It can be quite difficult to recognize various pathologies in the uterus in time. One of these pathologies is a hematoma. This article will help you understand how to diagnose and treat hematoma in the uterus during pregnancy.
What it is?
For a variety of reasons, hematomas can develop in the uterus during pregnancy. Doctors call a hematoma a pathological condition in which blood accumulates in a confined space. The clinical form of the hematoma depends on where the blood has accumulated.
Doctors identify several variants of this pathology. Each of them has its own characteristics and in a certain way affects the prognosis of pregnancy. With some types of hematomas localized in certain areas of the uterus, complications that are dangerous for the expectant mother and her baby can develop.
It should be noted that hematomas in the uterus can appear at different stages of pregnancy. Some pathologies occur only in the first trimester, while others occur in the second half of pregnancy.
In this case, the severity of the arising violations is different. Sometimes the symptoms that arise can worsen the general condition of the expectant mother so much that it becomes extremely difficult for her to bear the child before the due date.
Options
When determining the diagnosis and clinical type of pathology, doctors use a variety of terms. Such specific medical terminology can confuse anyone. The complex and long name of the diagnosis can completely confuse the expectant mother. It is worth understanding what are the most common hematomas that occur in the uterus during pregnancy.
Subchorial hematoma is one of the pathology options. In this case, blood accumulates between the chorionic membrane covering the embryo and the uterine wall. Unfortunately, this pathology is often found in obstetric practice. The risk of developing a spontaneous abortion in this case is quite high.
In medicine, it happens that often several terms can be used to refer to the same process. Many experts also call the subchorial hematoma retrochorial or transcochial. Doctors have learned to diagnose such a pathology quite well. Transgenic hematoma is currently determined using ultrasound examination.
Blood can accumulate in various places in the uterus. It can spread between the chorionic membranes, and also completely flow behind them. In this case, intershell and intrathecal hematomas develop. The accumulation of blood directly behind the membranes of the chorion can also be called a retro-membranous hematoma.
Pathologies that are associated with chorionic development usually develop in the very early stages of pregnancy. It is at this time that the chorion is very important for the intrauterine development of the fetus. Then it is gradually transformed into the placenta, which already "takes over" the provision of a number of functions necessary for the full growth of the baby in the mother's womb.
Another unique organ that appears in the female body only during pregnancy is the amnion. This is the water shell in which the baby is located. It provides a special aquatic environment, without which the intrauterine development of the child is impossible.
Hemorrhages that occur for various reasons can also lead to the accumulation of blood in the amniotic membrane. In this case, hematomas appear in different parts of the uterus. They can be subamniotic, retroamniotic.
Pathologies associated with the embryonic membranes develop in the first half of pregnancy. Gradually, the placenta begins to form from the embryonic membranes. This feature explains the differences in the names of different hematomas.
With the accumulation of blood behind the placental tissues, a retroplacental hematoma appears. This condition can be extremely dangerous and even lead to the development of fetoplacental insufficiency. With this pathology, insufficient oxygen and nutrients are supplied to the child's body. Prolonged placental insufficiency can even lead to the formation of various defects and developmental anomalies in the baby.
The accumulation of blood in the uterus can cause the pregnant woman to develop adverse symptoms. Bloody and dark brown discharge from the genital tract comes from emptying the hematoma. The accumulated blood can be poured out, which leads to the appearance of specific secretions from the genital tract. This symptom can really scare the mom-to-be.
In such a situation, a pregnant woman should definitely seek medical help. Only a doctor can determine the exact reason why the expectant mother is bleeding from the uterus.
How is the diagnosis carried out?
Currently, thanks to the development of ultrasound examinations, doctors can establish a dangerous diagnosis of hematoma in the uterus quite accurately and simply. Modern devices have a fairly high resolution. With their help, even small accumulations of blood can be determined. Ultrasound helps doctors identify even complex pathologies that were previously impossible to identify in a timely manner.
The main method for diagnosing various hematomas localized in the uterus is ultrasound.
The main method
Reviews of many women who have already become mothers, but are faced with the appearance of a hematoma in the uterus during pregnancy, indicate that they were diagnosed precisely after an ultrasound scan. In most cases, a hematoma in the uterus is determined during routine or screening examinations. It often happens that with this pathology, a woman does not develop any uncomfortable symptoms. In such cases, the hematoma is detected only during screening. Quite often, retroamnial hematoma is diagnosed at 11-13 weeks of gestation.
Modern ultrasound devices not only help to accurately determine the location and size of the hematoma, but also reveal the development of dangerous complications. An ultrasound specialist can quite easily determine the onset of placental abruption - a dangerous pathology that can contribute to premature birth or even intrauterine fetal death.
During the analysis, the ultrasound specialist determines the localization of the ovum, as well as any of its deformations. He also estimates the thickness of the uterine walls. A thickening of the uterus can be a sign of a hematoma in it.
When conducting a study, the doctor necessarily assesses not only the general development of the fetus and the condition of the woman's reproductive organs. He studies the structure of the placental membranes or placenta. Such a detailed diagnosis allows the ultrasound doctor to identify all defects and damage, as well as accumulations of blood between the membranes.
Many doctors believe that the prognosis of pregnancy depends on the size of the hematoma. It can be of various sizes. The prognosis for a 14 mm hematoma is generally better than for a 60-70 mm hematoma. The development of pregnancy largely depends on the localization of the hematoma in the uterine cavity, as well as on the state of the pregnant woman's body.
If the expectant mother does not have concomitant chronic diseases, and her pregnancy was proceeding well before the appearance of the hematoma, then the probability of a favorable outcome in this case is quite high.
Ancillary examinations
An important study that helps to assess the severity of functional disorders arising from hematoma in the uterus is Doppler ultrasonography. This diagnostic method allows you to assess the blood flow in the blood vessels feeding the fetus. Very often, with a hematoma localized in the uterus, intrauterine hypoxia develops - a condition in which a sufficient amount of oxygen does not enter the child's body. This pathological condition contributes to the fact that the formation of internal organs in a child may slow down. In such a situation, the risk of developing dangerous anomalies is quite high.
By means of Doppler ultrasound, doctors can quite easily assess the indicators of uteroplacental blood flow, and also, if necessary, correct them (by prescribing drug therapy). Doppler studies of women with a hematoma in the uterus can be performed several times during pregnancy. This is necessary so that doctors can assess the dynamics of the development of pathology, as well as, if necessary, adjust the chosen tactics of pregnancy management.
Doppler ultrasonography is an absolutely painless method. The mother-to-be does not need to do any special training. The doctor must record all the obtained blood flow parameters in his conclusion, which is glued into the medical card of a pregnant woman.
A hematoma in the uterus can be accompanied by the development of a number of complications. In order not to miss them, doctors resort to prescribing some tests. Simple laboratory tests also allow you to assess the extent of the disorders that have occurred, which means that you can choose the right therapy regimen.
An expectant mother who had a hematoma in the uterus during pregnancy may be assigned the following examinations:
- general clinical studies (general blood and urine tests);
- biochemical test to determine blood clotting;
- sampling of material from the vagina and genital tract (smear) for bacteriological examination;
- determination of hormone levels.
In each case, the list of analyzes may vary. The examination scheme is selected individually by the obstetrician-gynecologist.
If necessary, the doctor can refer the expectant mother to other doctors (for the purpose of additional consultations). If a hematoma in the uterus is complicated by the development of disorders in the blood coagulation system, the pregnant woman is referred for consultation to a hematologist. This specialist will carry out a more extensive diagnosis of the pathological condition that has arisen and select the necessary therapy to correct the developed functional disorders.
Therapy
The choice of therapy tactics for hematoma localized in the uterus depends on different conditions. Doctors necessarily assess the general condition of the pregnant woman and the fetus, determine the possible risk of complications, and take into account the gestational age. The expectant mother can be treated both in a hospital and on an outpatient basis. It depends on how strong the developed disorders are.
With a hematoma in the uterus, which is practically asymptomatic and is not accompanied by the appearance of any unfavorable signs, doctors usually conduct outpatient supervision. At the same time, the expectant mother is informed that she should limit her exercises in the gym and visits to the bath or sauna. A woman is also strictly forbidden to lift heavy objects. In some cases, doctors also prescribe sexual rest. It is very important that the expectant mother has a healthy diet and a sufficient amount of protein products, and also get enough sleep.
It often happens that women do not heed these recommendations, considering them too banal and ineffective. However, such a frivolous attitude towards one's own health and the unborn child can be very dangerous and even contribute to the aggravation of the pathology.
If the doctor recommended the expectant mother to rest more and be more attentive to her well-being, then these recommendations should still be heeded. The appearance of adverse symptoms (bloody vaginal discharge, abdominal pain) should be the reason for an urgent visit to the doctor. An expectant mother should pay attention to how she looks. Sometimes a hematoma in the uterus can be complicated by the development of bleeding, in which case the woman may develop anemia. Anemic syndrome is manifested by pallor and dryness of the skin.
If the expectant mother noticed that her skin has become too pale and even acquired a bluish tint, then she should also definitely show herself to her obstetrician-gynecologist and tell him about the appearance of this symptom.
Therapy for hematoma in the uterus with the use of drugs is selected individually. In this case, the gestational age is necessarily taken into account. In the early stages, hormonal agents are often prescribed, which contain an analogue of the female sex hormone - progesterone. They have a positive effect on the uteroplacental blood flow, reducing the negative manifestations of pathology.
Doctors may prescribe special medications to reduce the amount of blood that is poured out. Taking such drugs contributes to the fact that the hematoma in the uterus gradually resolves.
Some doctors prescribe the drug "Wobenzym" for this purpose. It is prescribed in tablets. The course dosage and duration of treatment are chosen by the doctor who leads a specific pregnancy and knows about its features.
In some cases, with a hematoma in the uterus, pain in the abdomen appears. In the early stages, pain is usually localized in the lower abdomen. It can and extend to the lumbar region. To relieve pain, doctors resort to prescribing antispasmodics. They can be prescribed in the form of tablets, intramuscular injections or rectal suppositories (suppositories).
Multivitamin complexes can also improve the general condition of the expectant mother and baby. It is extremely important that they contain folic acid. Such drugs are usually prescribed from the earliest stages of pregnancy (and for a rather long period).
Ancillary means for hematomas localized in the uterus are sedatives (sedatives). They are assigned to women who have a rather high anxiety or a strong tendency to worry. Sedatives can help the expectant mother cope with depression and also improve sleep. During pregnancy, doctors give preference to products containing herbal ingredients. Medicines containing motherwort or valerian are often prescribed.
For hematomas in early pregnancy, see the following video.
