Every third pregnant woman experiences retrochorial hematoma from her own experience. This is one of the most common early pregnancy pathologies. Is this condition dangerous, why is it developing, is it necessary to treat the hematoma, will be discussed in this article.
What it is?
Retrochorial hematoma during pregnancy is an insidious and dangerous pathology, which can have very sad consequences for the mother and child. A hematoma is a hemorrhage, a bruise. To understand where and how this bruise is formed during pregnancy, you need to understand how a fertilized egg is attached to the uterine cavity.
8-10 days after ovulation, the fertilized egg, after a long journey through the fallopian tube, enters the uterine cavity. Her task is to implant, gain a foothold. Special enzymes that produce the membranes help literally dissolve the epithelial layer of the uterus, penetrate and grow tightly into it.
The place of attachment of the chorion is a close vascular connection between the ovum with the embryo growing in it and the wall of the uterus, which becomes looser before implantation under the action of the hormone progesterone. The vascular mesh provides the embryo with nutrition, oxygen access from the mother's blood.
The chorion subsequently changes and becomes a young placenta. But this happens only by 12-14 weeks of pregnancy. Until the end of the first trimester, the placenta as such does not exist, there is only the chorion - its predecessor.
Any, even a slight detachment of the ovum from the uterine wall causes rupture of blood vessels from the vascular network. From the damaged vessels, blood flows out and accumulates between the ovum and the wall of the uterus. This is a hematoma.
Since we are talking about the chorion, the hematoma is called retrochorial. In this way, pathology occurs only in early pregnancy. If the detachment occurs later, when the placenta is formed, the hematoma is called retroplacental.
The danger of such a detachment is that the hematoma will not go away by itself. If there is no outlet for the accumulated blood, then the hematoma will increase, all new parts of the chorion will be involved in the detachment, until the ovum loses its connection with the uterine wall over a large area or does not move away from it at all. For the embryo, discharge means death, since it will no longer receive the necessary nutrients and oxygen. In the body of a pregnant woman, a damaged and deprived of blood supply, the chorion will cease to produce the hormone necessary for bearing the baby - hCG, and this will lead to spontaneous miscarriage at an early stage.
The mechanisms of the occurrence of hematoma are not completely clear to modern medicine, but statistics exist, and they are far from comforting: the diagnosis of "retrochorial hematoma" is made by about 35-40% of pregnant women.
This does not mean that all pregnancies end in miscarriage, since the mere presence of such a hematoma does not necessarily lead to the termination of the fetus.
Causes of occurrence
The reasons can be very different, and it is far from always possible to find the true cause in a particular woman, because doctors tend to believe that several negative factors are usually "guilty" of the formation of a hematoma. The most likely of these are several reasons.
- Hormonal disruptions. If pregnancy occurs against the background of insufficient progesterone levels, if a woman has other hormonal pathologies, thyroid dysfunction, then it is very likely that in the earliest stages of pregnancy, the endometrium of the uterus will not be ideally ready for implantation. The risk of developing partial or complete detachment increases. Hormonal causes are one of the most common; they accompany early miscarriages in about 15% of pregnant women.
- Stress... Violation of the close relationship of the chorion and the endometrium of the uterus can occur due to severe stress, anxiety, emotional shock, since the stress hormones produced during this block the production of female sex hormones. In addition, stress causes fluctuations in blood pressure levels, and detachment can occur due to them.
- Early toxicosis... If the toxicosis appeared early, and it is very strong, the woman's work of all organs and systems, including the cardiovascular, nervous, and endocrine systems, is disrupted. Due to complex disorders associated with a change in the composition of the blood, its viscosity, detachment may occur.
- Bad habits... Smoking and alcoholic beverages, if a woman continues to consume them during pregnancy, have a detrimental effect on the condition of the blood vessels and pressure. Chorionic detachment at an early stage in this case is associated precisely with the fragility and vulnerability of blood vessels, which is characteristic of all women who smoke and drink.
- Gynecological diseases and a burdened history. Quite often, chorion detachment from the uterine wall occurs in women who, even before pregnancy, had problems with their reproductive health - uterine fibroids, endometriosis, often had abortions or have postoperative scars on the uterus.
- Autoimmune processes... It is relatively rare, but it happens that a woman's immunity cannot adapt itself to pregnancy and produces specific antibodies to her own cells and the cells of the embryo. Then rejection occurs by the action of immune processes. This is the most difficult cause that is difficult to correct.
- Fetal pathology... At a short time, a woman may still not know about the chromosomal or structural abnormalities existing in the child, but nature already knows this for sure, the ovum is sometimes rejected due to the impossibility of further development of the fetus. It is usually not possible to stop such detachment.
- External negative influences. A woman's body can be affected by work in hazardous industries, with paints, varnishes, toxic substances. Both household chemicals and radioactive radiation are dangerous. And also increased risks are created by vibration, shaking, strong physical exertion, jumping.
In addition, medication without the permission of a doctor, chronic diseases of the heart, kidneys, liver and urinary system can affect the integrity of the contact between the chorion and the uterine wall. Sometimes the cause of the detachment is not obvious, and it is almost impossible to establish it.
Symptoms
Most often, retrochorial hematoma is manifested by aching pains in the lower abdomen and lower back (as with menstruation), unusual discharge from the genital tract. The discharge has blood impurities and can be bloody, pink, bloody, orange, and others. The abundance of discharge depends on the degree of detachment and the size of the hematoma, as well as the presence of blood flow from the damaged vessels into the vagina.
If the hematoma is closed, there is no way out, the pathology proceeds without discharge, but with aching and pulling pains. The presence of scarlet blood on the daily pad indicates that the detachment has just begun, the blood has not yet baked, it is fresh. Brown discharge suggests that the detachment occurred earlier, and now the process of caked blood coming out and the resorption of the hematoma has begun.
Brown discharge is considered the most favorable symptom. The more abundant they are, the better the prognosis - the hematoma resolves, the detachment has stopped.
If the scarlet discharge continues, and the pain becomes stronger, it is likely that the detachment of the ovum from the uterine wall continues. At the same time, the pain increases, they become cramping, constant. Due to changes in hormonal levels, a woman begins to experience severe anxiety, anxiety and even fear. The heartbeat becomes more frequent and the blood pressure decreases. The woman begins to feel severe weakness, malaise.
If the chorion is located in the bottom of the uterus (at the highest and widest part of it), then symptoms may be absent. And the expectant mother can find out about the probable detachment only during the next ultrasound scan or when it is too late to do something - if the ovum completely exfoliates and a miscarriage begins.
Retrochorial hematoma is considered one of the main causes of the threat of miscarriage in the early stages of pregnancy. This is bad news. But there is also a good one - up to 95% of all cases of such chorionic detachment ends quite well - the pregnancy is preserved, the child grows and develops further, this incident then does not affect his condition in any way.
Diagnostics
Determination of retrochorial hematoma during pregnancy does not cause great difficulties. If there are symptoms, then a preliminary diagnosis is established based on clinical signs, if there are no symptoms, then the hematoma can only be detected by ultrasound scanning. The doctor will send an ultrasound scan in any case if he has even the slightest suspicion of chorionic detachment.
The risk group is women who have previously suffered from chorionic or placental detachment, carrying twins or triplets, mothers with many children whose uterine walls have already lost their natural elasticity, women with a burdened history, as well as those who have become pregnant after a long period of infertility on their own or through IVF.
Ultrasound is performed intravaginally, this allows not only to assess the presence or absence of a hematoma, to determine its exact location and size, but also to examine the cervix, to assess the state of the internal pharynx. If the detachment is large, and the pharynx opens slightly, they speak of a miscarriage that has begun, but if the fragments of the ovum have already begun to leave the uterine cavity, they speak of a miscarriage that has taken place.
With retrochorial hematoma, a cavity filled with blood is defined as a darkened echogenic area, the ovum itself may have an irregular shape, be deformed.
To clarify the condition, a woman is recommended to pass general and biochemical blood tests, blood for progesterone, and a general urine test. The size of the detachment will be a decisive factor in the choice of treatment tactics.
How to treat?
If the doctor offers hospitalization, you should not refuse it - the detachment is a serious matter, and they are offered to go to the hospital only in case of a rather serious detachment. A small hematoma may well be treated at home.
A pregnant woman will be sent to the hospital if she has a severe pain syndrome, bright scarlet blood is released from the genital tract, blood pressure is lowered, and a general deterioration is observed. And also women are sent to the hospital, whose hematoma is quite large, and the blood does not have an outlet (there is no discharge).
The accumulation of blood between the chorion and the uterus in an amount of more than 20 milliliters is considered dangerous. With small pink or brown discharge, a woman may well be allowed to be treated at home.
The main task of treatment is resorption of the hematoma. In order for the smooth muscles of the uterus not to tone up and thereby increase the detachment, antispasmodic drugs are prescribed: "No-shpa", "Papaverin". To improve blood circulation, general systemic drugs "Actovegin", "Curantil" are used, and hemostatics, for example, "Dicinon", "Vikasol", are used to stop bleeding if it increases.
If the detachment occurs against the background of hormonal insufficiency, progesterone preparations are prescribed - "Utrozhestan", "Duphaston" and others in an individual dosage, which the doctor selects on the basis of a blood test for a hormonal profile. Particular attention is paid to vitamins, they are shown to all pregnant women with a threat of miscarriage. To eliminate the symptoms of stress and uterine tone, Magne B 6 is recommended.
A woman is recommended to use products containing iron to eliminate the symptoms of anemia, if any, as well as to prevent anemia, which can aggravate and aggravate detachment. For a woman even with a small retrochorial hematoma, bed or semi-bed rest is recommended; in the supine position, it is best to place a roller under the lower back.
Foods that thin the blood are not recommended. The ban, in particular, applies to white cabbage, peas and other legumes.
It is not recommended for a woman to have sex, masturbate, lift weights, bend over, change body position abruptly, or drive on uneven roads in a car.
But you should also avoid visiting the baths and saunas, do not swim in a hot bath. Hygienic procedures should be limited to a warm shower; any overheating of the body threatens to result in the development of uterine bleeding and loss of pregnancy.
It is important to avoid constipation, as excessive pushing during bowel movements can lead to undesirable consequences. If constipation still occurs, you should find out from your doctor which mild laxative you can use in early pregnancy.
If you do not follow the recommendations, it is possible that a miscarriage will still occur. And there is also a possibility that even with a saved pregnancy, placental abruption may occur later, and this is the most dangerous.
Reviews
According to numerous reviews that expectant mothers left on the pages of thematic forums on the Internet, most often signs of retrochorial hematoma in the form of obvious symptoms appear at 6-7 and 9-11 weeks. Latent retrochorial hematoma is most often detected during the period of the first mandatory screening - at 12-13 weeks of pregnancy.
The treatment, according to women, takes from two weeks to one and a half months. Usually, at the end of the course, a repeated ultrasound scan shows either a decrease in retrochorial hematoma, or its complete disappearance. In some cases, visual signs of hematoma remnants persist for quite a long time, they should not frighten the expectant mother.
Women emphasize that in almost all cases of pregnancy loss due to extensive detachment of the ovum, the visit to the doctor was belated.
The experience of a girl faced with such a serious problem during pregnancy will be very useful for all the fair sex who are planning to become a mother.
