Dr. Nadia Khan
Obstetrics and Gynecology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My wife is 15 weeks pregnant and went to the ER with bleeding on Monday. They did an ultrasound, bloodwork, etc., she followed up with her OB the next day. The OB really did not seem concerned, and she put her on pelvic rest and scheduled a follow up for two and a half weeks out. She continued to bleed (mostly brownish blood), sometimes heavier and sometimes almost nothing she said. She measured right on schedule and the heart rate was good. I am not sure if the radiology report is saying that there are one or two hypoechoic areas. Can you determine? Also, she said that she passed a couple of clots, but the blood has been brown blood for the most part. What I want to know is, is this a subchorionic hemorrhage? Also, based on the details, how much more at risk for miscarriage or preterm delivery does this put us? The OB said that this does not put her at any higher risk for miscarriage, but from what I am seeing online, I believe that. She had her previous delivery without any bleeding issues, but she did have pre-eclampsia and Hellp syndrome on 39 weeks when she was induced. Here is what the radiology report says:
The amniotic fluid volume is within normal limits on inspection. The placenta is posterior, fundal, and grade 0. No placenta previa. No low-lying placenta. No placental abruption is seen. Hypoechoic area is adjacent to the gestational sac in the cervical region. The cervix measures 1.1 inch in length. The hypoechoic area within the cervix measuring 2.9 x 1.1 x 0.7. The maternal right and left adnexa were not evaluated.
Impression:
1. Single live intrauterine gestation as noted above. No suspicious findings.
2. Hypoechoic area adjacent to the gestational sac in the cervical region is compatible with a bleed. Hypoechoic area within the cervix measuring 2.9 x 1.1 x 0.7 is compatible with blood products. Recommended attention to these findings on follow up ultrasound.
Hello,
Welcome to iclinq.com.
Thanks for sharing this information with us. You are right that hypoechoic area on the scan corresponds to the bleed but as far as this bleed is concerned there is no way to stop it and in my opinion as your wife has already progressed to 15 weeks the chances of miscarriage are reduced a lot rather there are chances of having pre term labor in the later half of pregnancy. So for that her gynecologist should keep an eye on her, and you have mentioned that she was having pre-eclampsia in last pregnancy then in my opinion she must have been started on Aspirin 75 mg in this pregnancy to reduce the chances of developing pre-eclampsia and also reduces formation of clots elsewhere in the vascular system which is definitely helpful for now. I might say that your wife can discuss having tablet Duphaston (Dydrogesterone) and Aspirin with her doctor and they can come up with the best advice for her health. Pelvic rest is the only thing that can be done for now as she is in her early pregnancy.
I hope this helps.
Patient's Query
Thank you doctor,
The only thing I was not sure of is if the report says that there are one or two hypoechoic areas. It looks like it says there is one that is adjacent the sac and one in the cervix. Is that accurate? Are these hypoechoic areas also known as subchorionic hemorrhage?
Hello,
Welcome back to icliniq.com.
Hypoechoic areas have differentials like it could be placenta or could be hematoma and a couple of other things, and please accept my apologies as the finer details could only be discussed by the radiologist him or herself. Secondly, subchorionic means behind the placenta, so it could be the one where the placenta is lying but if you still have any ambiguity you can always ask the radiologist discussing it in more detail. I hope it helps.
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Obstetrics and Gynecology
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