clotting. Obstetrician - gynecologist can appoint tranexamic acid, dicinone, prophylaxis C, vikasol, askorutin, rutasorbine. Vitamin preparation askorutin is taken one tablet three times throughout the day, preventive dosage - one tablet twice a day. Duration of treatment is from three to four weeks.

Contraindication to taking ascorutin is an increased intolerance to the body of a woman's constituents of the drug, including vitamins P and C. And you should not take this medication if you have a history of a woman with diabetes, gout, kidney stones, and thrombophlebitis.

For the removal of spasmodic pain, the doctor enters into the protocol of treatment such antispasmodics, for example, as a suppository with papaverine, viburkol, drotaverin, no-shpa.

Spasmolytic drug, relaxing the smooth muscles of blood vessels, as well as other internal organs - No-shpa. This drug is taken orally inwards at a dosage of 40 to 80 mg two to three times throughout the day, or 2% solution in a vein (injected very slowly), 2 to 4 ml. Rarely, but intra-arterial administration of the drug is permitted.

Do not prescribe the drug in question if a pregnant woman suffers from increased intraocular pressure (glaucoma), as well as in case of individual intolerance to the drug. Included in the protocol for the therapy of retrochoric hematoma during pregnancy is a drug that is designed to relax the muscles of the uterus. It is Magne B6, a vitamin that is taken with food. For this, the content of three to four ampoules is 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. To the contraindications of Magne B6 injection include hypersensitivity to any component of the drug, as well as a severe form of renal failure with creatinine clearance less than 30 ml / min. Drugs are also introduced on the basis of female sex hormones and their synthetic analogues, such as utrozhestan or djufaston.

Duphaston is taken orally at a starting dose of 40 mg once, then women are injected into the body every eight hours for 10 mg. This schedule of admission is maintained for a week. Then, the amount of the drug administered is gradually reduced.

Contraindicated djufaston with increased sensitivity of the pregnant woman to dydrogesterone or other components of the drug, as well as with certain liver diseases.

Drugs are also being introduced that improve utero-placental permeability. To solve this problem allows the pharmacodynamics of such drugs as curantyl and actovegin.

The angioprotective drug curantil is administered at a dosage of from 0.075 to 0.225 g, divided into three to six receptions. When the therapeutic effectiveness is obtained, the amount of the drug administered is reduced to 0.025 to 0.050 grams. The maximum daily allowable amount of curantyl is 0.6 g.

Contraindicated churantil if a woman's history has an individual intolerance to the body of dipyridamole or other components of the drug, as well as with subaortic stenosis, renal and / or cardiac dysfunction, which is in the terminal stage.

They are used in the therapy of retrochoric hematoma in pregnancy and homeopathic preparations: sulodexide or wobenzyme.

Sulodexide is administered orally between meals, as well as intramuscular and intravenous administration is acceptable. Do not prescribe a medicine if the pregnant woman suffers from hemorrhagic diathesis, as well as in case of hypersensitivity to the components of the drug.

After the medication treatment is over, the attending physician must prescribe a control ultrasound examination. Its results allow you to evaluate the effectiveness of the therapy, and if necessary, adjust the treatment or cancel it.

Prevention of retrochoric hematoma in pregnancy

Analyzing the already known reasons that are capable of provoking the pathology under consideration, it can be concluded that the appearance of some sources can be completely avoided if the woman is more attentive to her body and will adjust to a healthy lifestyle. Prevention of retrochoric hematoma in pregnancy is a complex exercise that can prevent the development of the disease or reduce the risk of its manifestation.

Such activities include:

• Remove negative habits from your life: alcohol, drugs, nicotine.
• When there is a viral or infectious disease of any genesis, it is necessary to conduct timely and complete treatment, not allowing relapses.
• Treatment of chronic diseases of the genitourinary system.
• If there is a risk of development of retrochoric hematoma during pregnancy, the woman should spend more time resting and spending in bed.
• Under the pelvis it is recommended to put an ottoman, a roll or a folded blanket.
• Avoid emotional - psychological shocks and stressful situations.
• Do not let falls and bruises.
• A pregnant woman should not lift weights.
• Adjust your diet.
• Walk more, but avoid overloading and fatigue.
• Do not delay with registration for pregnancy.
• If negative symptoms occur, do not hesitate to seek medical advice from your doctor.

Prognosis of retrochoric hematoma in pregnancy

The answer to this question depends largely on the size of the hematoma. If its parameters are less than 20 ml, the prognosis of retrochoric hematoma in pregnancy is favorable. Pathology is able to dissolve on its own or requires little medication.

If the hemorrhage occupies more than 40% of the surface of separation of the chorion membrane and the uterine wall or the volume of the hematoma is more than 20 ml, the probability of losing the baby becomes more real. In order to achieve a positive result in such a situation, the pregnant woman, at the first signs of pathological changes, should inform her obstetrician - a gynecologist, who, after evaluating the clinical picture, appoint an additional examination and will list the necessary recommendations. This approach to therapeutic treatment is a guarantee of health, both for the future mother and her baby.

A future mother should clearly realize that any pathological symptomatology should not be left without attention, because, it would seem, a small discomfort can develop into very dangerous pathologies, for example, such as retrochorional hematoma in pregnancy, which, without proper therapy and ignoring her symptoms, is capable of lead to a spontaneous termination of pregnancy. And, more simply, a woman can lose her baby. Therefore, to prevent this, it is necessary to be more attentive to your body, and if it signals a different symptomatology, then one should not brush off his signals. After a timely detection of the problem and the beginning of therapy will quickly stop bleeding, block the growth of the hematoma and lead to its resorption. After treatment, up to 98% of pregnant women, without any problems, wear out and in due time give birth to a healthy child.