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Chorionic hematoma is the pooling of blood 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 .
A retained placenta is commonly a cause of postpartum haemorrhage, both primary and secondary. [1] Retained placenta is generally defined as a placenta that has not undergone placental expulsion within 30 minutes of the baby’s birth where the third stage of labor has been managed actively. [2]
Postpartum bleeding or postpartum hemorrhage (PPH) is often defined as the loss of more than 500 ml or 1,000 ml of blood following childbirth. [2] Some have added the requirement that there also be signs or symptoms of low blood volume for the condition to exist. [ 6 ]
Bleeding before childbirth is that which occurs after 24 weeks of pregnancy. [4] Bleeding may be vaginal or less commonly into the abdominal cavity. Bleeding which occurs before 24 weeks is known as early pregnancy bleeding. Causes of bleeding before and during childbirth include cervicitis, placenta previa, placental abruption and uterine rupture.
Causes of increased foetal-maternal haemorrhage are seen as a result of trauma, placental abruption or may be spontaneous with no cause found. Up to 30ml of foetal-maternal transfusion may take place with no significant signs or symptoms seen in either mother or foetus. [3]
A placental abruption caused by arterial bleeding at the center of the placenta leads to sudden development of severe symptoms and life-threatening conditions including fetal heart rate abnormalities, severe maternal hemorrhage, and disseminated intravascular coagulation (DIC).
Especially when these symptoms are evident at early stages of pregnancy. [3] The abnormal invasion of the trophoblast cells, lack of important growth factors such as vascular endothelial growth factor (VEGF) and placental growth factor (PlGF), has an association with the onset of placental disease.
Symptoms include postpartum bleeding, abdominal pain, a mass in the vagina, and low blood pressure. [1] Rarely inversion may occur not in association with pregnancy. [5] Risk factors include pulling on the umbilical cord or pushing on the top of the uterus before the placenta has detached. [1]