How does a hematoma form?
In the first trimester, chorionic villi grow into the uterine mucosa and form the future placenta. If the connection is disrupted in any area, small vessels are damaged, and blood accumulates between the chorion and the wall of the uterus. The doctor evaluates the size of the hematoma using an ultrasound and compares it with the size of the fetal egg. Then there are two possible ways: the blood gradually resolves or comes out, which is manifested by brown and then lighter discharge. The appearance of such discharge often means that the hematoma is emptying and not growing.
- Partial separation of the chorion from the uterine wall
- Accumulation of blood in the resulting space
- Estimation of size relative to the ovum
- Resorption or emptying of hematoma
- Brown discharge is often a sign of bowel movement
- An asymptomatic finding on ultrasound is also possible.
Causes and risk factors
Most often, the exact cause cannot be determined. The role of blood coagulation disorders, insufficiency of the corpus luteum and hormonal support, inflammatory processes in the endometrium, abnormalities in the structure of the uterus and fibroids located near the attachment site are discussed. Heavy physical activity, stress, smoking and high blood pressure all contribute. It is important to understand that a hematoma is often a consequence of the characteristics of the pregnancy itself, and not the result of a woman’s mistakes, and you should not blame yourself.
- Blood clotting disorders
- Lack of hormonal support
- Chronic endometritis
- Anomalies of the uterine structure and fibroids
- Heavy physical activity
- Smoking and high blood pressure
- Often the cause remains unknown
Symptoms
The most common symptom is brown spotting, sometimes streaked with blood. They may appear and disappear within a few days. Often there is a nagging pain in the lower abdomen and lower back, reminiscent of premenstrual pain. About a third of women have no complaints, and the hematoma is detected during a routine ultrasound. Alarming signs include heavy red bleeding, severe cramping pain, dizziness and weakness - in these cases, urgent medical attention is needed.
- Spotting brown discharge
- Bloody discharge of varying intensity
- Nagging pain in the lower abdomen
- Lower back pain
- Often no complaints at all
- Excessive bleeding is a reason for urgent treatment
Diagnosis and observation
The main method is ultrasound, preferably transvaginal: it determines the location and size of the hematoma, and most importantly, assesses the viability of the embryo by heartbeat and timing. Control studies are performed at the time prescribed by the doctor to track the dynamics. Additionally, blood tests, assessment of progesterone levels and coagulation parameters, as well as examination for infections if relevant complaints may be required. Speculum examination helps rule out other sources of bleeding, such as cervical erosion or polyp.
- Transvaginal ultrasound with heartbeat assessment
- Measuring the size of a hematoma over time
- Inspection in the mirrors
- General blood test and coagulogram
- Progesterone according to indications
- Screening for infections during discharge
Treatment and lifestyle
There is no specific drug that dissolves hematoma, and in most cases the body copes on its own. The doctor may prescribe gestagens to support pregnancy, short-course hemostatic agents and antispasmodics for pain. It is recommended to limit physical activity, exclude heavy lifting, sports, sauna and sex life until the discharge stops. Strict bed rest is not considered mandatory today. It is important to remain calm: anxiety increases muscle tension and makes you feel worse, and the prognosis for small hematomas is usually good.
- Observation with ultrasound control
- Gestagens as prescribed by a doctor
- Short course hemostatic agents
- Antispasmodics for pain
- Limiting exercise and sexual rest
- Quitting smoking
- See a doctor if your discharge increases
