Empowered Pregnancy Education - Subchorionic Hematoma / Subchorionic Hemorrhage - SCH

By: Aunt Doula (02/12/2023)

A subchorionic hematoma or subchorionic hemorrhage - SCH - can be an alarming event and diagnosis that usually occurs in the first trimester of pregnancy and rarely may continue into or occur in the second trimester. By definition, the term describes what is happening Sub (below) Chorionic (the chorionic membrane) Hemorrhage (bleeding) which all together means that there has been a bleeding event that is usually at the edge of the placenta, and the blood collects between the uterine wall and the chorionic membranes. Here is a drawing that shows what is happening, it is not a photograph. This pocketing or collection of blood is known as a hematoma which can be measured after the bleeding has happened & while bleeding is actively happening it is known as a hemorrhage. Some bleeds occur without any collection, and on ultrasound there will be no evidence of cause for bleeding - it may have been due to a subchorionic bleed that did not collect and all the blood passed vaginally.

Characterized most often by spontaneous (without trigger or direct reason) vaginal bleeding in the first trimester, an SCH may also be accompanied by cramping that can come an go after bleeding has stopped. The bleeding may be bright red to dark brown and can vary from a significant flow that fills panty liners to smaller amounts of intermittent spotting. This wide range of possible pain, cramping and amount of blood does not indicate more or less risk associated with the SCH and it is currently unknown what causes these variations. In some cases as an SCH progresses or heals, passing clots of tissue is also normal, and also does not determine higher or lower risks of miscarriage.

In recent large studies, it has been found that on its own, an SCH of even large size does not seem to increase the rate of miscarriage. This means that if a miscarriage does occur, the SCH is not the immediate culprit for pregnancy loss. This is an extremely important fact to note, because it means that just by having an SCH, you are not at a higher risk of having a miscarriage. Most healthy pregnancies weather subchorionic hematomas very well, and continue on as healthy pregnancies.

Subchorionic hematomas are not well understood in etiology (why they happen and who will be affected) and because they happen spontaneously, most often resolve on their own, and currently trying to apply any treatment is more harmful than helpful, it is difficult for researchers to make significant headway in understanding this pregnancy complication.

Some SCH will bleed only once, some will bleed repeatedly, some may collect in a large pocket that does not resolve for the course of the pregnancy, and some are an "incidental finding" meaning if no one had been looking, it may have never been found. Some cause no symptoms and some cause significant symptoms throughout the first and second trimester. It is difficult to predict the course any one SCH will take even if found early, and that also makes them a frustrating diagnosis for pregnant people who are rightfully concerned when they learn they have an SCH and are often only told to 'just take it easy and rest - there's nothing to be done' which no matter how true it may be, feels dismissive and cold.

The most important facts to remember and to take comfort from if you have been diagnosed with an SCH are the following:

• Your risk of miscarriage regardless of the SCH size is not increased.
• You may experience bleeding, cramping and pass clots, but it does not mean you are having a miscarriage
• Most SCH resolve on their own and do not disturb the growing fetus
• Rest, focusing on positive outcomes, going to all your scheduled appointments and seeking support are all ways you can proactively respond to your diagnosis.
• There may not be a pill or a procedure that can make the SCH go away, but how you react and respond are the things in your control - to the best of your ability rest, keep stress low, eat nutritious foods and drinks and think positively.

Your SCH will be monitored closely if it is large, or if you have continuous bleeding. In general, a tapering of bleeding and symptoms is expected over the course of a few weeks. The body handles the collected blood in two ways, it may do one, the other, or both. The first form of healing is done by the body breaking down the hematoma slowly and re-absorbing the cells. The second way is the body may pass the hematoma vaginally in the form of a clot. Neither is better and it is again not possible to know which a body will do. Knowing the size of your SCH can help you gauge if you have passed it as a clot however, so ask for a measurements at each scan and find a rough comparison online to it like an egg or a golf ball.

If you are experiencing any of the following - vaginal bleeding that is bright red that fills a regular period pad in under 1 hour, you pass a clot the size of an egg or multiple clots that equal an egg in under 1 hour, become dizzy, lightheaded or feel faint: you should call 911 or have someone in your home drive you to an Emergency Room.