What is the emergency department treatment for subchorionic hemorrhage?

From the Guidelines

Emergency department treatment for subchorionic hemorrhage should prioritize assessment, monitoring, and supportive care, as there is no specific intervention that can stop or reverse the bleeding. The management of subchorionic hemorrhage involves a thorough evaluation, including a pelvic exam, ultrasound to confirm the diagnosis and assess fetal viability, and laboratory tests such as complete blood count, blood type, and Rh status 1.

Key Components of Treatment

• Patients with mild cases and stable vital signs may be discharged home with instructions for pelvic rest, hydration, and follow-up with an obstetrician within 1-2 days.
• Patients should be advised to return to the emergency department if they experience increased bleeding, severe pain, dizziness, or fever.
• For moderate to severe bleeding, IV access should be established, and fluid resuscitation initiated if there are signs of hemodynamic instability.
• Anti-D immunoglobulin (RhoGAM) 300 mcg IM should be administered to Rh-negative mothers to prevent sensitization, as recommended by guidelines such as those from the American College of Emergency Physicians 1.

Considerations for Hospitalization

• Hospitalization may be necessary for patients with heavy bleeding, hemodynamic instability, or concerning fetal status.
• The natural course of subchorionic hemorrhage often involves gradual resolution over days to weeks as the blood is reabsorbed, though the risk of miscarriage is increased, particularly with larger hematomas or bleeding occurring in the first trimester.

Important Considerations

• The American College of Emergency Physicians provides guidelines for the initial evaluation and management of patients presenting to the emergency department in early pregnancy, which can inform the approach to subchorionic hemorrhage 1.
• It is essential to prioritize the patient's stability and fetal viability when determining the appropriate course of treatment.

From the Research

Emergency Department Treatment for Subchorionic Hemorrhage

• The treatment for subchorionic hemorrhage (SCH) is not well-established, and there are no uniform clinical treatment guidelines 2, 3.
• Management of SCH in the second or third trimesters can be complicated, especially in the setting of a large SCH that requires hospitalization and blood transfusion 2.
• Serial growth ultrasounds, umbilical artery Doppler studies, and antenatal fetal testing should be considered, particularly if the SCH is large or treatment requires a maternal blood transfusion 2.
• The use of lactated Ringer's solution or bicarbonated Ringer's solution may be considered for fluid resuscitation in patients with hemorrhagic shock, although the optimal choice of fluid is not well-established 4, 5.
• Bicarbonated Ringer's solution may have benefits in reducing shock-related complications and inhibiting the expression of inflammatory factors in patients with traumatic hepatic rupture and hemorrhagic shock 5.

Diagnosis and Risk Factors

• The diagnosis of SCH is usually made by ultrasound imaging 2, 3.
• The only known risk factors for SCH are maternal factor deficiency and anticoagulation therapy 2.
• Other potential risk factors for SCH include abnormal coagulation function, autoimmune factors of pregnant women, assisted reproduction, drug use during pregnancy, and reproductive tract infection 3.

Fetal Outcomes

• Subchorionic hemorrhage in the second and third trimesters has been associated with several adverse fetal outcomes, including preterm birth, preterm prelabor rupture of membranes, fetal growth restriction, fetal demise, and neonatal pulmonary morbidity 2.
• The occurrence of SCH may be related to several factors, such as abnormal coagulation function, autoimmune factors of pregnant women, assisted reproduction, drug use during pregnancy, and reproductive tract infection, although the exact etiology remains unclear 3.