A loving married couple expecting a child will do anything they can to get what they wish for. Pregnancy can be a terrifying yet exciting experience especially for young women. Health screening, specifically antenatal check-up is important for expectant mothers to comply as to make sure they are having a healthy pregnancy. There are many possibilities that could happen especially during the early pregnancy. Sometimes, seeing a bleeding vagina or spots of blood during pregnancy can cause the woman to panic relentlessly and cost them a visit to the doctor.
Vaginal bleeding is a common complication happening in the early pregnancy of the first trimester. This accounts for 15 to 25 in 100 pregnancies and usually presented with light bleeding or spotting. Subchorionic hematoma or subchorionic haemorrhage are the most common causes of vaginal bleeding in pregnancy within 10 to 20 weeks of gestational age. Subchorionic hematoma is the bleeding beneath the chorion membranes that cover the embryo in the uterus or in other words, accumulation of blood between the amniotic membrane and the uterine wall. This occurs as a result of partial detachment of the chorion membranes from the wall of the uterus. In some cases, it can be due to malformation of the uterus, history of recurrent abortion or infections in the pelvic area.
A person experiencing a subchorionic hematoma should not be alarmed as it is not a definite indicator that she will face a complicated pregnancy that could affect the baby. Although, there is few reports shows this bleeding condition might increase risk for early pregnancy loss or risk for spontaneous abortion when the volume of the gestational sac (measured by doctors through ultrasound imaging) loss is 25 % or more. It is likely that patients complaining of vaginal bleeding and cramping are tend to have high risk for miscarriage. The earlier a subchorionic hematoma is detected in the early pregnancy, the higher rate of subsequent pregnancy failure.
Patients suspecting of a subchorionic hematoma will either show signs of vaginal bleeding or no such sign. Some patients might be complaining of cramping or contraction of the abdomen but rarely painful sensation. When this patient comes to the doctor, the doctor will ask questions regarding the vaginal bleeding such as the quantity of blood, the bleeding pattern and other patient’s medical history such as history of previous pregnancies and gynaecologic history including history of sexually transmitted infections or pelvic inflammatory disease. Examination of the abdomen and pelvic examination including using a vaginal speculum (a medical tool partially inserted into the vagina to provide better view of the cervix and vagina). This vaginal examination using a speculum is essential to evaluate the bleeding amount and the cervix appearance. Ultrasound of the abdomen and the vagina is needed to get a much clearer picture of the uterus and find the bleeding source. These examinations done by doctor help doctor to eliminate possibility of a possible miscarriage, an ectopic pregnancy or a molar pregnancy as these disorders also causes symptoms of vaginal bleeding in early pregnancy.
Treatments given are based on patient complaints, gestational age and the general health condition of the patient. If a patient has lost a great amount of blood, doctors will order blood tests specifically the type and crossmatch of blood, haemoglobin/haematocrit, and coagulation studies as preparation in case the patient becomes unstable. A stable mother with a stable foetus with no signs of large blood loss, there is no specific treatment given and only follow-up ultrasound evaluation is needed. An anti-D immune globulin will be given if the mother’s blood is Rh(D)-negative.