Bleeding during early pregnancy is likely to cause concern. While bleeding during early pregnancy may be interpreted as a sign of impending miscarriage and should be reported to your doctor, it actually occurs commonly in pregnancy (almost 20% of the time), and often goes away without requiring any treatment at all. If you experience bleeding during early pregnancy, it may be the result of a subchorionic hematoma (SCH). A SCH is a collection of blood beneath the chorion, or placenta, where the embryo implants into the uterine lining.
Why Does a Subchorionic Hematoma Cause Bleeding?
Dr. Alan Copperman, Medical Director of Progyny and Co-Founder of Reproductive Medicine Associates of New York, explains: “When an embryo implants in the uterus, the placenta starts to grow and establish a rich vascular supply to exchange nutrients and gases such as oxygen between the mom and the fetus. Even a tiny disruption in the rich capillary network can over time cause enough bleeding to be noticed on ultrasound or clinically through vaginal bleeding”.
Can a Subchorionic Hematoma Cause Miscarriage?
While hematomas often resolve spontaneously, in some cases, they could expand and lead to miscarriage
Am I More Likely to Develop a Subchorionic Hematoma with Fertility Treatment?
The incidence of SCH is nearly equal between fertility patients and those who have conceived without medical assistance. However, a fertility patient who uses blood thinners like aspirin or Heparin could be slightly more inclined toward a subchorionic bleed. In a 2016 study, investigators actually found an increase in subchorionic hematomas in early pregnancy in women taking low-dose aspirin.
Dr. Copperman believes that patients should be informed of the risk of SCH, and be reassured that spotting and even light bleeding is not uncommon and not necessarily problematic.
In the event that bleeding occurs, he usually recommends patients come into the office the next morning for an ultrasound and hormone levels, and recommends pelvic rest (no intercourse or tampons) until resolution of the bleeding.
Dr. Alan Copperman is a board-certified reproductive endocrinologist and infertility specialist with a long history of success in treating infertility and applying fertility preservation technologies. He serves as Medical Director of Progyny, a leading fertility benefits management company, and co-founded and serves as Medical Director of RMA of New York, one of the largest and most prestigious IVF centers in the country. Dr. Copperman is also the Vice Chairman and Director of Infertility for the Icahn School of Medicine at Mount Sinai, and Chief Medical Officer of Sema4, a health information company. Dr. Copperman has been named to New York magazine’s list of Best Doctors 17 years in a row. He has been recognized by his peers and patient advocacy organizations for his commitment to patient-focused and data-driven care. He has published more than 100 original manuscripts and book chapters on reproductive medicine and has co-authored over 300 scientific abstracts on infertility, in vitro fertilization, egg freezing, ovum donation, and reproductive genetics.