Subchorionic Hematoma

QUESTION

Dear Midwife,
I have been experiencing vaginal bleeding throughout my pregnancy. I had a particularly bad incident at about 10 weeks while I was at work. I began gushing blood and by the time I made it to the ER I had soaked through 3 pads. The baby’s heart was beating so the ER doctor said to monitor the bleeding and follow up with my OB.

At 11 weeks my OB diagnosed me with a large subchorionic hematoma. She said I could continue working. I went back for my 12 week scan and the sonographer found that the clot was much larger than they initially thought. They also said my cervix was shaped like a U.

The Dr on duty in the office said it would be best for me to go on indefinite bed rest. I of course want to do what is best for the baby- but my husband and I depend on my income as well. I am wondering if there is any medical proof that bed rest will help the baby.

I am also wondering what having a U shaped Cervix means. As well as what type of risk SCH poses on the baby. I did not get the measurement of the clot but at this time it is located between the placenta and the sac and is about 2xs the size of the baby. I have not stopped bleeding since my gushing incident and I have passed a few large “rubbery” clots. I can not find many medical information sites on this topic- only blogs and a lot of people giving their personal experiences/feelings about the topic. Could you recommend a site that might shed some light on my questions?

My OB says the only thing we can do is monitor the baby and the clot week by week

ANSWER

Your OB is right. Most likely, the hematoma will either drain or continue to build and eventually result in a miscarriage, but there is nothing to either predict which will happen or to affect which way it will go.

As long as your baby "sticks" and continues to grow normally, you might very well end up with a normal pregnancy that goes to term. I don't know of any scientific evidence that says that bed rest helps in these situations, but bed rest makes many (including doctors) feel like they have done all they can.

On the other hand, if you were my client I wouldn't recommend horseback riding and I would recommend taking it as easy as you can (no lifting groceries or laundry, for instance). Whether you should work depends on what kind of work you do. Remember that I don't know the details of your history, so in your case, there may be a good reason for bed rest, I can't say without more information.

Do take your vitamins and make sure you are not getting anemic, and of course head straight for the ER of you start gushing again. But hopefully, this will all resolve and you will have a healthy delivery. Good luck!

-- Cynthia, CNM

Send Page To a Friend

Cynthia Flynn

Cynthia Flynn, CNM. PhD, is the General Director of the Family Health and Birth Center which provides prenatal, birth, postnatal, gynecological and primary health care to underserved women and their families in Washington, D.C. Recently Cynthia served as Associate Professor of Nursing at Seattle University. There she not only taught, but remained in full scope clinical midwifery practice at Valley Medical Center where she cared for pregnant and birthing women, and practices well-woman gynecology, family planning, and treatment of sexually transmitted diseases.

Cynthia founded Columbia Women's Clinic and Birth Center, where she took care of pregnant women and infants up to two weeks of age and attended both birth center and hospital births. Before Cynthia earned her CNM, she worked as a registered nurse in labor and delivery and postpartum and is a certified Doula and Doula trainer.