A subchorionic hemorrhage is a bleed between the placenta and the wall of the uterus, usually in the first trimester of pregnancy. This is an extremely common complication of pregnancy and sometimes passes undetected. In cases where patients experience symptoms and go to a doctor for treatment, the options for managing this condition vary. There is a slightly elevated risk of miscarriage with this complication, and patients can also develop placental abruption, where the placenta tears away from the uterine wall, posing a serious risk to the pregnancy.
The reasons subchorionic hemorrhages develop are not readily apparent. They do not seem to be strongly linked with any particular behaviors, although activities like smoking can increase the risk of complications if such bleeds develop. Usually, patients notice a subchorionic hemorrhage because they experience bleeding or spotting during pregnancy. A doctor can conduct an ultrasound and spot the distinctive dark clot of blood outside the placenta.
Depending on the size of the hemorrhage, the pregnancy, and the doctor's experience with patients, treatment options can vary considerably. Some doctors tell their patients to continue normal activity levels because they have reasonably healthy pregnancies. Others may recommend bed rest until the bleeding resolves and the body reabsorbs the blood. Clot busting medications to break up the blood clot more quickly can also be an option with subchorionic. In all cases, the patient needs to make a follow-up visit to see if the bleed is resolving or growing larger and to check for complications.
Many pregnancies with a subchorionic hemorrhage follow a normal progress, as the bleed will eventually resolve on its own, although it may take several weeks. Having such a bleed does not necessarily increase the risks of the pregnancy, unless it gets larger or does not clear up within a reasonable period of time. An obstetrician can monitor the patient to see how she is doing and spot complications as early as possible, in order to provide interventions in a timely fashion.
If a subchorionic hemorrhage causes pregnancy loss, the doctor can provide treatment and referrals to counseling services. Patients usually need to wait several months after pregnancy loss to try again, and they are not at increased risk of another miscarriage if they lost a pregnancy because of the hemorrhage. In cases where the bleed causes placental abruption, an emergency delivery may be the best treatment option for saving the pregnancy.