Experiencing bleeding or abdominal discomfort during pregnancy can cause significant anxiety. Many people with these symptoms are eventually diagnosed with a subchorionic hemorrhage (SCH). SCH involves the accumulation of blood between the lining of the uterus and the membranes surrounding the fetus. This condition is a frequent cause of bleeding in the first trimester, and understanding its symptoms, including the potential for cramping, is important.
Understanding Subchorionic Hemorrhage
A subchorionic hemorrhage is a collection of blood that forms between the uterine wall and the chorionic membrane (the outer layer of the gestational sac). This accumulation occurs when the chorion, or developing placenta, partially separates from the inner lining of the uterus. The size of the hemorrhage can vary widely, ranging from a small collection to a large clot occupying a substantial portion of the space around the gestational sac.
SCH is the most common sonographic abnormality detected in the presence of a live embryo and frequently causes bleeding in early pregnancy. Diagnosis is typically made during an ultrasound examination, where the hemorrhage appears as a crescent-shaped fluid collection adjacent to the gestational sac. Many individuals with SCH experience some degree of vaginal bleeding, ranging from light spotting to a heavier flow with clots. In some cases, the hemorrhage may be discovered incidentally during a routine scan without any outward symptoms.
Connecting Hemorrhage to Uterine Cramping
A subchorionic hemorrhage can cause cramping, though it is not a universal symptom. The cramping sensation arises from the uterus’s physiological response to the presence of blood within its cavity. The hemorrhage, which is a collection of blood, acts as an irritant to the muscular uterine wall, known as the myometrium.
The uterus reacts to this irritation by contracting gently, attempting to expel the foreign material. This muscular activity is perceived as pelvic cramping or abdominal discomfort. The cramping associated with SCH is typically described as mild or similar to menstrual cramps, presenting as a dull ache or pressure rather than severe, sharp pain.
It is important to distinguish this mild discomfort from intense, debilitating pain, which signals a more serious complication and warrants immediate medical evaluation. While a larger hematoma size is associated with a higher risk of adverse pregnancy outcomes, the severity of the cramping does not always directly correlate with the hemorrhage’s size. The presence of blood actively irritating the uterine lining can trigger noticeable cramping, even if the hemorrhage is small.
Management, Monitoring, and Prognosis
Management of a diagnosed subchorionic hemorrhage is primarily supportive, as there is no specific treatment available to dissolve the blood collection itself. Healthcare providers recommend reducing activity levels and avoiding strenuous exercise or heavy lifting to minimize further separation or bleeding. Pelvic rest is also advised, which includes abstaining from sexual intercourse and avoiding the use of tampons, to prevent irritation to the cervix and uterus.
Monitoring the condition involves serial ultrasounds to track the size of the hemorrhage and confirm its eventual resolution. For individuals with Rh-negative blood type who experience bleeding, an injection of Anti-D immune globulin is administered to prevent the development of antibodies that could affect future pregnancies. In some cases, particularly where a threatened miscarriage is a concern, hormonal support like progesterone therapy may be introduced, as it can help reduce the excitability of the uterine smooth muscle and lessen contractions.
The prognosis for SCH is generally favorable, with most cases resolving spontaneously as the pregnancy progresses. The blood collection is typically reabsorbed by the body or expelled through the vagina as spotting or bleeding. Factors influencing the prognosis include the hemorrhage’s size relative to the gestational sac; a collection greater than 50% of the sac size is considered large and carries a higher risk.
People with SCH must be vigilant for specific symptoms that require immediate medical attention. These warning signs include:
- Heavy vaginal bleeding that soaks through a sanitary pad within an hour for two or more hours.
- The passage of large clots.
- Sudden, severe abdominal or pelvic pain.
- Dizziness, lightheadedness, or fever.