Blood inside uterus while pregnant

Subchorionic bleeding: Causes, symptoms, and risks

A subchorionic bleed is also called a subchorionic hemorrhage. It refers to a collection of blood that can develop between the gestational membranes, such as the placenta, and the uterus during pregnancy.

This accumulation of blood can lead to vaginal bleeding during pregnancy. This article will look at the causes and risks of a subchorionic hemorrhage (SCH) and explore other reasons for vaginal bleeding during pregnancy.

Subchorionic bleeding is when blood collects between the uterus and the gestational membranes during pregnancy.

Vaginal bleeding during pregnancy is common, with 16–25% of pregnant people experiencing some vaginal bleeding during the first trimester of pregnancy. SCH accounts for around 11% of vaginal bleeding cases in 10–20 weeks of gestation.

Many people experience light bleeding or spotting from the vagina during pregnancy. That said, this spotting does not require a pad or tampon, and it can occur between conception and giving birth.

Some other causes of bleeding or spotting in early pregnancy are:

sexual intercourse
infection
implantation bleeding
changes in the cervix

While bleeding during pregnancy is common, it may indicate a dangerous complication in the pregnancy.

Other more serious causes of bleeding in early pregnancy include:

pregnancy loss
ectopic pregnancy, when a fertilized egg implants somewhere other than the uterine cavity
molar pregnancy, a rare mass of tissues that forms inside the womb instead of a fetus

It is unclear why SCH occurs in some people and not others. It may result from a partial separation between the chorionic membrane from the walls of the uterus.

The collection of blood between the womb and the gestational membranes can result in blood clots called subchorionic hematomas, which can be small or large and may lead to vaginal bleeding.

The main symptom of SCH is vaginal bleeding, but a pregnant person may also feel discomfort and tenderness and a pain in the belly or back that comes on suddenly and does not go away.

Some people will not experience any symptoms and will only find out they have SCH during a routine ultrasound examination.

Subchorionic bleeding does not usually cause any problems. However, scientific research is inconclusive on whether SCH can cause pregnancy complications, such as preterm delivery or pregnancy loss.

For example, a 2014 study found that vaginal hemorrhage accompanying a subchorionic hematoma increased the risk of miscarriage before 20 weeks in people with threatened abortion.

However, a further study found that SCH did not increase the risk of pregnancy loss before 20 weeks.

Another possible complication is placental abruption, a severe complication when the placenta detaches from the womb lining.

Anyone who experiences vaginal bleeding during pregnancy should contact a doctor.

To diagnose the cause of the bleed, a healthcare professional will usually perform a physical examination and order blood tests and an ultrasound examination.

An ultrasound uses high-frequency sound waves to generate a black and white image of the fetus and placenta on a screen. If a person is experiencing subchorionic bleeding, the areas of blood inside the uterus may show up on this picture.

These tests will assist doctors in ruling out any associated conditions that may be causing vaginal bleeding.

The treatment for SCH will depend on a person’s symptoms, age, and overall health status.

For example, an individual with a stable pregnancy and no significant blood loss may be able to recover from SCH with close surveillance and supportive care. However, the condition represents a serious medical emergency if a person has a bleeding disorder.

Therefore, a doctor may wish to monitor people with SCH in the hospital until the bleeding stops or the SCH itself resolves.

Although subchorionic bleeding is common in the first trimester, it is still best to speak with a doctor to get a correct diagnosis whenever bleeding occurs in pregnancy.

Most SCHs are not harmful, but some research suggests they may have associations with certain adverse pregnancy complications.

Is It Dangerous During Pregnancy?

Subchorionic Bleeding: Is It Dangerous During Pregnancy?

Medically reviewed by Debra Sullivan, Ph.D., MSN, R.N., CNE, COI — By Kristeen Cherney on January 4, 2018

Overview

Bleeding during pregnancy is certainly a cause for worry. After all, pregnancy — in theory — shouldn’t cause vaginal bleeding. Still, there are other causes of bleeding besides menstruation. Vaginal bleeding in some form occurs in about half of all pregnancies, according to the March of Dimes.

In pregnancy, some types of bleeding are a big issue, while others aren’t. Subchorionic bleeding is just one type of bleeding. As with bleeding in general, some cases can become serious while others don’t adversely affect the pregnancy. But it’s important to call your doctor right away when you experience any form of vaginal bleeding while pregnant.

Subchorionic bleeding, explained

Subchorionic bleeding occurs when the placenta detaches from the original site of implantation. This is called a subchorionic hemorrhage or hematoma. It affects the chorionic membranes. These lift apart and form another sac between the placenta and the uterus. The movement and resulting clots are what cause this type of bleeding.

These hematomas can range in size, with the smallest being most common. Larger versions can cause heavier bleeding.

How it differs from other types of bleeding

Subchorionic hematomas are just one cause of bleeding in pregnancy. Their precise cause is unknown. They’re also not the same as spotting.

Spotting occurs in about 15 to 25 percent of women during the first trimester, according to the American College of Obstetricians and Gynecologists. While spotting can occur at any stage of pregnancy, it’s most common in the first trimester.

Causes of spotting include:

implantation
uterine expansion
intercourse
increases in hormone level
cervical changes, including cervical polyps
vaginal exams

Spotting is exactly as it sounds — a few spots of blood. While it’s still a good idea to report any form of spotting to your doctor, the symptoms are very different from vaginal bleeding.

Bleeding that goes beyond a few spots and requires a pantyliner is often a sign of something else. Subchorionic bleeding is one such possibility. Bleeding tends to be the only sign or symptom of subchorionic hematoma. You may not even realize you have one until your doctor performs an ultrasound.

Heavy bleeding can also be a sign of:

ectopic pregnancy, which occurs when an egg fertilizes outside of the uterus
miscarriage
molar pregnancy, a rare condition that results in a mass of tissue in the uterus
uterine rupture
separation of the placenta from the uterus
preterm labor, which occurs earlier than 37 weeks

These more serious causes of vaginal bleeding are also accompanied by other symptoms, such as severe abdominal pain and dizziness.

Is subchorionic bleeding harmful?

Many subchorionic hematomas aren’t harmful in the long term. Your doctor will have a better idea after looking at the hematoma on an ultrasound. Smaller hematomas have better outcomes. Larger versions can present problems.

According to a 2014 study, reports vary on the risk of miscarriage related to subchorionic hematomas with vaginal bleeding. However, the risk does increase during the first half of pregnancy. The earlier you seek a diagnosis, the better the outcome.

Prompt treatment is key

If a diagnosis of vaginal bleeding is deemed subchorionic, then your doctor will likely start treatments to prevent miscarriage. Options may include progesterone or dydrogesterone. If the hematomas are large, you may also be advised to:

Stay in bed, on bed rest.
Avoid standing for long periods of time.
Avoid sex.
Avoid exercise.

Follow up with your doctor

Subchorionic bleeding is a sign of a related hematoma. While not considered a normal occurrence in pregnancy, these hematomas aren’t unusual. They also don’t necessarily mean the pregnancy will fail. With treatment and close monitoring, many women go on to deliver healthy babies at full term.

Even though subchorionic bleeding doesn’t pose an immediate threat like other types of vaginal bleeding, you should still follow up with your doctor. Call your doctor whenever you experience any bleeding or spotting. If the cause is unknown, an ultrasound may be performed to rule out hematoma.

Last medically reviewed on January 5, 2018

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Bleeding and spotting from the vagina during pregnancy. (2014).
marchofdimes.org/complications/bleeding-and-spotting-from-the-vagina-during-pregnancy.aspx
Bleeding during pregnancy. (2016).
acog.org/Patients/FAQs/Bleeding-During-Pregnancy
Stamatopoulos N, et al. (2013). OPO3.03: Does the presence of subchorionic haematoma increase the risk of miscarriage? DOI:
10.1002/uog.12736
&Scedil;ükür YE, et al. (2014). The effects of subchorionic hematoma on pregnancy outcome in patients with threatened abortion. DOI:
10.5152/jtgga.2014.14170

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Jan 5, 2018

Kristeen Cherney, PhD

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Medically Reviewed By

Debra Sullivan, PhD, MSN, RN, CNE, COI

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Medically reviewed by Debra Sullivan, Ph.D., MSN, R.N., CNE, COI — By Kristeen Cherney on January 4, 2018

Pathological and physiological causes of bleeding during early pregnancy

The gestation period is a complex process that does not always go well. Every second woman has various complications. Most often, women go to the doctor with complaints of spotting. Why does bleeding appear during early pregnancy, how dangerous is it?

Causes of bleeding in pregnancy

Blood in the first trimester of pregnancy in the vaginal secretion is observed in 30% of expectant mothers. Bleeding can be weak, spotting, plentiful.

Most often, blood during early pregnancy is observed during implantation of the fetal egg. When the egg is attached, the vessels are often damaged, which leads to the appearance of blood secretions. They are similar to menstruation, last 1-2 days. This process is considered natural, does not indicate any pathologies.

Any spotting during early pregnancy is a reason for an urgent appeal to a gynecologist. Even if there is no additional discomfort. At a remote consultation, our doctor will collect an anamnesis, draw up a clinical picture in order to identify the cause of bleeding. And he will select effective methods to eliminate the problem.

Blood during pregnancy - other common causes

In addition to the main ones, there are some other reasons why pathology can develop.

No.	Cause
one	Excessive exercise, deep penetration during intercourse. If the cervix is damaged, slight red discharge occurs, which disappears within two hours.
2	Progesterone deficiency. With a low level of the hormone, the body starts the process of menstruation. Bloody discharge during pregnancy appears when the uterine mucosa is exfoliated. The situation may adversely affect the implantation of the fetal egg.
3	Miscarriage - occurs in 2-8% of pregnant women. It is characterized by pain in the lower abdomen, which is rapidly increasing, bloody discharge at the beginning of pregnancy. The causes of the pathological condition can be different - infectious diseases, fetal malformations that are incompatible with life, dehydration, abdominal trauma, taking certain drugs.
four	Ectopic pregnancy. Dangerous condition, urgent hospitalization is required.
5	A failed miscarriage. Blood discharge during pregnancy, abdominal pain are the main manifestations of intrauterine development of the fetus.
6	Infections. To avoid dangerous complications, it is necessary to treat diseases. Parents of both sexes should be tested.
7	Full or partial hydatidiform mole. Pathology of the chorion, in which the size of the villi increases, bubble expansions form. The risk group includes women with ovarian dysfunction, inflammatory diseases of the reproductive system, and a history of cystic mole. Bleeding is profuse and constant, characteristic blisters are present. The symptoms of early toxicosis are very pronounced, the size of the uterus, the hCG indicators do not correspond to the gestational age.
eight	Cervical cancer. Pregnant women are rarely diagnosed. The risk group includes women with a large number of abortions and childbirth, often changing sexual partners.
9	Subchorionic hematoma. Hemorrhage around the placenta most often resolves on its own. But it increases the risk of preterm birth and other complications.
ten	Cervical erosion. Detected in 50% of women. For pregnant women, the disease is not dangerous, but constant medical supervision is needed.

Bleeding in the first trimester can be caused by causes that appear at any gestational age. These are fibroids, polyps in the uterus and cervical canal, cardiovascular pathologies that are associated with a weakening of the endothelium.

Physiological or pathological bleeding during gestation - differences

Clinical manifestations of bleeding in pregnant women depend on the causes of occurrence. Physiological discharge of blood from the genital tract in the early stages of gestation proceeds without deterioration in well-being. With bleeding caused by erosion, fibroids and polyps, there are also no additional discomfort. In this case, only a few drops of blood are released, it bleeds for a short time.

Abundant bleeding, similar to menstruation, against the background of a general satisfactory condition, occurs with a deficiency of progesterone.

Bleeding with spontaneous interruption is accompanied by constant or periodic pain in the lumbar region, abdomen. Disturbed by nausea, bouts of dizziness, slightly increased body temperature. Bleeding can be weak or intense, and clots are often observed in the discharge.

When a fertilized egg is fixed outside the uterus, internal bleeding often occurs, and discharge from the genital tract may appear much later. Characteristic manifestations - acute pain in the abdomen radiates to the anal region, right or left side, blood pressure decreases, cold sweat appears, fainting is possible. Significant blood loss leads to the development of a state of shock with a high probability of death.

Learn more about implantation bleeding

Why does it bleed at the initial stages of gestation? Most often, the appearance of spotting during pregnancy is associated with the implantation of the embryo. They occur 6-12 days after conception and are often one of the first signs of conception.

Usually, the appearance of spotting at the beginning of pregnancy coincides with the time of the onset of menstruation, if the cycle is regular. But discharge in pregnant women is not as abundant as menstrual bleeding. Duration - from several hours to three, with the first pregnancy up to 5 days.

How does implantation bleeding manifest?

weak, pulling pain in the lower abdomen;
headache, dizziness;
sudden change of mood;
bouts of nausea;
increased sensitivity, swelling of the mammary glands;
fatigue, drowsiness.

Important! When the embryo is implanted, little blood is released, usually these are small spots. The discharge may be pink, brown, orange, and there should be no clots.

Possible causes of early bleeding by week

The first months of pregnancy are the most difficult and dangerous. It is in the early stages that various pathologies and complications often appear.

Why blood may appear in the early stages during pregnancy:

At the 4th week of pregnancy, discharge with an admixture of blood may appear - this is implantation bleeding. Heavy bleeding is a dangerous sign, most often indicates a miscarriage. Spontaneous abortion can be caused by exercise, fever, infections, drugs or alcohol. Such bleeding is profuse, painful, blood clots are present.
The appearance of sanious discharge at the 5th week of pregnancy may be a sign of a missed pregnancy. The reasons are overwork, Rh conflict, bad habits, bacterial and viral diseases of the reproductive system, genetic disorders in the embryo. Symptoms - causeless fever, severe pain in the lower back and lower abdomen, the disappearance of signs of toxicosis.
Blood in the discharge at the 6th week of pregnancy appears with an ectopic attachment of the fetal egg, fetal fading, Rhesus conflict. Discharge with blood at 6 weeks of pregnancy is a reason for an urgent visit to the gynecologist.
At the 7th week of pregnancy, discharge with blood is not the norm. May indicate a miscarriage, missed or ectopic pregnancy.
From the 8th week of pregnancy, one of the most dangerous periods of pregnancy begins. The formation of the placenta begins, the hormonal background changes. Bloody discharge appears with the threat of miscarriage or spontaneous abortion. Pregnancy is often not saved.

Pay attention! In the second trimester, bleeding occurs only in 5-10% of women. Most often this is due to late spontaneous abortion, isthmic-cervical insufficiency. The appearance of blood in the third trimester mainly occurs with presentation, placental abruption.

Early bleeding after IVF

The appearance of blood discharge during pregnancy on the 8-10th day after IVF is not considered a pathology, provided that the woman feels normal. After the introduction of the embryo into the uterine cavity, minor damage to the small uterine vessels often occurs. Brown, dark cream, pale pink, odorless discharge most often indicates a successful transplant, pregnancy.

If spotting after IVF is observed for 1-2 days, slight pulling pains in the lower abdomen are disturbing, this may be due to a progesterone deficiency. After the examination, the doctor will adjust the hormonal maintenance therapy.

Pink discharge on the 16th day after the transfer is a dangerous symptom. It may be a sign of detachment of the fetal egg, the threat of termination of pregnancy.

According to studies, uterine bleeding in the first trimester is a common occurrence in pregnancy after IVF. Discharge does not affect the incidence of adverse reproductive outcomes. The number of embryo rejections in women with and without uterine bleeding is approximately the same. Consult with our doctors by phone for more details.

Diagnostics

If blood has gone from the genitals of a pregnant woman, the doctor conducts an external and gynecological examination.

Analyzes and examinations:

general and biochemical blood test;
general urine analysis;
tests for hCG, other hormones;
Ultrasound of the pelvic organs;
CTG is performed to assess the vital activity of the fetus.

Treatment

Methods of treatment depend on the results of the examination.

Bloody discharge in the first trimester - causes and therapeutic measures:

The reasons	Treatment
Miscarriage	Cleansing the uterus.
Ectopic pregnancy	Diagnostic laparoscopy, removal of residual fetal tissues, antibiotic therapy.
Risk of miscarriage	Hospitalization, bed rest, prescribing drugs to maintain pregnancy, sedatives and tocolytics to reduce uterine tone.
bubble skid	Curettage of the uterine cavity.
Cervical cancer	Operational intervention.
Polyp injury, cervical erosion	Expectant management, if the condition does not worsen, removal and cauterization is carried out after childbirth.
progesterone deficiency	hormone therapy.
Damage to the uterus	Complete bed rest.
Infectious pathologies	Depending on the type of pathogen - antibiotics, antiviral or antifungal drugs.

Complications and consequences

It is impossible to ignore bloody impurities in vaginal discharge during pregnancy. Without proper and timely assistance, the following complications may occur:

miscarriage;
intrauterine fetal death;
the development of an infectious process, sepsis due to the remainder of dead tissues in the uterine cavity;
profuse blood loss can lead to death.

Important! Urgent medical attention is needed in case of heavy bleeding, discharge of bright scarlet blood, presence of blood clots in the discharge. In life-threatening and fetal conditions, severe pain in the abdomen, lower back, convulsions, profuse cold sweat, and loss of consciousness are disturbing.

Methods of prevention

If there is blood in the first trimester, it is important to remain calm. Stress and anxiety will only exacerbate the situation. But any health problem is easier to prevent than to treat.

How to avoid bleeding during childbearing - recommendations from a gynecologist:

eat right and balanced, give up junk and junk food, eat more fresh vegetables and fruits;
observe the drinking regime;
in the absence of contraindications, moderate physical activity is indicated - yoga, swimming, special gymnastics for pregnant women;
more time to walk in the fresh air;
avoid stress, overwork, observe the daily routine, get enough sleep;
give up bad habits, do not be in smoky rooms;
timely visit a gynecologist;
according to the doctor's prescription, take vitamin complexes for pregnant women;
do not self-medicate.

The prognosis for bleeding during gestation depends on the causes and timely visit to the doctor. Properly provided medical care can save the life of the fetus and the woman.

FAQ

Why is there blood from the genital tract during gestation?

The causes of bleeding in early pregnancy are different. Most often, spotting appears when the fetal egg is fixed, progesterone deficiency, with erosion of the cervix and polyps. Dangerous causes - ectopic, molar, miscarriage, miscarriage.

What to do if there is bleeding during pregnancy?

Much depends on the amount of blood released, general well-being. If the bleeding is not strong, not for long, the general condition is normal, it is enough to lie down and rest. Write down the date of the attack, inform the doctor at the next visit. But if even slight spotting during early pregnancy lasts more than 72 hours, is accompanied by cramping or acute pain, fever, you should immediately visit a gynecologist or call an ambulance.

How can you recognize a miscarriage?

With the threat of interruption, spotting is scanty, pain in the lower abdomen is absent or may be dull, aching. The condition is considered reversible, with timely treatment, pregnancy can be saved. If a miscarriage has begun, bleeding intensifies, cramping pain appears. The general condition is satisfactory. Urgent hospitalization is required, the probability of maintaining pregnancy is decided on an individual basis.

Expert opinion:

Bleeding during pregnancy is a dangerous symptom. Sometimes spotting can be caused by physiological reasons. But often such a symptom appears in life-threatening conditions for the woman and the fetus.

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Menshikova Maria Viktorovna obstetrician-gynecologist

Experience 38 years

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Specialist with extensive practical experience. He has a certificate of a mammologist, a certificate of professional certification. Participates in foreign business trips and individual training programs (Los Angeles).

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