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Can a Subchorionic Hematoma Lead to Pregnancy Loss?
September 5, 2013
A woman who experiences bleeding during early pregnancy may actually have a condition known as a subchorionic hematoma (SCH). A SCH is a collection of blood below the chorion, or placenta, which develops naturally as an embryo implants into the uterine lining.
While bleeding during early pregnancy may be interpreted as a sign of impending miscarriage and should be reported to your doctor, it is common in most pregnancies and often a normal part of embryo development. William Kutteh, M.D. of Fertility Associates of Memphis explains: “It is a natural process if you can imagine. An embryo lands in the uterus naturally or through IVF and cannot survive without nutrients and oxygen. The embryo produces a substance that causes capillaries in the lining of the uterus to breakdown. Then they reform to feed into the embryo at a microscopic level. During that process, there can be leakage of blood.” If the embryo does not take in nutrients from the mother, it will not survive within the uterus. The process of capillary breakdown is recurrent as the embryo grows and requires greater nutritional intake and blood flow from the mother.
In some cases, a SCH could lead to miscarriage depending on size and location of the hematoma in relation to the embryo. If the SCH forms between the gestational sac and uterine wall, the pregnancy could be jeopardized. “It is better to have the SCH low and the baby’s gestational sac up high in the uterus,” states Kutteh. Should the placenta separate from the wall of the uterus, or blood become trapped between the gestational sac and uterine lining, then there is a risk of miscarriage. If a pregnancy does begin to terminate as a result of the SCH, separation from the uterine lining will be evident and the SCH may appear larger in size.
The incidence of SCH is nearly equal between fertility patients and those who have conceived without medical assistance. However, if a fertility patient uses blood thinners like aspirin or Heparin, they could be slightly more inclined toward a subchorionic bleed. In a 2009 study, Dr. Kutteh found subchorionic hematomas in 30-40% of patients in the study, regardless of fertility treatment or natural conception.
Dr. Kutteh firmly believes that patients should be informed of the risk of SCH and has made it a policy in his practice to describe the range of potential symptoms from spotting to bleeding. He says: “There is a lot of anxiety and apprehension during fertility treatment. We prefer to tell the patient about the risks, and tell them to call us, come in, and we can do an ultrasound scan. We emphasize that this is a normal process and if it doesn’t happen, the baby doesn’t grow. Just like a plant has to dig roots to absorb nutrients, an embryo must breakdown and reform capillaries in the same manner.”
Women who become pregnant with or without fertility treatment should be informed of the risk of bleeding in early pregnancy and report to their doctor to rule out pregnancy complications.