(Image source network, not allowed to invade and delete)
In addition to paying attention to whether the HCG doubles on time, the most asked questions are the subchorionic hematoma in the first trimester, or the uterine effusion, or the paragestational fluid dark area, these names all refer to the same thing.
When you find this problem on ultrasound, please calm down first, don't be afraid.
So if there is fluid accumulation, do I need to protect the fetus? Is this a sign of threatened miscarriage? I heard on the Internet that this phenomenon is serious, is it true? There are also doctors who prescribe tocolytic drugs, is this considered overtreatment?
Today, please follow Sister Quan's correct interpretation of subchorionic hematoma in early pregnancy, understand scientifically, do not exaggerate, do not ignore, do correct diagnosis and treatment, and ensure a safe pregnancy.
01Correctly recognize subchorionic hematoma
Subchorionic hematoma, which is its scientific name, is called uterine effusion in many places, which refers to the fluid that accumulates in the uterine cavity, which can be blood, pus, or uterine secretions.
But after pregnancy,.
A subchorionic hematoma is a separation of the chorionic membrane from the decidua at the bottom, resulting in a build-up of blood in it, which is simply an extra hematoma next to the gestational sac.
How exactly does subchorionic hematoma appear, there is no unified theory in the academic community at present, and some of the current statements are speculation.
The most speculated is that due to the expansion of the chorion into the decidua in the first trimester of pregnancy, the trophoblast layer of the outer chorionum invades the capillaries, spiral arterioles, and venules of the endometrium.
Only in this way can the maternal blood circulation reach the placenta and establish the maternal and fetal circulation.
Other scholars believe that this may be due to hypobaric bleeding due to rupture of venous sinuses at the edge of the placenta or bleeding due to placental stromal dysplasia.
It is also believed that the chorion of the outer layer of the fetal membrane invades and expands to the decidua in the first trimester, and the syncytiotrophoblasts in the outer layer of the chorionic villus may cause a large amount of proteolytic enzymes to be released for some reasons, which causes decidual vascular injury and causes bleeding between the chorion and the decidua.
There are also many comparative studies that believe that choriohematoma is related to immunity, and patients with subchorionic hematoma have a higher autoimmune positive rate, such as antinuclear antibodies, antiphospholipid antibodies, etc., and believe that subchorionic hematoma is an immune rejection phenomenon of the body.
In addition, some studies have suggested that subchorionic hematoma in the first trimester is related to the use of aspirin in the first trimester.
in a word
02Can choriohematoma cause miscarriage?
I think that's where people ask the most questions, but it's also a question that is hard to conclude yes or no.
First of all
Let's look at a test-tube study, because test-tube ultrasound is more frequent, so the detection rate of hematoma is also higher than that of natural pregnancy, so I use test-tube hematoma study as an example.
In a cohort of 3074 patients, the incidence of hematoma was 17.1%, and the group was divided into 92 patients with hematoma and 215 patients without hematoma, as they all had vaginal bleeding.
415 women with subchorionic hematoma and 807 women without hematoma were divided into asymptomatic groups.
The results showed no significant differences in live birth rate (91.3% vs. 92.9%, P = 0.314), miscarriage rate (8.4% vs. 6.7%, P = 0.267) and preterm birth rate (4.8% vs. 5.7%, P = 0.519) between the two groups.
However, for symptomatic patients, both univariate and multivariate regression analyses showed no significant association between subchorionic hematoma and pregnancy outcomes, but subgroup analyses showed symptoms of vaginal bleeding, rather than hematoma size, associated with live birth.
Other words
In addition to vaginal bleeding, miscarriage is also associated with the presence or absence of contractions, and one review analyzed the pregnancy outcomes of infertile patients with subchorionic hematoma found on the first ultrasound after pregnancy versus those without hematoma.
It was found that
In addition to vaginal bleeding and contractions, miscarriage is also related to the size of the hematoma.
Some studies have found that
Based on the above research, we can actually draw the following conclusion:
03Does subchorionic hematoma need to protect the fetus?
At present, most opinions suggest that subchorionic hematomas in the first trimester of pregnancy may be a common pathological phenomenon, especially small and medium-sized hematomas without symptoms of threatened miscarriage (vaginal bleeding, uterine contractions).
For this kind of problem, it is generally mainly repaired by the patient's own absorption of the hematoma, without special treatment, and there is no need to worry too much and worry.
However, now, especially for sisters who have had adverse pregnancies, there are more fetal preservation treatments for hematoma, and they have rich clinical experience, but there are no relevant guidelines and consensus at home or abroad.
For threatened miscarriage and large hematomas, clinical treatment is also symptomatic.
Ultrasound results showed that the hematoma in the treatment group was absorbed more rapidly than in the control group (only vaginal progesterone) in the first and second weeks.
In addition, subjective symptoms, such as vaginal bleeding, abdominal pain, and uterine contractions, also decreased faster in the treatment group than in the control group.
In addition, there are many clinical uses, and the specific medication is generally related to the patient's condition, and it is particularly important to note that overtreatment should be avoided as much as possible.
Of course, whether the above symptomatic treatments are excessive treatments or not, and whether they have a positive effect on holding a baby is also very controversial.
So, for now, if you only find a hematoma by ultrasound, there is no need to panic, let alone worry, but if there is vaginal bleeding and contractions, and the hematoma is large, it means that there is a risk of miscarriage.
There is no consistent conclusion as to whether the miscarriage will be real, whether treatment is needed, and whether the outcome can be improved after treatment.
in a word
So, back to the title, if you occasionally find a subchorionic hematoma, it doesn't matter at all if you don't protect the fetus, and it doesn't increase the risk of miscarriage.
However, if there are comorbid symptoms, the results are less certain, but most are good.
Solemnly declared
The content published on this account is only for information sharing, this account does not do any form of marketing promotion, and the views of the article cannot be directly used as medical diagnosis or health intervention suggestions. Talk to your healthcare provider before taking any preventive or curative measures.
No gossip and rumors
Don't be an official account that exists only for the number of forwards
Always care about real data and documentary arguments
On the way to hold the baby, I am willing to accompany you through the most helpless years
——THE END——
bibliography
[1] Autoantibodies in association with subchorionic haematoma in early pregnancy. Ann Med. 2021 Dec; 53(1):841-847. doi: 10.1080/07853890.2021.1936150.
[2] Association between first-trimester subchorionic hematoma detected at 6-8 weeks of gestation and pregnancy outcomes after fresh embryo transfers: a propensity score-matching cohort study. Arch Gynecol Obstet. 2022 Dec; 306(6):2167-2175. doi: 10.1007/s00404-022-06775-y. Epub 2022 Sep 16.
[3] Outcomes of subchorionic hematoma-affected pregnancies in the infertile population. Int J Gynaecol Obstet. 2022 Dec; 159(3):743-750. doi: 10.1002/ijgo.14162. Epub 2022 Mar 14.
[4] How does subchorionic hematoma in the first trimester affect pregnancy outcomes? Arch Med Sci. 2021 Jan 8; 18(3):639-646. doi: 10.5114/aoms/113645.
[5] The Association of High-Molecular-Weight Hyaluronic Acid (HMWHA), Alpha Lipoic Acid (ALA), Magnesium, Vitamin B6, and Vitamin D Improves Subchorionic Hematoma Resorption in Women with Threatened Miscarriage: A Pilot Clinical Study. J Clin Med. 2024 Jan 25; 13(3):706. doi: 10.3390/jcm13030706.