What is the management of subchorionic hemorrhage in the first trimester of pregnancy?

From the Guidelines

Management of subchorionic hemorrhage in first trimester pregnancy should primarily involve conservative measures, including bed rest and pelvic rest, with close monitoring through serial ultrasounds to assess the size of the hemorrhage and fetal viability. The primary goal is to minimize the risk of complications while maximizing the chances of a successful pregnancy outcome, considering morbidity, mortality, and quality of life as the key outcomes. According to the American College of Radiology Appropriateness Criteria 1, ultrasound (US) is the primary imaging modality for evaluating first trimester vaginal bleeding, which can help distinguish between a normal intrauterine pregnancy, a nonviable intrauterine pregnancy, and an ectopic pregnancy.

Key considerations in managing subchorionic hemorrhage include:

• Avoiding inappropriate treatment with methotrexate or surgical intervention, which can harm a normal pregnancy
• Using pulsed methods of Doppler US judiciously, as they should generally be avoided in the first trimester when a normal or potentially normal intrauterine pregnancy is present 1
• Considering the use of MRI as a problem-solving tool in complex cases
• Providing reassurance about the generally good prognosis for small to moderate subchorionic hemorrhages, while also educating patients about the signs of complications that require immediate medical attention, such as increased bleeding, severe pain, or passage of tissue.

It's also important to note that while progesterone supplementation may be considered in some cases, its specific benefit for subchorionic hemorrhage is not definitively established, and NSAIDs should be avoided as they may worsen bleeding. The management approach should be individualized based on the size of the hemorrhage, fetal viability, and the patient's overall clinical condition, always prioritizing the minimization of morbidity, mortality, and optimization of quality of life.

From the Research

Management of Subcorneal Damage in First Trimester Pregnancy

• The management of subcorneal damage in the first trimester of pregnancy is crucial to prevent further complications and ensure the best possible outcome for both the mother and the fetus.
• According to 2, corneal injuries can occur due to various causes, including traumatic, chemical, inflammatory, metabolic, autoimmune, and iatrogenic causes, and ocular infection may frequently occur concurrent to corneal injury.
• The treatment of non-infectious corneal injury involves the use of diagnostic agents, therapeutic medications, and future targets, including fluorescein, lissamine green, and rose bengal to formulate a diagnosis and develop effective treatment strategies 2.
• Topical pain control for corneal abrasions is also important, and a systematic review and meta-analysis found that topical NSAIDs demonstrated significantly reduced pain scores at 24 and 48 hours, as well as lower oral analgesia use compared to control 3.
• However, there is limited information available on the management of subcorneal damage specifically in the first trimester of pregnancy, and more research is needed to determine the best course of treatment.
• It is essential to consider the potential risks and benefits of any treatment during pregnancy, and to consult with a healthcare professional to determine the best approach for each individual case.

Considerations for Pregnancy

• Pregnancy can affect the eyes and vision, and certain conditions, such as preeclampsia and diabetes, can increase the risk of ocular complications 4.
• The use of certain medications, including NSAIDs, during pregnancy should be carefully considered, as they can have potential side effects and risks for the fetus 5.
• The management of subcorneal damage in the first trimester of pregnancy should take into account the potential risks and benefits of treatment, as well as the need to prioritize the health and well-being of both the mother and the fetus.

Diagnostic and Therapeutic Approaches

• Diagnostic agents, such as fluorescein, lissamine green, and rose bengal, can be used to formulate a diagnosis and develop effective treatment strategies for corneal injuries 2.
• Therapeutic medications, including topical NSAIDs, steroidal anti-inflammatory agents, and non-steroidal medications, can be used to control ocular inflammation and promote healing 2.
• Other approaches, such as amniotic membrane therapies, blood-based therapies, and protective methods, such as bandage contact lenses and mechanical closure of the eyelids, can also be used to manage corneal injuries 2.