Retrochorionic hematoma in pregnancy

Chorion is the name of a thin, but elastic and strong film that protects the fertilized egg, and subsequently the embryo. It is formed from the first days of conception. Then, with further development of the embryo against the background of normal fetal development, this film is transformed into the placenta. But there are situations when there is a failure in development, leading to the separation of the embryonic egg from the chorion. The resulting gap begins to fill with blood. This pathological change is what doctors call a retrochorial hematoma during pregnancy. This is a very dangerous pathological deviation that can lead to the loss of a woman's unborn baby.

Causes of Retrochorial Hematoma During Pregnancy

In order to get one or another disorder 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 been established.

Analyzing the list below, you can decide for yourself that it is quite possible to protect yourself from the appearance of a certain number of sources if a woman is more attentive to her body and tunes in to a healthy lifestyle, although some of the sources listed below are not subject to the will and desire of the fair sex.

• Congenital pathology in the formation of female reproductive organs, including the uterus.
• Underdevelopment of female genitalia or as it is also called infantilism. This term means that in an adult representative of the weaker sex who has reached reproductive age, the gynecologist observes one or more criteria that are typical for small children or teenagers.
• Diseases affecting the endocrine system can lead to hormonal imbalance, which can be the primary source of retrochorial hematoma during pregnancy. And if we consider that pregnancy is also stress for the female body, then the hormonal imbalance can only increase.
• Active physical labor and increased loads can also provoke chorionic detachment. It is for this reason that a woman who has learned about her "interesting situation" should not lift heavy objects. Neglecting these recommendations can lead to complications during pregnancy, the threat of miscarriage or defects with which the baby will be born.
• Chronic endometritis is an inflammation of the inner layer of the uterus that occurs under the influence of an invasive infection.
• Intrauterine fetal developmental defects.
• Infectious diseases and inflammatory processes affecting the genitourinary system of the female body. When the first signs of infection appear, it is necessary to immediately consult a specialist and undergo clinical therapy, preventing the transition of pathological lesions into a chronic condition.
• The development of retrochorial hematoma during pregnancy can be provoked by harmful conditions in which the expectant mother works. These can be constant vibrations; high dustiness of the room; monotonous, incessant noise.
• Constant stress, emotional overload.
• The cause of the pathological disorder may be an injury.
• Autoimmune diseases. Such 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 its own body. In this case, as a rule, the destroyed cells are quite healthy.
• Psychological shock.
• The presence of a benign or malignant neoplasm in the pregnant woman's medical history.
• Uterine fibroids.
• Problems with blood formation and blood clotting.
• Severe manifestations of toxicosis should be a reason for immediate contact with a specialist.
• Bad habits that the expectant mother suffers from: drugs, alcoholism, nicotine.
• Overweight, obesity.

From this we can conclude that there are many sources that can provoke the development of retrochorial hematoma during pregnancy, but the probability of its occurrence can still be reduced. This is possible if a woman removes those provoking factors that she can fully influence.

Symptoms of Retrochorial Hematoma During Pregnancy

The pathological change in question is the accumulation of a blood clot, which forms in 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 an appearance of signs of this pathology indicates the emergence of 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 has pathological disorders represented by a mild form of pathology, she may not even suspect the presence of this problem. This form of retrochorial hematoma can only be diagnosed by ultrasound examination. This clinical picture is observed because the resulting blood clots do not flow out due to the chorionic villi, which hold them in a limited space.

The average stage of the disease already has its own symptoms, which begin to cause discomfort to the expectant mother:

• She experiences a nagging pain in the lower abdomen and lumbar region.
• Brownish discharge appears from the genitals.

But if the discharge is brown, then specialists are in no hurry to worry, they just take such a patient under closer control. Brown discharge can only indicate that the internal hematoma is simply beginning to resolve on its own.

But if bloody discharge appears, 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 chorionic detachment is progressing, which will inevitably lead, if urgent adequate measures are not taken, to termination of pregnancy.

Symptoms of severe retrochorial hematoma during pregnancy:

• A nagging pain in the lower abdomen develops into cramping attacks.
• A sharp decrease in blood pressure is observed.
• Large volumes 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 there is no need to worry too much. The 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 the fertilized egg, or an already developing embryo, by at least 40%.

This clinical picture causes suppression of normal development of the fetus, and also increases the risk of increasing the process of detachment, which invariably provokes termination of pregnancy.

But immediately, when such symptoms appear, a woman should not panic. If the pregnant woman is given timely assistance, then therapy for retrochorial hematoma during pregnancy is favorable. Even if the bleeding was extensive, the probability of a successful outcome is quite high.

If the pathology in question is diagnosed and treated in a timely and effective manner, a woman is quite capable of giving birth on her own if there are no other contraindications in her medical history. However, before successful obstetric care, such patients undergo a number of additional examinations and are, until the moment of delivery, under the close supervision of an obstetrician-gynecologist.

But there are known cases when bleeding and blood clots in the uterine cavity occur in the prenatal period, then the obstetrician-gynecologist may not allow the pregnant woman to give birth, prescribing a cesarean section, which is performed together with amniotomy (surgical opening of the amniotic sac).

In retrochorial hematoma, miscarriages are recorded in isolated cases. Such a result is usually more likely if the woman registered for pregnancy very late, as well as in the case of untimely medical care when the pregnant woman experiences uterine bleeding.

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Diagnostics of retrochorial hematoma during pregnancy

If a specialist suspects a woman has the pathology in question, then the diagnosis of retrochorial hematoma during pregnancy is represented by the only available method - ultrasound examination.

A specialist can assume the presence of this disease based on certain characteristics:

• One of the uterine walls is thicker than the others. This is the result of the presence of hypertonicity in this area, 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 the location.
• On the ultrasound screen, the deformation of the uterine contour is clearly visible. This is due to the fact that there is a protrusion of contracted muscle tissues, which rise above the other structures.
• The configuration of the fertilized egg is also changed. The outline of the embryo differs from the normal shape of a healthy embryo. It is more like a slightly elongated drop or has the shape of a boat.

Sizes of retrochorial hematoma during pregnancy

There is probably no need to explain why this pathology is dangerous? Its most serious result can 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 the doctor's control of the pregnant woman's condition will not be superfluous, and therapy for the pathology is also necessary, but such hematomas do not cause any particular 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 chorionic membrane and the uterine wall, the probability of losing the baby becomes more real. When such a situation develops, the coccygeal-parietal size of the embryo slows down, sometimes lagging behind the accepted norms for up to ten days, which is also an unfavorable indicator of the course of pregnancy.

But even with successful therapy for stopping retrochorial hematoma during pregnancy, the threat of a negative situation for the fetus is not exhausted. In pregnant women who have suffered from the pathology in question, gynecologists later much more often observe the formation of placental insufficiency, that is, it begins to "age" much faster than is allowed by the natural course of pregnancy. Against this background, the fetus receives insufficient nutrition, which leads to its hypoxia, and as a result, such a baby is born with a lower weight.

But it should still be recalled that the scenario of development of pathological changes largely depends on the volume of the hematoma, its location, and the timeliness of adequate medical care. However, the level of modern medicine allows the overwhelming majority of cases to be brought to a favorable outcome for both the woman and her unborn baby.

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Treatment of retrochorial hematoma during pregnancy

All modern methods are reduced 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 given to her by the attending physician, and also leads a healthy lifestyle.

After the diagnosis is 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 of the disease. 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 heavy work, and it is also necessary to abstain from sexual intercourse for the period of treatment. The requirements of this period include a review of the woman's diet. The food products that end up 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, soy, beans and other legumes, as well as coffee, carbonated drinks and strong tea. During this period, it is better to eat more liquid food.

There is a recommendation that pregnant women who have been diagnosed with this condition should place a small pouf under their pelvis to improve blood flow in the uterus and prevent stagnation.

In terms of medication, the pregnant woman must receive complex therapy. She is prescribed vitamin E, which allows activating the synthesis of necessary hormones, which improves the situation with the hormonal balance, promotes the resorption of the hematoma.

This medicine is taken orally with a sufficient amount of liquid. The capsule is administered whole during a meal or immediately after its completion. One capsule per day is enough to obtain a therapeutic effect. The duration of therapeutic therapy is determined by the attending physician.

Contraindication to the use of this drug is individual hypersensitivity to its component composition. And also with special caution should be prescribed this drug if the woman's tests show low prothrombin time.

Folic acid is also mandatory in the treatment protocol, as it is essential for the normal course of pregnancy and the necessary development of the fetus. This drug is involved 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 3 mg (three tablets, respectively) during lactation. The duration of the course of treatment with folic acid is usually from 20 to 30 days.

Folic acid is not recommended for use if the woman has a history of allergic reactions, especially to folic acid. Pregnant women are required to be prescribed sedatives, as negative emotions slow down the achievement of an effective result. For example, the doctor may prescribe magnesium sulfate, valerian extract or Novo-passit, which is taken 5 ml three times a day; if there is no measuring cup, it can be replaced with a teaspoon, which is exactly the right amount of the drug.

If medically necessary, the dosage can be doubled. If a pregnant woman experiences excessive lethargy, the drug is administered in such a schedule that ¼ of the dose is taken in the morning and at lunchtime, and the remaining half of the daily dosage is left for the evening and taken immediately before going to bed.

The medicine is approved for use in the released concentration, and can also be added to drinks. If Novo-Passit provokes the development of a disorder of the digestion process, 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 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 C, vikasol, askorutin, rutascorbin. The vitamin drug askorutin is taken one tablet three times a day, the prophylactic dosage is one tablet twice a day. The duration of treatment is from three to four weeks.

A contraindication to taking Ascorutin is increased intolerance by the woman's body to the components of the drug, including vitamins P and C. Also, this drug should not be taken if the woman has a history of diabetes, gout, kidney stones, and thrombophlebitis.

To relieve spasmodic pain, the doctor introduces into the treatment protocol such antispasmodics as suppositories with papaverine, viburcol, drotaverine, no-shpa.

An antispasmodic drug that relaxes the smooth muscles of blood vessels and other internal organs - No-shpa. This drug is taken orally in a dosage of 40-80 mg two to three times a day, or as a 2% solution intravenously (administered very slowly), 2-4 ml. Rarely, but intra-arterial administration of the drug is also allowed.

The drug in question should not be prescribed if the pregnant woman suffers from increased intraocular pressure (glaucoma), as well as in case of individual intolerance to the drug. The protocol for treating retrochorial hematoma during pregnancy includes a drug that is designed to relax the uterine muscles. This is Magne B6, a vitamin that is taken together 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 to the introduction of 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 administered to the woman's body every eight hours. This schedule of administration is maintained for a week. Then the amount of medication administered is gradually reduced.

Duphaston is contraindicated in case of hypersensitivity of the pregnant woman's body to dydrogesterone or other components of the drug, as well as in case of certain liver diseases.

Medicines that improve uteroplacental permeability are also introduced. The pharmacodynamics of such drugs as curantil and actovegin allow this problem to be solved.

The angioprotective drug Curantil is prescribed for administration in a dosage of 0.075 to 0.225 g, divided into three to six doses. Upon receipt of therapeutic effectiveness, the administered amount of the drug is reduced to 0.025 - 0.050 g. The maximum permissible daily amount of administered Curantil is 0.6 g.

Curantil is contraindicated if a woman has a history of individual intolerance to dipyridamole or other components of the drug, as well as subaortic stenosis, renal and/or cardiac dysfunction in the terminal stage.

Homeopathic preparations 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 drug should not be prescribed if the pregnant woman suffers from hemorrhagic diathesis, as well as in case of hypersensitivity to the components of the drug.

After the drug treatment is completed, the attending physician must prescribe a control ultrasound examination. Its results allow 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 causes 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 that allows you to 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 a viral or infectious disease of any genesis appears, it is necessary to carry out timely and complete treatment, preventing relapses.
• Treatment of chronic diseases of the genitourinary system.
• If there is a risk of developing a retrochorial hematoma during pregnancy, a woman should rest more and spend more time in bed.
• It is recommended to place a pouf, bolster, or blanket folded several times under the basin.
• Avoid emotional and psychological shocks and stressful situations.
• Avoid falls and bruises.
• A pregnant woman should not lift heavy objects.
• Adjust your diet.
• Walk more, but avoid overexertion and fatigue.
• Do not delay registering for pregnancy.
• If negative symptoms appear, consult your doctor without delay.

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 for 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 of the separation of the chorionic 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-gynecologist, who, having assessed the clinical picture, will prescribe 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 should clearly understand that any pathological symptoms should not be ignored, because, it would seem, 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 termination of pregnancy. Or, simply put, a woman can lose her baby. Therefore, in order to prevent this, it is necessary to be more attentive to your body, and if it signals with various symptoms, then you should not brush off its signals. After all, timely detection of the problem and the beginning of therapy will allow you to quickly stop bleeding, block the growth of the hematoma and lead to its resorption. After undergoing treatment, up to 98% of pregnant women carry the pregnancy to term without any problems and give birth to a healthy child on time.