Vaginal bleeding during pregnancy is often caused by a subchorionic hematoma (SCH). When identified, medical providers frequently prescribe pelvic rest, a management strategy involving specific activity modifications. This approach is intended to support the pregnancy while the body addresses the hematoma. This article details the nature of this complication and the restrictions involved in pelvic rest.
Understanding Subchorionic Hematoma
A subchorionic hematoma (SCH) is an accumulation of blood that forms between the uterine wall and the chorion, the outer membrane of the gestational sac. This pooling occurs when a small area of the chorion partially separates from the uterine lining, causing localized bleeding. The resulting hematoma can be identified and measured using ultrasound imaging.
SCH is the most common sonographic abnormality detected when a live embryo is present and is a frequent reason for vaginal bleeding in the first half of pregnancy. Bleeding can range from light spotting to heavier flow with clots, though some individuals may not experience any symptoms. The size, location, and gestational age influence the level of concern, but most small to moderate hematomas resolve when the body reabsorbs the pooled blood.
Specifics of Pelvic Rest Restrictions
Pelvic rest restricts activity to reduce physical strain and mechanical forces on the uterus. The primary goal of this management strategy is to minimize uterine activity and prevent further detachment of the chorionic membrane, which could enlarge the hematoma. The most consistent restriction involves avoiding sexual intercourse and eliminating any activity that leads to orgasm.
Sexual activity, including orgasm, is restricted because it may mechanically disrupt the hematoma, increase bleeding, or cause mild uterine contractions. Similarly, the insertion of anything into the vagina is prohibited. This means avoiding tampons, menstrual cups, or douching, as these items pose a risk of infection or mechanical irritation.
Restrictions also extend to activities that increase abdominal pressure or strain the body. Healthcare providers advise against heavy lifting, often defined as exceeding 10 to 15 pounds. This limit is set because straining increases intra-abdominal pressure, which may transmit force to the uterine wall.
Strenuous exercise is restricted, especially high-impact activities or those that significantly elevate the heart rate. The focus is on avoiding movements that could jar the uterus or lead to premature uterine contractions. These modifications are commonly prescribed to give the body the best chance to reabsorb the hematoma without exacerbation.
Medical Monitoring and Duration of Management
The management of a subchorionic hematoma requires close surveillance to ensure the condition is resolving and not posing a worsening risk to the pregnancy. The most common tool for tracking the hematoma is follow-up ultrasound imaging. These serial scans allow the medical team to measure the hematoma’s size and volume, noting whether it is shrinking or growing, and confirming the continued viability of the pregnancy.
The duration of pelvic rest is highly variable, determined by the individual’s clinical course and the hematoma’s status. The restriction is often maintained until the hematoma has significantly decreased in size or completely resolved on ultrasound. This resolution process can take several weeks, and providers may recommend continuing pelvic rest until 48 hours after any associated vaginal bleeding has stopped.
Individuals must monitor for specific signs that warrant immediate medical attention. These include a sudden increase in vaginal bleeding, the passage of large clots, or the onset of severe cramping or pelvic pain. Following up with a healthcare provider remains essential throughout the management period for proper assessment and guidance.