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What is a subchorionic hematoma?

Subchorionic hematoma (also known as subchorionic hemorrhage or subchorionic bleeding) is a pool of blood clot that resides between the membrane of the placenta (chorion) and the wall of the uterus. On ultrasound, subchorionic hematoma appears as a crescentic or oval fluid collection adjacent to the gestational sac, separating the chorion from the uterine wall. The clot is typically the result of bleeding that occurs when only the placental margin of the chorion is separated from the uterine wall.

Subchorionic hematoma is the most common type of chorionic hematomas. Other types of chorionic hematoma are retroplacental hematoma (when the hematoma is totally behind the placenta) and subamniotic/preplacental hematoma (when the hematoma is totally in front of the placenta/between the placenta and the uterus).

What are the risks of having a subchorionic hematoma during pregnancy?

The risks depend on the time of onset, the size and the location of the hematoma. A small subchorionic hematoma in early pregnancy usually does not intervere with the pregnancy as it regresses and disolves away on its own by 20 weeks of pregnancy. Most babies grow and develop normally despite the fact that they share the womb with a blood clot. However, a larger-sized hematoma in early pregnancy may increase the risk of placental abruption (miscarriage)– and other pregnancy complications such as growth retardation or preterm delivery if occurs in later trimesters. A hematoma that is very close to the placenta is more dangerous than if it is further away from the placenta.

What are the signs & symptoms of subchorionic hematoma?

A subchorionic hematoma may cause intermittent vaginal bleeding of varying quantities, ranging from light spotting to a heavy flow with clots. The bleeding can be painless, or there may be abdominal cramping, pain in the uterus and tenderness in the abdomen over the uterus. Sometimes, it does not cause bleeding and other external symptoms at all.

What can you do when you have a subchorionic hematoma?

There is no standard care for a subchorionic hematoma. Doctors all suggest something different in regards to a safe activity level. Some doctors would suggest that you can continue with your everyday activities with no restrictions at all. Some doctors even suggest total bed rest for a week, although the benefit of this practice has not been proven.

Like a normal pregnancy, however, straining, heavy lifting and high impact workout should be avoided. Full pelvic rest (no sexual intercourse) is also recommended during periods of bleeding. Drink a lot of water is important to avoid dehydration, which is very dangerous for pregnant women as it can cause the uterus to contract and worsen the bleeding. Pregnant women should be drinking at least eight glasses of water everyday to keep them and their baby healthy.

Can the hematoma be surgically removed?

No, surgery is not an option for this kind of hematoma. Non-operative treatment include administration of medications such as blood thinners (aspirin, heparin, lovenox) to dissolve the clot. However, some doctors prefer to just “wait and see”, letting the patient’s body to absorb the hematoma naturally.