Bruising in the first trimester of pregnancy

Uterine hematomas are an accumulation of blood within the uterine cavity, occurring during pregnancy, usually located between the chorion or placenta and the inner surface of the uterus.
They usually occur more frequently in the first trimester, although they can also happen in later stages of pregnancy, presenting other types of complications.
They are also more frequent in patients undergoing assisted reproduction treatments (22,4%) than in spontaneous pregnancies (11%).
They are the main cause of metrorrhagia (abnormal bleeding) in the first trimester of pregnancy; however, sometimes they occur without any bleeding.
If bleeding occurs, it is usually highly variable in color and amount. In any case, whenever there is bleeding during pregnancy, it is recommended to contact your medical center.
They generally disappear on their own, especially if they are small or moderate in size.

What is its cause?

In most cases, the cause is unknown. It is a low-pressure bleeding of maternal origin, resulting from the rupture of blood vessels within the placenta.

How are they diagnosed?
They are usually seen on ultrasound as anechoic images at the placental edge. They are not always visible, as there may be bleeding and the blood may be expelled through the vagina, making it invisible during the ultrasound. If the hematoma is visible, your gynecologist will likely take measurements to monitor its evolution.

If I am diagnosed with a placental hematoma, what is the prognosis for my pregnancy?
The most common hematomas in the first trimester of pregnancy are subchorionic hematomas. The majority of these hematomas, approximately 70%, resolve spontaneously without affecting the pregnancy, even if bleeding occurs.
However, 10-15% of these hematomas have been linked to first-trimester miscarriages. The risk of abortion The risk of miscarriage increases with maternal age and the size of the hematoma; the larger the hematoma, the greater the risk. Hematoma size is considered in relation to the size of the gestational sac. If the hematoma occupies less than 20% of the sac's size, it is considered small; if it occupies more than 50%, it is considered large.
If the hematoma is located at the supracervical level, it usually has a very good prognosis; however, its clinical presentation often generates a lot of fear in the patient, since it produces noticeable bleeding that is eliminated through the vagina.

What is the treatment for bruises?

There is no treatment for bruising. In cases where bruising occurs, the following will be recommended:
• Relative rest (You can get up, walk around the house and do things, but you have to lead a very relaxed life. This type of rest allows you to perform light tasks, but not much more.) or absolute rest (You must stay in bed or on the sofa, lying down, without getting up except for essential things, such as going to the bathroom), depending on the risk based on its size and location.
• Sexual abstinence
• Gynecological check-ups every 1 or 2 weeks, depending on each case, until the risk has passed.
• Make changes to the medication, at the discretion of the gynecologist.
• Avoid constipation

In summary, Hematomas in the first trimester of pregnancy have a favorable prognosis in 70% of cases, especially if they appear early and depending on their location and size. They may occur with or without bleeding, which may vary in color or amount.

If a hematoma is present and you have not experienced any symptoms, you should not worry, as we can diagnose it early in the first ultrasound we perform at Inebir around week 7 of pregnancy, so the measures described can be taken prematurely.

If you experience any bleeding before your follow-up ultrasound, you should contact us so we can assist you, advise you on the cause of the bleeding, and assess whether you require medical attention.

There is no need to panic unnecessarily; not all bleeding is dangerous. The bleeding could be due, for example, to inflammation of the cervix, a fairly common problem in pregnancy, especially in patients who are being treated with vaginal progesterone, and which does not compromise the evolution of the pregnancy.