Hematoma in pregnancy

It may happen that the expectant mother feels fine, she does not bother, but when she comes to the ultrasound, she finds out that she has a hematoma during pregnancy. An ordinary person understands that a hematoma is a hemorrhage into the tissue layer, which occurs as a result of the resulting injury.

To date, doctors have also called other causes of this pathology.

[1],

Causes of the hematoma in pregnancy

Modern obstetrician-gynecologists are increasingly confronted with the problem of bearing a fetus by a woman who has been diagnosed with intrauterine hemorrhage. Quite often it develops against the background of fragile blood vessels, which provide nutrition to the uterus and placenta.

The following are the main causes of hematoma in pregnancy:

• Failure in the exchange processes of women.
• Inflammatory and infectious diseases affecting the genitourinary system of a future mother.
• Severe degree of toxicosis, which is especially dangerous in late pregnancy.
• Sharp jumps of blood pressure. High figures are especially dangerous.
• Strong stressful situations.
• The cause of hematoma during pregnancy can be and pathology of development of the fetal egg.
• Failure hormonal background.
• Problems observed with blood clotting, pathological changes in the walls of the vessels of the placenta and the entire body of a woman.
• Abuse of alcohol and smoking during the period when a woman carries a child.
• Congenital or acquired pathology of the development of the uterus.

[2], [3], [4]

Symptoms of the hematoma in pregnancy

Waiting for the birth of a child is a state of complete happiness, a time of hope and one of the fascinating moments in the fate of any woman. But at the same time, it is an anxiety and an experience for the health of an unborn baby. Hematoma in the uterus during pregnancy is a difficult test for a woman waiting for a baby. After all, if there is a fetal egg begins to exfoliate from the surface of the endometrium of the uterus, in this place gradually accumulates blood, forming a bruise.

Hematoma in the uterus during pregnancy is a serious danger to the carrying of the child, as it can provoke spontaneous miscarriage, especially with a severe form of pathology. With mild severity, a woman may not even notice and learn about her existence after a successful birth resolution.

A severe degree of development of the hematoma during pregnancy is a danger not only for the baby, but for his mother. Bleeding provokes a worsening of the general state of health in the mother, posthemorrhagic anemia develops. In connection with a malfunction in the circulation, the fetus receives less oxygen, which leads to "oxygen starvation," and this, in turn, inhibits the development of the child, both physically and psychologically.

Hematoma in early pregnancy

For many, the word "hematoma" is directly associated with a serious trauma. Therefore, having heard such a diagnosis and not fully understanding its essence, the pregnant woman begins to get nervous. And it can be understood. After a hematoma in the early stages of pregnancy may indicate the beginning of rejection of the fetal egg, which leads to miscarriage (termination of pregnancy). By the way, this pathology is not very rare, and a greater percentage of its manifestation is in the fifth to eighth week of pregnancy.

The reasons for this pathology are many: this is a hormonal failure, and a hereditary anamnesis, a sexual act, a great nervous or physical strain.

But the diagnosis of hematoma in the early stages of pregnancy allows, as soon as possible, to undergo a course of treatment that will become a pledge of normal fetal development and favorable delivery.

Quite often, the future mother does not even suspect the existence of an internal hematoma and for her the most complete surprise is its presence, which was discovered during the passage of a planned ultrasound. Symptoms of hematoma in pregnancy mainly depend on the degree of severity and localization of pathology.

• Light degree of severity. In this case, the pregnant woman feels fine, no physical manifestations of internal hemorrhage are determined. Hematoma in pregnancy is diagnosed only with the help of ultrasound or after the birth safely ended naturally, as it leaves its markings on the placenta.
• The average severity. In this case, the woman experiences a drawing, aching pain in the lower abdomen. May appear from the genital tract of a red or brownish hue. If you have such symptoms, you should immediately seek help from an obstetrician-gynecologist, who leads the pregnancy. Whether or not there are excretions, largely determines what the volume of the hematoma and the location of its localization. At a pathology of an average degree the disturbance of palpitation at the yet not born kid is listened.
• Hematoma in severe severity. The intensity of blood discharge increases, and pain in the lower abdomen increases. It becomes cramped. Against the background of the bleeding, the future mother's blood pressure drops. A woman can even lose consciousness.

Any practitioner knows that if a retrochoric hematoma is diagnosed, it means that there is a direct threat of termination of pregnancy.

[5], [6]

Allocations during hematoma in pregnancy

If during the first trimester of pregnancy a woman watches light brown discharge from the vagina, but does not feel any discomfort and deterioration of health, against this background, one should not be particularly worried, even if in the ultrasound study (which is scheduled every pregnant woman) pregnancy.

Another question is if the color of the discharge is bright red. This already indicates that the bleeding does not stop. In this situation, urgent measures must be taken urgently, otherwise premature rejection of the fetus may occur and the woman will lose the child.

[7]

Forms

We used to see various kinds of hemorrhages on the surface of the skin, but many did not even realize that there are uterine hematomas that appear on the uterus during the period when a woman carries her baby. There is a classification of this pathology. Differentiate these types of hematomas during pregnancy:

• Clinic and period of the disease:
  • Retrochorial. This type of outpouring is diagnosed in the early stages of pregnancy (before 16 weeks) and represents a detachment of the fetal egg from the chorion (external embryonic membrane).
  • Retroplacental. By the 16th week of pregnancy, with the normal development of the fetus, the placenta is already finally formed. If there is a subsequent hematoma, she, before the due date, provokes an abruption of the placenta, which is fraught with spontaneous termination of pregnancy, that is, a woman loses an unborn child.
• By severity of pathology:
  • Pathology of mild severity.
  • The average degree of manifestation of the disease.
  • Hematoma during pregnancy is acute, severe.

Hematoma in pregnancy of mild or moderate severity is an indication for caesarean section, while the operation is prescribed for an earlier period than the term of natural delivery was put.

Retrochorial hematoma in pregnancy

Chorion is the external embryonic membrane that surrounds the embryo and is formed at the initial terms of the gestational period, being the precursor of the placenta. Hence the name retrochorial hematoma during pregnancy, which is due to its timing of origin and location of localization. This pathology develops as a consequence of detachment of the fetal egg from the chorion. It is observed in the first trimester of pregnancy, before switching to the second. In the place of rejection, blood gradually begins to collect - a hematoma is formed, a clear sign of the threat of the development of spontaneous abortion.

This pathology is accompanied by secretions from the vagina slightly brownish hue. At the same time, the woman experiences pain in the lower abdomen. If the localization of the hematoma occurs at the bottom of the uterus, there can be no obvious symptoms of pathology. Then you can detect hemorrhage only with the help of ultrasound.

When brown precipitations appear, a woman begins to worry about the fate of her pregnancy, obstetricians - gynecologists do not consider this a bad symptomatology. Since the blood accumulates in the cavity between the chorion and fetal membranes, it folds there, taking a brownish tinge, the discharge of this color on the contrary can indicate that the blood clots gradually start leaving, "dissolving" the hematoma.

When you really need to sound an alarm, it's then when the discharge goes scarlet. This is a clear sign that the bleeding has not stopped, the hematoma continues to grow, the fetal egg continues to exfoliate and if you do not take emergency measures, the mother can lose a child, since in such a situation premature termination of pregnancy occurs. In this case, to assess the growth of the hematoma during pregnancy, the doctor appoints not only ultrasound, but also is required to control the level of fibrinogen in the blood plasma.

[8], [9], [10]

Retroplacental hematoma in pregnancy

In the case when rejection of the fetal egg goes from the chorion, as a rule, it occurs in the first trimester, the retrocchial hematoma develops. If this process begins later (after the 22nd week of pregnancy), when the chorion has degenerated into the placenta, the same embryo rejection process is called a retroclavitary hematoma. It proceeds according to the same scenario as in the first case, when the appearance of bleeding is a real threat of termination of pregnancy.

Likewise, retroplacental hematoma in pregnancy is the main symptom of the threat of miscarriage. Clinic of this pathology: there was a drawing pain in the lower abdomen, bloody discharge, increased tone of the uterus ... The behavior of the fetus is also changing: its motor activity is increased, negative changes occur in the heart rhythm (tachycardia, and then bradycardia), which speaks of violation of its normal development. These signs obstetrician-gynecologist treats as untimely rejection of placental tissue, which can lead to miscarriage.

In this case, in the early diagnosis of retplacental hematoma during pregnancy helps to conduct ultrasound, which allows timely to take adequate measures to save the fetus, and even the mother in childbirth.

Subchorional hematoma in pregnancy

The most common subchorial hematoma occurs during pregnancy. This is a rather dangerous type of hemorrhage. It requires immediate treatment of your doctor. In case of differentiation of this pathology, the size of the hematoma must be observed in dynamics.

Retroamnotic haematoma in pregnancy

Diagnosed retro-amniotic hematoma in pregnancy at the first ultrasound study (approximately 12 weeks of pregnancy), often no bloody discharge is different, but still for re-insurance, a pregnant obstetrician-gynecologist can put a future mother in the obstetrics and gynecology department in order to observe the growth hematoma.

Submaniotic hematoma in pregnancy

It does not pose a threat to the normal development of the unborn child. Subsequently, the hematoma, especially if the site of its localization is the uterine pharynx, is able to dissolve independently or go out in the form of clots.

Intrauterine hematoma in pregnancy

This is a serious enough pathology. External or internal causes lead to exfoliation of the fetal egg, which provokes bleeding, then it forms in the place of rejection of the hematoma. If the hemorrhage area does not increase, and the pregnant woman feels satisfactory, the embryo develops normally - then there should be no cause for concern. If the obstetrician-gynecologist sees the progression of pathology, the question is raised about the hospitalization of the mother and her treatment.

Complications and consequences

The birth of a new man is the greatest sacrament that nature has given to man. But how much the future mother has to perenervnichat until the moment when the light will be her baby. Hemorrhages of different locations. How dangerous are they? What are the effects of hematoma in pregnancy? Naturally, complications can manifest themselves, and maybe everything goes well. Much in this issue depends on the parameters of the hematoma. The most dangerous is the hematoma, which occupies not less than 40% of the total area of the envelope of the embryo and whose volume exceeds 20 ml. Such a hematoma can inhibit the growth and full development of the fetus, and cause a spontaneous abortion. Deceleration in the growth of CTE (coccygeal-parietal size) for more than ten days indicates an increased risk of adverse outcomes of childbearing.

The most dangerous consequence of this course of events may be "Queen of the Queen". Premature detachment of the placenta leads to the fact that the endometrium is recruited by blood, necrosis foci appear in it, which is already an indication for complete uterine resection. And this is a sentence - a woman can never become a mother.

Also, when the hematoma is pregnant, the probability of heavy bleeding is high, the consequences of which are difficult to predict, since it can even lead to a fatal outcome, both for the child and for the mother in childbirth.

But if the pregnant woman has undergone effective treatment in a timely manner, the chances of giving birth independently and in the time of a normally developed baby sharply increase.

What is the risk of hematoma in pregnancy?

The first question asked by a woman after (on the passage of ultrasound) she heard this diagnosis: "What is dangerous for hematoma in pregnancy?". In many respects the answer to this question depends on the size of the hematoma, the timing of manifestation and its localization. When diagnosing hematoma in the first trimester of pregnancy, it is fraught with spontaneous termination of pregnancy. If the pathology occurs at a later date - the consequences of its appearance can affect the development of the fetus (lag in physical development, hypoxia (insufficient amount of oxygen for the full development of the child)).

The most dangerous in this category are effusions of 20 ml and more, which is about 40% of the volume of the fetal egg. In addition to inhibition in the development of the fetus, the risk of further detachment of the placenta increases. If the CTE (coccygeal parietal size) of the embryo lags behind in growth for more than ten days is a bad sign that indicates a greater likelihood of an unfavorable pregnancy resolution. Although with adequate therapy the fetus continues to develop normally, but in this case a caesarean section is indicated.

[11], [12], [13], [14]

Diagnostics of the hematoma in pregnancy

Any pathology should be diagnosed in the early stages of its manifestation, when there have not yet been any dramatic negative changes that can not be corrected. Therefore, in order for pregnancy to end with normal births, a diagnosis of hematoma is carried out during pregnancy.

The main source of information during this period is ultrasound (ultrasound) - this is a modern, fairly informational, research method. In addition, an obstetrician-gynecologist also prescribes another examination.

• Clinical detailed blood test
• General urine analysis.
• A blood test for RW and HIV is being conducted.
• Coagulogram. Determination of a prothrombin index (PTI), which shows how well the blood is folding, as well as activated partial thromboplastin time (APTT).
• Smear on the microflora, which is taken from the vagina.
• Blood chemistry.
• Examination for various sexually transmitted infections (STIs).
• Dopplerometry (one of the varieties of ultrasound, is used to assess the nature and speed of blood flow in the vessels, in this case in the baby and in the placenta).
• If there is a need, then a blood test for hormones is prescribed.

Hematoma during pregnancy on ultrasound

Hemorrhage in the period of bearing of the baby appears in the case when, by coincidence, a fetal egg starts to be torn from the attached place. This leads to the development of bleeding. This pathology in this period is observed quite often and, based on the severity, can cause a miscarriage. Hematoma during pregnancy on ultrasound is easily recognized - this is one of the most accurate and informative methods for determining it. On the presence of hemorrhage in the uterus testifies:

• Increase the thickness of one of the walls.
• Change in the parameters of the fetal egg.
• The presence in the interval of the chorion - uterus of the blood clot.
• Deformation of the contour of the uterus.

Treatment of the hematoma in pregnancy

When diagnosing uterine hemorrhage, the expectant mother is shown bed rest (physical and emotional rest). At the same time in the treatment of hematoma during pregnancy includes not only the drug complex, but also the adjustment of the nutrition of the pregnant woman. From the diet excluded products that stimulate increased intestinal peristalsis.

To stop or prevent bleeding, the attending physician, if necessary, can prescribe medications such as vicasol, dicinone, vitamin C.

Vikasol. This drug is injected into the muscle for three to four days with a four-day break. The daily dosage is 1-1.5 mg, divided into two to three injections. The maximum daily dose is 30 mg, single dose is 15 mg. If necessary, after a break, the course of treatment is repeated.

Has this drug and side effects: the appearance of spasms in the bronchi, thromboembolism (acute clotting of the blood vessel with a thrombus), rash and itching of the skin, hemolytic anemia (increased destruction of erythrocytes), urticaria, as well as erythema (reddening of the skin).

Categorically contraindicated the drug at a high level of blood coagulability, individual intolerance to the components of the drug.

Dicinon. To prevent bleeding, the doctor usually assigns one to two ampoules of the drug that are injected into the muscle or vein, then after four to six hours a woman is given one ampoule or two tablets of the drug are taken.

Causes Dicycin and side effects, which include: headache, heaviness in the stomach, heartburn, lower blood pressure, paresthesia of the lower extremities, hyperemia of the face.

Contraindications of Dicinon:

• Thromboembolism of vessels.
• Thrombosis of veins.
• Hemorrhage.
• Individual intolerance to the components of the drug.

Vitamin C. A vitamin tablet is taken inside, chewed, with a small amount of water immediately after a meal. The daily dosage is 250 mg. The duration of the course is 10 to 15 days. If necessary, the dosage can be doubled.

Usually ascorbic acid is well tolerated, but there are exceptions when side effects begin to appear: diarrhea, diarrhea, nausea and vomiting, excitation of the central nervous system, formation of kidney stones, the appearance of an allergic reaction to the drug.

There are also contraindications: thrombophlebitis, predisposition to thrombosis, hypersensitivity to ascorbic acid.

Treatment of uterine hematoma in pregnancy

In case of early hemorrhage diagnosis, treatment of uterine hematoma during pregnancy is performed using the most popular medications such as papaverine and no-shpa.

But if the hematoma occupies a small area, then the treatment may not be given, the attending physician will only carefully monitor its parameters and, if it grows, begin treatment.

Papaverine. This drug is administered both intramuscularly and intravenously, 40 to 60 mg three to five times a day.

It is quite cautious to take this drug for women prone to constipation, which in history have individual intolerance to the components of the drug, liver function deficiency, glaucoma and other pathologies.

There are side effects: drowsiness, arterial hypotension, ventricular extrasystole and some other manifestations.

But-shpa. The dosage of this drug is 40-80 mg once. Reception - three times a day.

This drug is contraindicated for those patients who suffer from hypersensitivity to the components of the drug, as well as a violation of normal kidney and liver function, arterial hypotension, coronary artery atherosclerosis and so on.

There are side effects:

• Increased palpitations.
• Increased work of the sweat glands.
• Dizziness.
• Falling blood pressure.
• Rashes on the skin are allergic.
• And others.

To stop bleeding, the doctor attributes hemostatic medications (vikasol, askorutin, dicinone), they will not allow the hematoma to progress in pregnancy.

Ascorutin. This drug is taken one tablet three times a day. The course of treatment is necessary, but about three to four weeks. Contraindicated this drug for use in patients who have increased sensitivity to the components of the drug, as well as with gout, diabetes, thrombophlebitis and some other pathologies.

To relieve the stressful state, it is useful to drink tablets or drops of valerian, as well as tea with melissa leaves.

Not bad to take in this situation and vitamins B:

• Vitamin B1 or thiamine. Promotes the process of energy production from fats, proteins, carbohydrates. Its shortage can be replenished with products such as liver, pork and beef, spinach, yeast, cereals, nuts.
• Vitamin B2 or riboflavin. It is extremely important for maintaining vision, normal operation of the skin and mucous membranes, as well as for the synthesis of hemoglobin. They are very rich in asparagus, dairy products, eggs, meat, fish.
• Vitamin B3 or nicotinic acid (niacin). Promotes detoxification. Contained in foods such as: liver, veal and chicken meat, kidneys, heart, milk and others.
• Vitamin B6 or pyridoxine. This vitamin is involved in the processes of carbohydrate metabolism, hemoglobin synthesis and so on. In large quantities found in beans, rice bran, yeast, wheat germ ...
• Vitamin B12 or cyanocobalamin. Participates in the formation of red blood cells, positively affects the nervous system. Contain in seafood, liver, dairy products.

A woman with a hematoma during pregnancy should not enter into her food products that have obvious fixing and weakening properties. During this period, do not abuse carbonated drinks, drink coffee and very strong tea, as well as dietary supplements.

To support the immune system, pregnant women are assigned gestagens.

Dyufaston. In case of threat of termination of pregnancy, the drug is administered orally once in a dosage of 40 mg. Later, every eight hours the patient receives 10 mg of the drug until the symptoms disappear completely. To date, there is no evidence of contraindications to the drug in question, except for individual intolerance of its components.

Utrozhestan. The capsule of this drug when a threat of termination of pregnancy is injected into the vagina. The daily dose is 200-400 mg, taking in the morning and evening (I and II trimesters of pregnancy).

This medicine is contraindicated for people who are hypersensitive to its components, with thrombophlebitis, thromboembolism, bleeding of unclear etiology and so on.

Attributed as tocolytic drugs that contribute to the removal of spasms of the uterus.

Magnesium sulfate. The drug is administered intramuscularly 20% or 25% solutions. The doctor and gynecologist appoints the concentration and dosage individually. The prescribed dosage varies at a level of 5-20 ml.

Treatment of retrochoric hematoma in pregnancy

Retrochorial hematoma is formed when the rejection of the fetal egg from the chorion, the precursor of the placenta, occurs. This pathology is diagnosed quite often and with adequate approach and timely therapy does not lead to irreversible consequences. Treatment of retrochoric hematoma during pregnancy is carried out only in a hospital under constant supervision of an obstetrician-gynecologist.

During this period it is necessary for the future mother to reduce physical activity, to have more rest, and at medical indications it is attributed and bed rest. The diet should be balanced and complete.

Treatment of retrochoric hematoma during pregnancy includes not only adjusting nutrition and lifestyle, but also drug therapy. Women during this period are assigned blood-restoring medications (vikasol, dicinone, askorutin). To stop pain and relieve spasms, a pregnant woman should take antispasmodics (paraverin, no-shpu). The vitamin and mineral complex is also prescribed, ready to support the organism of the future mother. And also vitamin E (tocopherol) - an antioxidant, designed to protect cells from the influence of pathogenic flora; and folic acid is a vitamin enzyme necessary for the growth and development of the circulatory and immune systems.

For a more intensive outflow of blood from the female genital area, the woman needs to lie so that the pelvis is slightly elevated. This is easy to achieve by placing a folded blanket or pillow under the ass. During this period it is recommended to stop any sexual relations.

To remove the uterine cramps and relax the muscles, the pregnant woman is prescribed magnesium B6, which takes two tablets two to three times a day. Drink with a lot of water. Contraindications to this medication include kidney pathology and increased sensitivity to the components. Side effects were also revealed: peripheral neuropathy, diarrhea, numbness in the limbs, pain in the abdomen.

To improve the quality of fetal nutrition, to prevent the development of hypoxia, the doctor prescribes Actovegin, curantil.

Actovegin. To prevent normal blood circulation and metabolic processes in the brain, both the parturient and her child, the starting dose of the drug is intravenously injected - 10 ml daily for two weeks. In the future, if there are medical indications, this dose is adjusted - 5 - 10 ml several appointments per week (as prescribed by the doctor) during the month. Do not use this drug in the case when anuria is observed (complete cessation of urine from the kidneys into the bladder), pulmonary edema, heart failure, as well as individual intolerance to the components of the drug.

Currantil. The drug is attributed at the rate of 75 to 225 mg per day, divided into three to six receptions. Subsequently, the dose of the drug can be reduced to 25-50 mg. Only with acute manifestations of pathology, the daily dosage can be 600 mg.

Contraindicated the drug in question for people suffering from intolerance of some of the constituents of substances, as well as with such diseases as collapse, myocardial infarction, bleeding of unclear etiology and others.

Advice to women who have been diagnosed with retrochorial hematoma during pregnancy should not disregard the recommendations of the treating doctor, since such a pathology is a serious enough condition.

Traneksam with hematoma during pregnancy

With bleeding or its threat, obstetrician-gynecologists often attribute a haemostatic drug, which is an inhibitor of fibrinolysis. Performed well Tranexam with hematoma during pregnancy. In this case, this drug is prescribed in a dose of 250 to 500 mg three to four times a day. Duration of treatment is seven days.

Contraindications to the use of this medication:

• Individual intolerance to the component composition of the drug.
• Thrombophlebitis of deep veins.
• Subarachnoidal hemorrhage.
• Disturbances in the work of the kidneys.
• And others.

There are also side effects:

• Decrease in general tone, drowsiness and dizziness.
• Heartburn, diarrhea.
• Nausea and vomiting.
• Thrombosis.
• Tachycardia (rapid heart rate).
• A tooth and skin rashes.
• Hives.
• Pain in the chest.
• Visual impairment.

Prevention

Modern medicine, to date, can offer such activities that contribute to the prevention of pathology. Preventive maintenance of a hematoma at pregnancy consists:

• A full examination of a woman to identify risk factors before the planned pregnancy or in its first weeks.
• Identification of hereditary pathologies.
• Adequate and effective treatment of genitourinary infectious diseases.
• Treatment or maintenance therapy of vascular disorders.

[15], [16],

Forecast

A pathology diagnosed as a hematoma in pregnancy is a fairly frequent phenomenon. And on how early the diagnosis is made, what is the area of the "lesion" and the prediction of the hematoma during pregnancy depends.

If the disorder is recognized early and the volume of the hematoma does not exceed 20 ml, and adequate and timely treatment is carried out, there is no threat of termination of pregnancy in the future. In rare cases, when pathology captures large areas of rejection and is accompanied by heavy bleeding, there is a real threat to the life of a pregnant woman. In this case, the question of emergency termination of pregnancy is raised. If treatment has not been performed (and it has been shown), the prognosis of hematoma in pregnancy is unfavorable - the probability of spontaneous miscarriage is high, while timely treatment leads to normal childbirth and the birth of a healthy baby.

It can be concluded that hematoma in pregnancy is a frequently diagnosed pathology that occurs at different stages of fetal development. The same depends on the symptomatology. If the pregnant woman is diagnosed as such, you should not panic, but do not neglect the doctor's advice. After careful treatment of yourself and your health will not only help save your life, but also give birth to a healthy strong baby.

[17], [18]