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Why does a hematoma appear in the uterus during pregnancy and how is it treated. Brown discharge from a hematoma during pregnancy Signs of resorption of a hematoma during pregnancy

The psycho-emotional state of a pregnant woman is unstable and subject to constant changes. And the diagnosis of a hematoma in the uterus will not add joy. The definition of such a pathological condition sounds quite threatening and is considered a rather serious complication of pregnancy. But, no matter how it sounds, most women with such a pathology successfully carry their pregnancy to term and give birth to a healthy baby.

Uterine hematoma forms during pregnancy and is manifested by the accumulation of blood in a certain area of ​​the uterus and most often occurs as a result of detachment of the fertilized egg from the walls of the uterus.

Remember! A uterine hematoma is a cavity that can reach various sizes and is filled with blood from damaged vessels.
The formation of a hematoma in the uterine cavity in a pregnant woman can be influenced by many reasons that can cause detachment of the fertilized egg.

Types of hematoma

A hematoma can arise and develop, often without causing significant symptoms, without reaching a large size, and patients are often unaware of its existence. It is customary to divide hematomas into 2 types, depending on the timing of the pregnancy:

• retroplacental hematoma - occurs in the early stages of pregnancy, the development and formation of which ends at the sixteenth week;
• retrochorial hematoma, which can occur throughout the entire sixteen weeks.

Important! Retrochorial hematoma in obstetrics refers to conditions that threaten the course of pregnancy and cause its termination. This pathology has recently tended to increase and an increasing number of women are turning to specialists with similar troubling questions and for the necessary treatment.

According to the condition of the hematoma and what effect it has on the body of a pregnant woman, they are classified in a certain way:

1. Mild degree when the hematoma does not cause complaints and is discovered during a random examination. There are often cases when pathology is determined by the placenta after childbirth. This form does not interfere with the development of the fetus and does not require treatment, however, if it reaches a large size, it can cause bleeding. A frequent way out of such situations is the need to use an operation using the cesarean section method.
2. Average degree, in which some nagging pain may occur in the lower abdomen with blood-streaked discharge appearing. If such symptoms occur, immediate consultation with a doctor is necessary to prescribe appropriate treatment. Minor hemorrhage does not cause a major negative impact on the well-being of the expectant mother, but can negatively affect the development of the fetus due to insufficient blood supply to the fetal egg.
3. Hematoma in the uterus, developing in severe form causes severe cramping pain in the uterine area. Also, a significant drop in pressure, loss of consciousness, and dizziness may occur. These symptoms are accompanied by heavy bleeding that continues for a long time.

Causing causes

There are many reasons why hematomas can occur in a woman’s body during pregnancy. These include hormonal level disorders, in which a lack of hormones or their excess disrupts the process of attachment of the fertilized egg to the endometrium, as well as heavy physical activity that causes minor hemorrhages. Poor environmental conditions, stress, and trauma can be common causes of uterine hematoma. Reasons that can cause the development of uterine hematoma include defects in the formation of the fetus, diseases of the genital organs, which include infections. A frequent case of the development of such a pathology is late toxicosis of pregnant women, as well as bad habits that the expectant mother could not part with.

A hematoma in the uterus can occur as a result of hemorrhage in weak vessels passing through the uterine cavity or in the placenta. This condition often occurs as a result of a disrupted metabolic process in the body. A common cause of the development of pathology is pressure surges, especially in the direction of its sharp increase, as well as alcohol consumption, smoking or the use of narcotic drugs during pregnancy.

To determine retrochorial and retroplacental hematomas, examination procedures using ultrasound are used. Important signs obtained using ultrasound examination and indicating the presence of pathology are: a deformed fertilized egg, a slight increase in the thickness of the wall in the uterus, and identification of a blood-filled cavity.

In cases where the examination shows the presence of a hematoma, the doctor prescribes an additional number of some necessary tests. They include blood tests, biochemistry tests, testing for HIV infection and syphilis, smear tests, and blood tests for hormone ratios.

Treatment of retrochorial form

Retrochorial hematoma is a fairly common and common type. If treated in a timely manner, this form does not pose any danger to the developing fetus. A threat to the patient’s life also occurs quite rarely, only in cases of a large area of ​​detachment occurring with heavy loss of blood. If such a situation arises, as a rule, immediate termination of pregnancy is prescribed. If the manifestations of such a pathology are ignored and timely treatment is not started, spontaneous labor may occur, which, starting ahead of schedule, leads to the death of the fetus and poses a threat to the life of the pregnant woman.

Treatment of retrochorial hematoma is recommended to be carried out in a hospital setting, following dietary recommendations and not violating bed rest. During this period, it will be necessary to ensure that the patient takes vitamins and a course of medications that will increase blood flow in the uterus and sufficient oxygen saturation of the blood. The selection of prescribed therapy is based on the patient’s individual well-being and the area of ​​hemorrhage. The time for release of the hematoma will directly depend on its size, location in the uterine cavity and the body’s ability to suppress the development of pathological processes. It must be remembered that brown discharge is evidence of a hematoma emerging from the uterus.

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Retrochorionic (between the chorion and the uterine wall) hematoma is detected in every tenth pregnant woman in the early stages. The chorion is the part of the fertilized egg that is adjacent directly to the wall of the uterus, from which the placenta is subsequently formed. The accumulation of blood between the chorion and the endometrium - hematoma - during early pregnancy is the first evidence of a threat of miscarriage. However, timely treatment helps to preserve a viable fertilized egg in the uterine cavity and continue pregnancy.

Retrochorial hematoma has a different clinical course - from the absence of symptoms to active bleeding. It is an area of ​​amniotic sac detachment, inside which there are blood clots. It is quite difficult to establish the true cause of retrochorial hematoma, but the treatment is approximately the same in all cases. It is aimed at stopping the progression of abruption and maintaining pregnancy.

There is no exact position according to ICD-10 (the international classification of the disease from 2010), so hematoma falls into the headings 000-008 - “Interruption of pregnancy” or 095-099 - “Other conditions during pregnancy”.

Why does it occur

The causes of hematoma in the uterus during pregnancy are different, many of them do not depend on the woman. Only a specialist can understand the problem and prescribe the most effective treatment.

Only by 16-18 weeks of pregnancy does the final penetration of chorionic villi into the wall of the uterus and the formation of the “baby place” occur. Therefore, during the 1st and 2nd trimesters, the likelihood of hematoma formation between the endometrium and chorion is quite high. Its main reasons are the following.

• Pathology of the ovum. The formation of a retrochorial hematoma is the beginning of the development of a miscarriage in the presence of structural or chromosomal abnormalities of the embryo. This is one of the methods of natural selection in nature.
• Infection. Any acute infectious diseases in the early stages can provoke a threat of miscarriage and cause abruption. On the one hand, viral and bacterial infections can lead to malformations of the embryo, as a result of which it begins to be rejected. On the other hand, pathogens affect the process of implantation (introduction of chorion into the wall of the uterus), increase the fragility of blood vessels and contribute to the formation of hematomas and subsequently miscarriage.
• Inflammation of the genitals. Sexual infections or nonspecific inflammation in the uterine cavity and cervix lead to tissue deficiency, which disrupts the implantation process. Detachment of the ovum often occurs in women with chronic inflammation of the endometrium and cervical canal.
• Injuries and physical stress. Injuries in the abdominal area, including as a result of surgical interventions on the pelvic organs and abdominal cavity, as well as injuries to other parts of the body can lead to the formation of a hematoma due to mechanical stress and increased excitability of the uterus.
• Hormonal disorders. To successfully carry a pregnancy, a special hormonal background with a predominance of progesterone is required. It is responsible for relaxation of the myometrium and high-quality implantation. Lack of progesterone causes detachment (hematoma) and even miscarriage with overall normal development of the embryo.
• Toxicosis. Mild toxicosis with morning nausea and vomiting no more than five times a day does not threaten serious problems. But moderate and severe degrees lead to changes in the content of important microelements in the blood (calcium, magnesium, sodium, potassium). This provokes pathological uterine contractions, changing the permeability and stability of blood vessels. These processes increase the risk of detachment formation. It should also be taken into account that the body is trying to get rid of the cause of severe toxicosis - the developing embryo, and any miscarriage begins with detachment and the formation of a hematoma between the amniotic sac and the wall of the uterus.
• Malformations of the genital organs. Saddle-shaped uterus, bicornuate or rudimentary development, uterine hypoplasia are often accompanied by increased excitability of the myometrium. And this is a provoking factor for the formation of a hematoma. With an abnormal structure of the uterus, the fertilized egg can attach to a pathological area, for example, to the “saddle” area or to the septum. This will inevitably lead to the threat of miscarriage.
• Tumors of the uterus. When the fetal sac is attached to the area of ​​fibroids, the implantation process is disrupted, since in this place the uterine tissue and blood vessels have an abnormal structure. This is especially often caused by fibroids that are large in size or located closer to the internal cavity of the uterus.
• Abnormal implantation. The most favorable is considered to be the attachment of the fertilized egg in the area of ​​the fundus of the uterus and the posterior wall. Less successful is the front wall. The closer the chorion is implanted to the cervix (sometimes even directly above the internal opening of the cervical canal), the greater the likelihood of a pathological pregnancy with abruption and breakthrough bleeding.
• More than two fetuses in the uterus. When carrying twins, triplets or more, the risk of all pregnancy complications increases several times. In particular, what a hematoma may look like during ultrasound diagnostics is the second embryo, which stopped developing at a very short time.
• After IVF. Assisted reproductive technologies are accompanied by the use of numerous medications. At the same time, it is not always possible to provide “comfortable conditions” for the development of embryos, so the frequency of abruption is higher than with spontaneous pregnancy.
• Chronic diseases. Diabetes mellitus, pathology of the thyroid gland, diseases of the blood and the cardiovascular system are accompanied by changes in the properties of small and medium-sized vessels, which affects implantation.
• Stress. Psycho-emotional stress leads to spasm of the smooth muscles of the uterus and changes in a woman’s hormonal levels. Long-term stressful situations can also disrupt implantation.

The process of hematoma formation is most often simultaneously influenced by several factors. Most often, these are insufficient production of progesterone, chronic and acute inflammatory processes, as well as abnormalities of the fetal egg (with genetic and chromosomal abnormalities). This is taken into account during treatment, so treatment regimens are very similar in all cases.

Who is more likely to experience

A hematoma in the uterus during early pregnancy most often occurs in women with the following diseases and conditions:

• in multiparous women;
• after IVF;
• after abortion;
• after 35 years;
• with a history of infertility;
• in emotionally unstable people;
• with chronic diseases, including endocrine disorders;
• with genetic diseases, including undiagnosed ones.

When to suspect

Signs of a hematoma in the area where the fertilized egg is attached in pregnant women are not always obvious. Sometimes it is a “find” during a routine ultrasound in the 1st trimester. But more often, detachment manifests itself clinically, although the woman does not always pay due attention to the symptoms.

The general state of health does not change even with significant detachment for a short period of time. A slight decrease in blood pressure, dizziness, weakness, and a decrease in signs of toxicosis (if expressed) may appear. The main symptoms are pain in the lower abdomen and discharge.

Pain

The pain caused by a hematoma in the uterus during pregnancy is nagging, similar to menstrual pain. They can be constant or occur only in the evening, after overwork. They become cramping when the miscarriage begins.

Discharge

Discharge during detachment can be normal - whitish or mucous. Bloody ones appear when the hematoma is emptied. If it is small in size or located far from the cervix (for example, in the fundus), there will be no bloody or even brown discharge.

The intensity of the discharge depends on the size of the hematoma: from barely noticeable pinkish, brown, brown to heavy bleeding with clots. A hematoma is dangerous with the following discharges during pregnancy.

• If they intensify. They were light or brown and not abundant, but gradually become bright and scarlet, which indicates the progression of detachment.
• If clots appear. They talk about a large area of ​​detachment.

The hematoma may not be accompanied by discharge, but it may be large. In this case, the fertilized egg most often dies.

Detachment can be suspected if a pregnant woman has nagging pain in the lower abdomen and bleeding appears. But a reliable diagnosis can only be made using ultrasound. Especially if two sensors are used - abdominal and vaginal. At the same time, it is important to monitor the state of the detachment over time every three to seven days.

How does a hematoma during pregnancy affect the fetus and placenta?

The consequences of a hematoma during pregnancy for a child depend on many factors:

• size;
• location;
• reasons for education;
• time of start of treatment;
• quality of therapy.

If the course is successful, the hematoma “resolves” and does not in any way affect the further development of pregnancy. But the following complications cannot be excluded:

• frozen pregnancy;
• increased detachment and spontaneous miscarriage;
• a large hematoma after eight weeks can lead to fetal growth retardation;
• dysfunction of the placenta.

Treatment

Even at the slightest suspicion of a threat of termination of pregnancy with the formation of a hematoma, you should consult a doctor. Timely treatment is already half the success.

Therapy is carried out in a hospital; in the absence of any complaints, outpatient observation is possible, when the woman independently follows the doctor’s prescriptions at home. Clinical recommendations include medication and some restrictions in daily life. The use of folk remedies, dietary supplements, and homeopathy is not justified in terms of the effect obtained. Medicines from the following table are used.

Table - Drugs prescribed for the treatment of hematoma during early pregnancy

Group of drugs	Action	Reception scheme
Antispasmodics	Relaxes the smooth muscles of the uterus	- “Drotaverine” - 1 tablet 3 times a day or intramuscularly 2 ml 2 times a day; - “Papaverine” - intramuscularly 2 ml 2 times a day or rectal suppositories 2-3 times a day
Hemostatic	Promote the organization of hematoma and stop its growth	- “Vikasol” intramuscularly, 1 ml per day; - “Ascorutin” 1 tablet 2-3 times a day; - “Ditionon” 1 tablet 2-3 times a day
Hormones	Prescribed for a lack of gestagens or an excess of androgens	- “Duphaston” according to the regimen, maintenance dose of 20 mg per day; - “Utrozhestan” according to the regimen, maintenance dose of 200 mg per day; - “Methylprednisolone” is prescribed based on the level of androgens in the blood
Vitamins	They have a gestagenic effect (Vitamin E), strengthen the walls of blood vessels (A, C)	- Vitamin E 1 capsule (200 mg) 2 times a day; - “Ascorutin” 1 tablet 2-3 times a day; - “Folic acid” 1 tablet 1-3 times a day
Sedatives	Normalize the functioning of the nervous system, relieve spasms of smooth muscles	- Valerian extract 1 tablet 2 times a day; - Motherwort tincture 30 drops once a day; - “Novopassit” (dosage is individual in each specific case)
Antibiotics	Prescribed in the presence of colpitis, cervicitis, as well as other infections, taking into account safety during pregnancy

The combination of drugs and the most suitable ones in each case are selected by the doctor individually for each woman. Schemes and doses can vary significantly. It is equally important to follow a therapeutic and protective regimen to prevent the progression of hematoma throughout the entire pregnancy. It includes the following:

• bed rest until the discharge stops;
• limiting physical activity until the end of pregnancy;
• refusal of sex for a month or more - depends on the size of the hematoma;
• do not lift weights exceeding 3 kg;
• follow a diet that limits gas-forming foods;
• avoid constipation;
• undergo preventive treatment at a critical time in the later stages (16-18, 26-28, 32-34) weeks.

It happens that a pregnant woman feels quite normal, but an ultrasound shows that she has a hematoma in the uterus.
A hematoma in the uterus during pregnancy is usually considered a hemorrhage in the tissue that occurs as a result of injury. However, there are other reasons for receiving this anomaly.

Hematoma in the uterus during pregnancy

When it appears, the cell carrying the embryo peels off from the inner mucous membrane of the uterus, and blood accumulates in this place and a bruise forms.

For carrying a baby, a hematoma during pregnancy is very dangerous - it threatens the pregnancy process, because it can provoke a spontaneous miscarriage. At the same time, its mild manifestation can go unnoticed by the woman and she can find out about it only after childbirth.

However, severe hematoma development in a pregnant woman is a big risk not only for the fetus, but also for the mother. If bleeding occurs, her general health deteriorates and anemia develops. Failure in blood circulation leads to the fact that the child experiences oxygen starvation, and this slows down his development.

Hematoma in early pregnancy

This pathology indicates that rejection of the fertilized egg begins, and this leads to termination of pregnancy.
Causes: hormonal imbalance, bad genetics, sex, nervous and mental stress. Timely diagnosis and treatment normalizes the situation.

Risks of hematoma during pregnancy

When a hematoma is detected, much depends on its size, period of appearance and location. If it is diagnosed at the beginning of pregnancy, there is a high probability of its spontaneous termination. If a hematoma is discovered at a later date, its appearance can affect the physical development of the child and the occurrence of hypoxia.

The most dangerous are hemorrhages with a volume of 20 ml or more, that is, 40% of the size of the ovum. The risk of further placental abruption increases. If there is a delay in the growth of the coccygeal-parietal size by more than ten days, an unfavorable resolution of pregnancy is likely.

Factors causing hemorrhage

Quite often, intrauterine hemorrhage develops against the background of overly fragile blood vessels that provide nutrition to the uterus and placenta.

The main factors for the occurrence of hemorrhages:

• Diseases of the genitourinary system.
• Severe toxicosis, especially late.
• Sudden pressure surges.
• Severe stress.
• Anomalies in embryo development.
• Hormonal imbalance.
• Problems with blood clotting, disease-causing abnormalities in the walls of blood vessels of the placenta.
• Bad habits during pregnancy.
• Pathology of uterine development.

Symptoms of hematoma during pregnancy

The signs of this pathology depend on the level of its severity and form.

• Mild degree of pathology. The expectant mother feels fine. The hematoma manifests itself only with ultrasound or after a successful natural birth.
• Average degree. A pregnant woman is bothered by painful sensations in the lower abdomen of a pulling nature. Red or brownish discharge may appear from the vagina. The child's heartbeat is audible.
• Severe degree. Blood discharge becomes more abundant, abdominal pain becomes severe, spasmodic, blood pressure drops or disappears completely.

Consequences

Much depends on the volume of the hematoma. The most dangerous is the one that is located on 40% of the area of ​​the embryo membrane and is larger in size than 20 ml. In this case, it can inhibit the growth and development of the fetus and is fraught with spontaneous termination of pregnancy. With a slow increase in CTE for more than ten days, the risk of pregnancy failure increases.

The most dangerous consequence is “Kuveler’s uterus.” With premature placental abruption, the endometrium becomes engorged with blood and begins to become necrotic, which means that the uterus must be removed.

In addition, with a hematoma there is a high risk of severe bleeding.

Treatment of hematoma during pregnancy

When a pregnant woman is diagnosed with uterine hematoma, bed rest is prescribed. Therapy for this pathology includes, in addition to medication, nutritional adjustments. Foods that enhance intestinal motility are added to food.

To prevent or block bleeding, the doctor may prescribe vikasol, dicynon, vitamin C.

To maintain the immune system of the expectant mother, she is prescribed gestagens - duphaston, utrozhestan.

Tocolytic agents are also prescribed to relieve uterine spasms, for example, magnesium sulfate.

Pregnancy is the most pleasant period in the life of any woman. This is a time of blossoming and happy anticipation of a small miracle. Only the joy of future motherhood can upset various troubles. One of them is a hematoma in the uterus during pregnancy. During this period, the uterus is quite vulnerable, it can increase many times, and also be subject to hemorrhages.

A hematoma is a serious complication accompanied by the accumulation of blood in a specific area of ​​the uterus and posing a threat to the life of the mother and fetus. The accumulation appears due to the fact that for some reason the fertilized egg is separated from the walls of the uterus. Vascular dysfunction and hemorrhage occur.

Hematoma during pregnancy is a common pathology and occurs mainly in the early stages. But if you seek help in time, the treatment will give a good result.

With the appearance of a hematoma, the uterus becomes deformed, and this leads to an increase in blood pressure. And due to this, the nutrition of the fetus becomes difficult. But nevertheless, in most cases, pregnancy ends in successful birth.

Causes and types of pathology

Accumulation in a woman’s uterus in the early stages indicates that partial detachment (separation) of the fertilized egg has occurred. Doctors most often make this diagnosis to their patients in the second month of pregnancy. Symptoms do not appear in any way and a hematoma can only be detected using ultrasound.

There are many reasons for the formation of hematoma during pregnancy:

Blood clots in the uterus can easily affect pregnancy. Severe hemorrhage can lead to a change in the general condition of a woman, as well as provoke anemia. With a mild form of the disease, the pathology is not so dangerous. With it, women give birth safely by cesarean section.

Hematoma is divided into several types:

A hematoma often forms during pregnancy, but sometimes it can occur during childbirth. When the fetus is delivered, the expectant mother experiences ruptures, and as a result, a hematoma may appear. Also, after a cesarean section, when scars are formed (after suturing), pathology may appear. The scars should decrease after 8-10 days.

If the scars do not heal, the doctor must carefully examine the patient to rule out further problems. He will tell you how to clean and care for your stitches to prevent infection. The cause of the formation is a strong pressure on the tissue of the abdominal wall or a hematoma appears in the places where forceps were used.

Symptoms, diagnosis and treatment

A hematoma during pregnancy has the following symptoms:

In the early stages of pregnancy, when there is a severe form of hematoma, spontaneous miscarriages can occur. This form is difficult and subsequent artificial birth is possible. Retrochorionic congestion may occur without pain or discharge. But this complicates the situation, since diagnosis and therapy will not be carried out on time.

If the hematoma is small in size, then it can resolve on its own without causing any further incidents. With late consequences, fetal development may slow down, placental insufficiency, as well as fetal hypoxia.

Often the hematoma does not manifest itself at all. And sometimes a pregnant woman feels discomfort, she is tormented by aching pain in the lower abdomen or brown discharge with blood appears. Such symptoms are characteristic of a hematoma formed at the bottom of the uterus.

A hematoma in the uterus can be seen using an ultrasound examination. It makes it possible to recognize the type of pathology, its location, and the position of the fertilized egg. Fetal viability is also observed. If the pathology is enlarged, then anemia can be detected through laboratory testing.

The main course of complex treatment of hematoma during pregnancy is to prevent its further growth.

The doctor prescribes medications to resolve the clot. Therapy for retrochorial hematoma consists of:

When prescribing treatment, the doctor must take into account that separation of the chorion can lead to fetal hypoxia. For this reason, it is good to include medications in treatment to better provide the fetus with oxygen and other necessary means for growth. During this time, the woman must observe complete physical rest, diet and give up sexual activity until complete recovery.

A uterine hematoma can form at different stages of gestation. The subsequent prognosis of pregnancy will be determined by how early the problem was detected, as well as by establishing the exact size of the bruise.

If the pathology was noticed with a volume of no more than 19 ml, then the threat of miscarriage is reduced several times. But with severe pain and bleeding, when the life of the expectant mother is at risk, emergency surgery may be necessary. The prognosis will be disappointing if a woman does not take hemostatic medications.

Hematoma during pregnancy is considered a common pathology observed at different stages of fetal development. If a woman is diagnosed with this, there is no need to panic, she should take treatment seriously. Since attentive care of health will help not only save a woman’s life, but also carry and give birth to a healthy, strong baby.

Already during the first ultrasound, a pregnant woman may hear a frightening diagnosis - a hematoma in the uterus. The woman’s fears are justified, because this neoplasm, in the absence of adequate treatment, causes detachment of the fertilized egg, which leads to miscarriage or premature birth. However, you shouldn’t be too nervous either, because this can only aggravate the condition. Timely diagnosis and treatment will help prevent serious consequences.

Why does a hematoma occur?

The appearance of bruising in the mucous membrane can be caused by a number of factors:

• changes in hormonal levels, which may result in disruption of hemostasis (blood clotting);
• mental tension, severe stress and anxiety;
• injuries to the pelvic area;
• diseases of the genitourinary system of an inflammatory and infectious nature;
• intense sexual intercourse;
• complications of toxicosis;
• bad habits (alcohol and smoking affect the structure and tone of blood vessels);
• pressure changes in the arteries;
• pathologies of fetal formation and development;
• defects in the structure of the uterus and inflammatory processes in it: endometriosis, endometritis and others;
• genital infantilism (the woman’s genitals are underdeveloped);
• hereditary factors;
• diseases of the circulatory system: thrombophilia, thrombosis, thrombophlebitis and others.

A hematoma is a serious complication accompanied by the accumulation of blood in a specific area of ​​the uterus

Doctors specifically note that during pregnancy, weakness of the vascular network of the uterus or chorion, the future placenta, may occur. As a rule, the reason for this is a change in the functioning of the endocrine system, as well as metabolic disorders. Weak and inelastic vessels burst, as a result of which the membrane of the fertilized egg is separated from the endometrium, and at the site of the rupture a cavity filled with blood remains. At an early stage, it is called a retrochorial hematoma (chorionic detachment has occurred), and later - retroplacental (the placenta has been detached).

Clinical signs

The symptoms of a hematoma directly depend on its shape and degree. In medicine, there are mild, moderate and severe degrees of pathology:

1. With a mild degree, the woman feels normal and may not feel any symptoms. The presence of a bruise is detected by ultrasound or after childbirth. There are no pathological discharges from the genital tract.
2. The average degree is characterized by nagging or aching pain in the lower abdomen, which can radiate to the leg or lumbosacral region. A characteristic sign of pathology is spotting red or brown discharge. Ultrasound also shows abnormal fetal heartbeat.
3. In severe cases, the pregnant woman suffers from acute pain in the abdomen or back that cannot be tolerated. Blood pressure can drop sharply, resulting in dizziness and fainting, general weakness and loss of strength, blurred vision, a state of “intoxication,” increased sweating, and numbness of the extremities. There is copious bloody discharge from the vagina, which may occur before bleeding.

A woman should be able to independently assess the shade of discharge from a hematoma:

• clear or light white color is normal;
• brownish streaks or impurities that appeared in the early stages indicate that the hematoma is small in size and does not affect the formation of the fetus;
• a rich brown tint or the color of “meat slop” indicates that the hematoma is resolving on its own or is coming out as the blood coagulates;
• scarlet or burgundy discharge indicates open bleeding that is currently occurring. That is, the hematoma continues to increase in size and poses a real threat of termination of pregnancy.

Severe placental abruption usually causes severe bleeding and pain.

What types of hematomas are there?

There are various forms of hematomas, which directly depend on their location, structure, and also on the duration of pregnancy.

Retrochorial

The chorion is the membrane of the fertilized egg that surrounds the embryo and protects it from external factors. It is formed in the early stages of gestation and promotes the attachment of the embryo to the inner layer of the uterus. In fact, the chorion is the direct predecessor of the placenta.

A hematoma that occurs in the first weeks predetermines the detachment of the fertilized egg from the chorion. In this case, blood accumulates between it and the fetus, coagulates and affects oxygen exchange and metabolism. The pathology is observed in the first trimester of pregnancy before the formation of the placenta.

Symptoms of retrochorial hematoma may not develop if it is located in the uterine fundus area. In this case, hemorrhage can only be detected during an ultrasound examination.

With adequate treatment, the hematoma resolves, gradually decreasing in size, or comes out. Otherwise, open bleeding leads to complete detachment of the fertilized egg and miscarriage.

Subchorionic

This type of hemorrhage during pregnancy is the most common and very dangerous. On ultrasound, its structure looks like hypoechoic (differing in lower density from adjacent structures) or mixed formations. Dynamic growth control is required.

If the size of the subchorionic hematoma decreases in the future, an area of ​​fibrin deposition or a smaller hematoma may remain on the placenta, as well as detachment of the membranes. These elements can cause the appearance of a new hematoma - retroplacental.

Retroplacental

If rejection of the fetus from the uterine wall occurs after the 16th week, then the hematoma is called retroplacental.

A woman experiences nagging pain in the lower abdomen and spotting, but the hallmark of the pathology is the tone of the uterus and the feeling of a “stony belly.” Pregnant women also note that the baby begins to move more often, and this indicates hypoxia. Ultrasound reveals negative changes in the functioning of the fetal cardiovascular system (bradycardia, arrhythmia).
Retroplacental hematoma is usually diagnosed from the 16th week of pregnancy, after the placenta has fully formed

Retroamniotic and subamniotic

Retroamniotic and subamniotic types of hemorrhages are determined already at the first ultrasound (at the 12th week). They represent an accumulation of blood between the chorion and amnion (fetal bladder), and differ only in the area of ​​hemorrhage.

As a rule, these types of hematomas go away on their own and asymptomatically, but it is advisable to monitor their growth with ultrasound.
Retroamniotic and subamniotic hematomas are accumulations of blood between the chorion and amnion

Intrauterine

With an intrauterine hematoma, a cavity with blood forms in any area of ​​the uterus that is not connected to the chorion or placenta. This increases the risk of damage to the walls of the organ, its complete or partial rupture. Hemorrhage can reach not only the mucous layer, but also muscle tissue (myometrium).

If the area of ​​hemorrhage does not increase, and the hematoma does not put pressure on the developing fetus, then the pregnancy proceeds normally. When the pathology progresses, the expectant mother is sent to the hospital for preservation.

Possible complications and consequences for the body

The danger of a hematoma directly depends on its size and location. If the hemorrhage covers more than 40% of the area of ​​the fetal membrane, and its volume exceeds 20 ml, then the following consequences are possible:

• disturbance of nutrition and oxygen exchange of the chorion (placenta);
• fetal hypoxia;
• uterine tone;
• intrauterine growth retardation;
• slowing down the increase in coccygeal-parietal size;
• frozen pregnancy;
• miscarriage in the early stages or premature birth in later stages;
• severe internal bleeding, which in rare cases is fatal for a woman.

The most dangerous consequence is considered to be “Kuveler’s uterus”. Placental abruption occurs, which causes hemorrhage into the endometrium and necrotic processes (tissue death). In this case, a uterine resection is performed, which makes it impossible for the woman to become a mother again.
Kuveler's uterus is characterized by placental abruption in pregnant women ahead of schedule

Methods for diagnosing hematoma during pregnancy

When a formation is detected, the gynecologist prescribes basic tests:

• general and biochemical blood test;
• coagulogram (a test that checks blood clotting parameters);
• urine test;
• bacterial smear of vaginal discharge for flora;
• hormonal screening;
• blood test for HIV and syphilis;
• screening for STIs (sexually transmitted infections).

Ultrasound is the most accurate and objective method for examining hematoma during pregnancy. It allows you to determine:

• size and fullness of the bruise;
• localization (chorion, placenta, amnion, uterine tissue, etc.);
• the degree of deformation of the fertilized egg and the contour of the uterus;
• the presence of thickening of the uterine walls (indicates the development of bleeding).

Ultrasound is the main method for examining hematoma during pregnancy

Using Doppler ultrasound, the level and quality of blood flow in the chorion (placenta) and the vessels of the embryo are determined. During the study, insufficient blood supply to the fetus and hypoxia (oxygen deficiency) may be revealed. Also, the doctor must listen and evaluate the child’s heartbeat.

Treatment of hematomas

Treatment of hemorrhage in the early stages (uterine, amniotic and subamniotic hematoma) is used only when it occupies a significant area of ​​the membranes, tends to increase and.

The following treatment regimen is prescribed:

1. Tocolytic drugs. Designed to eliminate uterine spasms. Papaverine is used for intravenous or intramuscular administration, reduces peristalsis and tone of the uterus, relaxes its walls. No-Spa in tablets for oral use relieves muscle spasms and reduces pain. Magnesium sulfate in the form of a solution for intravenous administration relaxes smooth muscles and reduces pressure in blood vessels, which is important in the treatment of hemorrhages.
2. Hemostatic complex (Vikasol, Ascorutin, Ditsinon). Release form: tablets for oral use. Ascorutin is a vitamin preparation that supports vascular tone. Dicynone (Etamsylate) is used to reduce bleeding and spotty vaginal discharge. The complex of drugs stops blood loss, promotes blood clotting, as a result of which the hematoma gradually comes out or resolves.
3. Gestagens. Prescribed to support immunity and pregnancy. These are mainly drugs based on the hormone progesterone (Duphaston, Utrozhestan).
4. Soothing herbal tea. Herbal decoctions based on valerian, lemon balm leaves, peppermint and lavender will help relieve stress and calm a pregnant woman.
5. Diet. The expectant mother is prohibited from consuming foods and drinks that increase intestinal motility. With an eating disorder or constipation, the muscles and ligaments of the pelvic organs become tense, which can increase bleeding that has begun. You should avoid carbonated drinks, vegetables and fruits that cause fermentation in the stomach. Use dairy and fermented milk products, meat, beans and baked goods with caution.

Treatment of retro- and subchorionic, as well as retroplacental hematoma is carried out in a hospital and involves the following scheme.

1. Reduced physical activity. The expectant mother is prescribed bed rest and sexual tranquility. A woman needs to rest in such a position that the pelvis is elevated (you can place a pillow under the buttocks). This will ensure intense blood flow from the uterus, which will reduce bleeding.
2. Diet (described above).
3. Hemostatic drugs (Vikasol, Etamzilat).
4. Antispasmodics (Magnesium sulfate, Papaverine).
5. Vitamin-mineral complex and immunomodulators. Iron supplements play a special role in maintaining healthy levels of red blood cells (RBCs) and hemoglobin. It is also important to continue taking folic acid, which strengthens the circulatory and nervous systems of both mother and child. Vitamin complex Magne B6 has a calming effect and relaxes smooth muscles without the need to take medications.
6. Medicines to improve fetal nutrition and prevent hypoxia (Actovegin, Curantil). Actovegin intravenously improves metabolism and promotes normal blood flow.
7. Hemostatics (drugs to prevent massive bleeding). It has proven itself very well, which is an inhibitor of fibrinolysis (slows down the process of dissolving blood clots). The drug is prescribed for the treatment of various types of hematomas (oral administration in a course of 1 week). Contraindications for use are: kidney disease, subarachnoid bleeding, deep vein thrombosis or thrombophlebitis, allergy to the components of the drug.

Photo gallery: medications for hematoma

Tranexam is used to treat and prevent blood loss
Dicynone is a homeostatic drug intended to prevent, reduce and stop bleeding. Vikasol is an antihemorrhagic agent, a synthetic water-soluble analogue of vitamin K
Duphaston is prescribed by many gynecologists when there is a threat of miscarriage. Magne B6 produces a normalizing effect on the state of the nervous system.