Questioni passed a blood clot today that was about 3" x 2" x 2" with some bleeding and no cramping. i just thought i had to urinate and out it came. i called my doctors office and they told me to bring it and myself in. they did an ultra sound and the baby was still there. i was seen about 1 hour after i passed the clot and the babys heart rate was around 60 with very little fetal movement for about 2 minutes into the ultrasound then it perked up to normal with some movement. what is likely to be going on? the doctor said she didnt know what to tell me, that i could be in early stages of misscarage and that we would follow up in a week. what do you think? would the baby be ok with a heart rate of 60 for an hour? is there anything i should ask my ob/gyn next visit if the pregnancy is still viable? why would i have such a large clot? please help! thank you!
AnswerDear Jamie,
Many times, when bleeding/clots are passed during pregnancy, a subchorionic hematoma may be the cause. Vaginal bleeding affects 25% of all women during the first half of pregnancy and is a common reason for 1st trimester ultrasounds. The incidence of subchorionic hemorrhage is 1.3% of all pregnancies. In pregnant patients with 1st trimester vaginal bleeding, the incidence increases to almost 20%. A subchorionic hematoma is simply a collection of blood within the layers of the developing placenta or between the placenta and the uterine wall.
In the presence of a live embryo, subchorionic hematoma is the most common sonographic abnormality. In women whose ultrasound shows a subchorionic hematoma, the outcome of the fetus depends on the size of the hematoma, the mother's age, and the fetus' gestational age. Rates of miscarriage increase with advancing maternal age and increasing size of the hematoma.
2nd trimester bleeding may also worsen the prognosis. The subchorionic hematoma collects between the uterine wall and the chorionic membrane and may leak through the cervical canal. Late in the 1st trimester and early 2nd trimester, the subchorionic hematoma may partially strip the developing placenta away from its attachment site. Therefore, the prognosis of patients with this type of hematoma is worse than the prognosis of patients with hematoma early in 1st trimester.
The subchorionic hematoma often regresses, especially if it is small or moderate in size. Large hematomas, which strip at least 30-40% of placenta away from endometrium, may enlarge further, compressing the gestational sac and lead to further complications. Usually, if seen via ultrasound, it can be measured. Once diagnosed, with subsequent ultrasounds the hematoma can continue to be measured to determine whether it is dissipating or growing in size.
Now, typically these can be visualized on ultrasound and a proper diagnosis can be made. If they did not note anything, this may not be the case for you. But it would explain the clot. With the lowered FHR for an extended period of time, it really depends upon the cause as to what the prognosis would be. Obviously the fetus recovered from whatever was causing that episode of the heart rate lowering, but the real questions would be - what caused it and was it an isolated incident or will it continue happening? The answers to those questions will determine whether the pregnancy continues to be viable at this early stage. The follow-up ultrasound next week, along with additional hCG levels to make sure they are doubling appropriately, may help to answer those questions.
I hope this has helped you and answered your question. I wish you well and will have a good thought for you.
Brenda
