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What Does My Ultrasound Scan Report Indicate?
Question: Dear Doc,
This query is for my wife( Weight 80 kgs, height 5'4 cm, 33 years) who is 11 weeks pregnant with sub-chorionic haemorrage and clots revealed in the recent Ultra-sound. The gestational Sac is normal including the embryo.
We had to hospitalize her on 14th Feb 2015, due to a sudden onset of heavy bleeding. Upon admission, USG revealed subchorionic haemorrage. It has been 7 days that she is in hospital and even though the bleeding has subsidized, but not completely. Local doctors say that due to the clots inside such bleedings will continue till the clot is exhausted. My wife had a miscarriage in 2013. She is under Thyronorm 25 mcg for last 3 years. Prior to bring her to hospital, her Hb% was around 8%. Post this multiple session of bleeding and recent test done today, her reading is at 6.9%, which is worrying us. She had a 100 ml IV infusion of Orofer FCM on 19th Feb. She cannot tolerate Iron tablets, due to severe gastric problems. Would request you to kindly advise on the recent treatment being followed, specially to control her bleeding and also ensure that Hb% is also not compromised. Details are mentioned as under. She was today given Womenox 40 (Heparin) sub-cutenous injection. Would request your kind advise pls.
This query is for my wife( Weight 80 kgs, height 5'4 cm, 33 years) who is 11 weeks pregnant with sub-chorionic haemorrage and clots revealed in the recent Ultra-sound. The gestational Sac is normal including the embryo.
We had to hospitalize her on 14th Feb 2015, due to a sudden onset of heavy bleeding. Upon admission, USG revealed subchorionic haemorrage. It has been 7 days that she is in hospital and even though the bleeding has subsidized, but not completely. Local doctors say that due to the clots inside such bleedings will continue till the clot is exhausted. My wife had a miscarriage in 2013. She is under Thyronorm 25 mcg for last 3 years. Prior to bring her to hospital, her Hb% was around 8%. Post this multiple session of bleeding and recent test done today, her reading is at 6.9%, which is worrying us. She had a 100 ml IV infusion of Orofer FCM on 19th Feb. She cannot tolerate Iron tablets, due to severe gastric problems. Would request you to kindly advise on the recent treatment being followed, specially to control her bleeding and also ensure that Hb% is also not compromised. Details are mentioned as under. She was today given Womenox 40 (Heparin) sub-cutenous injection. Would request your kind advise pls.
Brief Answer:
Detail answer is given below.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
Your wife has subchorionic hemorrhage.
In subchorionic hemorrhage there is a hematoma formation between chorion and uterine wall.
This is responsible for bleeding.
In certain cases no treatment is required. Just wait and watch approch is useful. The clot will either bleed out or absorbed by body depending on size snd location.
If chances of miscarriage are high then blood thinner like aspirin or heparin are givrn alond with estrogen and progesterone.
Your wife has hypochromic microcytic anemia due to iron deficiency. Her anemia become aggravated by bleeding.
So first priority is to maintain hemoglobin.
For that she can go for one or two pinte of packed red cell. This will help to maintain hemoglobin.
Most important factor is rest. Avoid any weight lifting or sternous exercise. Take proper fluid. Avoid sexual intercourse.
Heparin or aspirin should be given. She has history of miscarriage and heavy bleeding so there is high chance of miscarriage so estrogen and progesterone should be given along with blood thinner.
Don't worry much about condition. Once your clot goes away, bleeding will stopped by itself.
Continue your other treatment for thyroid.
Most of the cases have healthy pregnancy after subchorionic hemorrhage. So hope for the best.
Consult your doctor and take treatment accordingly.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
Detail answer is given below.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
Your wife has subchorionic hemorrhage.
In subchorionic hemorrhage there is a hematoma formation between chorion and uterine wall.
This is responsible for bleeding.
In certain cases no treatment is required. Just wait and watch approch is useful. The clot will either bleed out or absorbed by body depending on size snd location.
If chances of miscarriage are high then blood thinner like aspirin or heparin are givrn alond with estrogen and progesterone.
Your wife has hypochromic microcytic anemia due to iron deficiency. Her anemia become aggravated by bleeding.
So first priority is to maintain hemoglobin.
For that she can go for one or two pinte of packed red cell. This will help to maintain hemoglobin.
Most important factor is rest. Avoid any weight lifting or sternous exercise. Take proper fluid. Avoid sexual intercourse.
Heparin or aspirin should be given. She has history of miscarriage and heavy bleeding so there is high chance of miscarriage so estrogen and progesterone should be given along with blood thinner.
Don't worry much about condition. Once your clot goes away, bleeding will stopped by itself.
Continue your other treatment for thyroid.
Most of the cases have healthy pregnancy after subchorionic hemorrhage. So hope for the best.
Consult your doctor and take treatment accordingly.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank You Doctor for your advice.
I was wondering on the impact of blood thinning agents like Heparin on the body, specially as her Hb% is already below 7. She was on Ecosprin 75 mg tablet(Blood Thinner) for the last 2 months during her pregnancy. Due to her sudden bleeding incident last week and subsequent hospitalization, Ecospiin was stopped as it might aggravate bleeding and she was put on Tranexa for stoppage of bleeding.
Now, as bleeding is stopped now. She has been recommended Womenox 40 mg, sub-cutenous daily. Upon administration, she started feeling sleepy and dizzy throughout the day.
Also, she was administered Orofer FCM infusion a couple of days back, but yesterday's Hb% was at 6.9%. I am asking out of sheer ignorance for the fact on why her Hb% is still low.
Would appreciate your kind advice on this and any other which might help us improve.
Regards
Shashwata
I was wondering on the impact of blood thinning agents like Heparin on the body, specially as her Hb% is already below 7. She was on Ecosprin 75 mg tablet(Blood Thinner) for the last 2 months during her pregnancy. Due to her sudden bleeding incident last week and subsequent hospitalization, Ecospiin was stopped as it might aggravate bleeding and she was put on Tranexa for stoppage of bleeding.
Now, as bleeding is stopped now. She has been recommended Womenox 40 mg, sub-cutenous daily. Upon administration, she started feeling sleepy and dizzy throughout the day.
Also, she was administered Orofer FCM infusion a couple of days back, but yesterday's Hb% was at 6.9%. I am asking out of sheer ignorance for the fact on why her Hb% is still low.
Would appreciate your kind advice on this and any other which might help us improve.
Regards
Shashwata
Brief Answer:
Blood transfusion for hemoglobin control.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
Use of blood thinner in subchorionic hemorrhage is double edged sward. It can increase the bleeding tendency. But still it is needed to remove blood clot.
You should go for blood transfusion initially to maintain your hemoglobin. Later on you can switch on to injectable iron.
No need to big worry. Once your hemoglobin is under control we can manage bleeding easily.
You can also use estrogen and progesterone according to your doctor's advice.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health to answer.
Wish you a very good health.
Blood transfusion for hemoglobin control.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
Use of blood thinner in subchorionic hemorrhage is double edged sward. It can increase the bleeding tendency. But still it is needed to remove blood clot.
You should go for blood transfusion initially to maintain your hemoglobin. Later on you can switch on to injectable iron.
No need to big worry. Once your hemoglobin is under control we can manage bleeding easily.
You can also use estrogen and progesterone according to your doctor's advice.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health to answer.
Wish you a very good health.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dear Sir,
Appreciate your advice.
He was loaded with 2 pints of packed RBC as advised by you and in consensus with local physician. She is much better today. Would request you to suggest future course for her to stabilize her Hb levels.
Also, today we conducted her USG to see the health of the fetus. The scan showed a healthy fetus at 11 weeks 4 days, but the concern is that the subchorionic haematoma have tremendously increased in size. The scan puts the size at 91 x 56 x 45 mm (120 cc in volume), much larger than the earlier scan conducted on 16th Feb which had the clot at 22 ml. The impression today is of Threatened abortion. Would request your advice on why such massive increase in the last 7 days, even though she was under complete bed rest at hospital.
Regards
Shashwata
Appreciate your advice.
He was loaded with 2 pints of packed RBC as advised by you and in consensus with local physician. She is much better today. Would request you to suggest future course for her to stabilize her Hb levels.
Also, today we conducted her USG to see the health of the fetus. The scan showed a healthy fetus at 11 weeks 4 days, but the concern is that the subchorionic haematoma have tremendously increased in size. The scan puts the size at 91 x 56 x 45 mm (120 cc in volume), much larger than the earlier scan conducted on 16th Feb which had the clot at 22 ml. The impression today is of Threatened abortion. Would request your advice on why such massive increase in the last 7 days, even though she was under complete bed rest at hospital.
Regards
Shashwata
Brief Answer:
iron deficiency anemia should be corrected
Detailed Answer:
Hi, dear
Nice to see you.
I have gone through your question. I can understand your concern.
She was given 2 pinte of packed red cell so her hemoglobin should be around 9 now.
She has iron deficiency anemia.
She should take iron rich food like dates, green leafy vegetables, dry fruits, jeggary etc.
she can take oral iron like ferrous sulphate or ferrous fumarate.
If she is not convenient with oral iron then she can take injectable iron like iron dextran or iron sucrose.
She should also go for ultrasound abdomen to rule out any other bleeding site.
For subchorionic hematoma, she should take complete bed rest. She should take heparin or warferrin for clot removal.
She has chance of miscarriage with large size hematoma so oestrogen and progesterone should be given. Hope for the best.
Consult your doctor and take treatment accordingly.
Regularly monitor your hemoglobin level.
If you still have any doubts then feel free to ask me.
I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
iron deficiency anemia should be corrected
Detailed Answer:
Hi, dear
Nice to see you.
I have gone through your question. I can understand your concern.
She was given 2 pinte of packed red cell so her hemoglobin should be around 9 now.
She has iron deficiency anemia.
She should take iron rich food like dates, green leafy vegetables, dry fruits, jeggary etc.
she can take oral iron like ferrous sulphate or ferrous fumarate.
If she is not convenient with oral iron then she can take injectable iron like iron dextran or iron sucrose.
She should also go for ultrasound abdomen to rule out any other bleeding site.
For subchorionic hematoma, she should take complete bed rest. She should take heparin or warferrin for clot removal.
She has chance of miscarriage with large size hematoma so oestrogen and progesterone should be given. Hope for the best.
Consult your doctor and take treatment accordingly.
Regularly monitor your hemoglobin level.
If you still have any doubts then feel free to ask me.
I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Dear Doc,
Greetings for the day.
My wife has been discharged on 26th Feb 2015 from the hospital. Now she is under complete bed rest at home. Her bleeding seemed to have stopped till the last 4 days, when she again started to have small clots coming out.
Yesterday night, there was again a major bleeding. I spoke to my local doctor who said that is from the existing clot. The bleeding has stopped now.
My Question
-------------
As you are aware that during her hospitalization she had a blood transfusion of 2 units. Yesterday, night she had itching throughout her body with rashes. Even though it has subsided considerable in the morning, but some itching and bumps remains in some some of her body. I was anxious to know whether this is something related to the blood transfusion done 14 days back. I am extremely worried. Please advise what needs to be done and any test to be conducted.
Regards
Shashwata
Greetings for the day.
My wife has been discharged on 26th Feb 2015 from the hospital. Now she is under complete bed rest at home. Her bleeding seemed to have stopped till the last 4 days, when she again started to have small clots coming out.
Yesterday night, there was again a major bleeding. I spoke to my local doctor who said that is from the existing clot. The bleeding has stopped now.
My Question
-------------
As you are aware that during her hospitalization she had a blood transfusion of 2 units. Yesterday, night she had itching throughout her body with rashes. Even though it has subsided considerable in the morning, but some itching and bumps remains in some some of her body. I was anxious to know whether this is something related to the blood transfusion done 14 days back. I am extremely worried. Please advise what needs to be done and any test to be conducted.
Regards
Shashwata
Brief Answer:
May be due to delayed blood transfusion reaction.
Detailed Answer:
Hi, dear
Nice to see you back.
I have gone through your question. I can understand your concern.
she has history of blood transfusion. Her itching and rash may be due to delayed immune mediated reaction. No need to worry. It should be monitored carefully. Antihistaminics drugs like chlorpheneremine malate(avil) can be useful in that case. If she has fever then paracetamol should be given. You should use this drugs on prescription of your consulting doctor.
No need to worry much about that. If her problems remain persistent then she need examination to search other cause. At now no other investigations are required.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
May be due to delayed blood transfusion reaction.
Detailed Answer:
Hi, dear
Nice to see you back.
I have gone through your question. I can understand your concern.
she has history of blood transfusion. Her itching and rash may be due to delayed immune mediated reaction. No need to worry. It should be monitored carefully. Antihistaminics drugs like chlorpheneremine malate(avil) can be useful in that case. If she has fever then paracetamol should be given. You should use this drugs on prescription of your consulting doctor.
No need to worry much about that. If her problems remain persistent then she need examination to search other cause. At now no other investigations are required.
Hope I have answered your question, if you have doubt then I will be happy to answer. Thanks for using health care magic. Wish you a very good health.
Above answer was peer-reviewed by :
Dr. Shanthi.E
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