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Ultrasound showing a subchorionic hemorrhage [1] Chorionic hematoma is the pooling of blood ( hematoma ) between the chorion , a membrane surrounding the embryo , and the uterine wall . [ 2 ] It occurs in about 3.1% of all pregnancies , [ 2 ] it is the most common sonographic abnormality and the most common cause of first trimester bleeding .
Early pregnancy bleeding (also called first trimester bleeding) is vaginal bleeding before 14 weeks of gestational age. [ 1 ] [ 2 ] If the bleeding is significant, hemorrhagic shock may occur. [ 1 ] Concern for shock is increased in those who have loss of consciousness , chest pain, shortness of breath , or shoulder pain.
Vaginal bleeding from atrophy, vaginitis, and ulcers also attribute to minor haemorrhaging. Similarly, varicosities , tumours or inflammation in the vulva can cause minor antepartum haemorrhaging. Non genital tract bleeding caused by haematuria or haemorrhoids can often be mistaken for antepartum haemorrhaging and are typically harmless.
Women with cardiac problems, disorders of circulation, monosomy, hypertension, and diabetes are predisposed to Breus' mole. The mole is formed as a subchorionic hematoma formed out of the intervillous blood, causing progressive accumulation of a clotting substance called fibrin with increasing gestational age.
This pathology occurs due to the normal physiological drop in maternal clotting factors after delivery which greatly increases the risk of secondary postpartum hemorrhage. [14] Another bleeding risk factor is thrombocytopenia, or decreased platelet levels, which is the most common hematological change associated with pregnancy induced hypertension.
[1] [2] Such bleeding could be visible or external, namely bleeding from the vagina, or it could be internal into the pelvic cavity or form a hematoma. Normal menstruation is not considered a gynecologic hemorrhage, as it is not excessive. Hemorrhage associated with a pregnant state or during delivery is an obstetrical hemorrhage.
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Before delivery all patients should be screened for risk factors and then assigned a postpartum hemorrhage risk stratification based on the American College of Obstetricians and Gynecologists recommendations. If the woman is at a medium risk, blood should be typed and screened. Those assessed to be high risk should be typed and cross-matched ...