To tell HCP or not...subchorionic hemmorrhage at 12 weeks

[justKate]

So I'm getting my care this pg at a military hospital, with midwives who are VBAC-supportive.  A couple have had VBACs themselves, and I'm happy with them so far.  I really want to stay with this facility/midwife group, because it is 1) free and 2) okay so far.

Four days ago (~12 weeks) I went to the ER (a different hosp) and they found two (one small and one moderate) areas of subchorionic hemmorrhage near the placenta.  The ER doc basically told me that it should heal and there's nothing to do except take it easy for a few days.  So i have been, and the bleeding has lessened.  I was told to follow up with my primary care doc, as they always tell you at the ER.  Just before I left the ER, the nurse told me "well I guess you're high risk now...." and told me about her DD who had 4 c-sections. 

I really don't want to give my midwives any reason to question my ability to have a VBAC.  Do they need to know about the bleeding and ER visit? Do I really need to follow up with them sooner than my next appt (16 weeks), just to have them say, yep, that's right, nothing we can do.

My thought at this point is to just mention it to them at the 16 week appt, like, BTW, I went to the ER at 12 weeks b/c I was bleeding, they checked and baby is fine, not bleeding anymore, etc.

What would you all do?  FWIW I am taking it super easy and I do truly believe that baby is not going to be helped by more people poking around in my vagina.  Blood is scant now and brown.

ETA: I haven't found any correlation between subchorionic hemmorrhages and VBAC success or failure...if anyone has info on that it would be appreciated!

[tangledblue]

I think that nurse didn't necessarily know what she was talking about. You should tell your midwives--they can monitor it to see if it gets bigger but the ER doc sounds right. I had a very small sch early in my pregnancy (it went away) and my OB is still encouraging me to vbac. They can see on ultrasound if it's still there. I doubt there is any correlation between small/moderate sch and being high risk (more than normal vbac risks), unless the sch sticks around and gets bigger.

Hope that helps.

[parsley]

I know the original post is over a week old so JustKate, you may have already made a decision. 

I was diagnosed with a (small) SCH at 8 weeks.  It went on my chart but my midwife practice never suggested it decreased my chance of a VBAC.  Instead they suggested that SCH's almost always clear up.  Mine was gone at my anatomy scan 3 weeks later.  I think the nurse you talked with was wrong to suggest that SCH means higher risk. 

I also talked with a dr. friend who's specialty is women's imaging recently and she said that SCH's are incredibly common, far more common then the literature suggests and that they virtually always clear up. 

I think it's fine to just mention the SCH at your Midwife appt at your 16 week appt if a) you're not worried and don't want to talk about it with them more; and b) don't think you would follow up for more care if the bleeding/spotting continues.  But, I think it would be better to call and mention it to the nurse or the midwife on call so they could get a copy of the images so they would have your full medical record. 

Try not to worry about this... from my research it doesn't seem to make any real difference for pregnancy or labor outcome. 

[MamatobabyA]

I had a huge SCH.  I bled like a period for 11 weeks.  I switched from the care of my RE to my OB at 14 weeks.  He did not care about the SCH since it had totally healed and it did not have any impact on my vaginal birth.  I ended up with pretty bad pre eclampsia though.  My OB felt they might be related since his belief is that pre-e is placental (which I find fascinating).

I would probably let them know.  I can't imagine it would affect your VBAC chances.

[AlexisT]

The current thinking is that pre-e is a disease of the placenta and may relate to poor implantation. I don't know if anyone has ever looked at PE rates for women with a diagnosed SCH. Many SCHs are symptomless and only discovered because early u/s is done.

I had a good sized SCH. It resolved, everything was fine. I did not VBAC but it had nothing to do with the SCH. You do want it monitored to make sure it shrinks. As long as it does, you're good to go.

[Super~Single~Mama]

I came in from the main page, but vbac or not, I can't think of a good reason not to tell your primary care provider about something that was severe enough for you to go to the ER for.  I don't know if a sch would risk you out of a VBAC or not, but your health care providers need to know about so that they can help you determine what it means, and so that they can monitor you knowing that it occurred.  I don't know if there would be additional monitoring, or if it would cause any type of concern, but I would absolutely want to know what concerns it raised, if any, so that I was going into the birth fully informed. 

I don't think there is any good argument for NOT telling them - even though you want a VBAC, and I know that it is very important to you, hiding things that may risk you out of a VBAC, is not a good way to get what you want.  I guess what I mean is that the comment by the nurse, who may or may not know what she's talking about, should not prevent you from sharing what could be valuable information from your health care providers.

I hope that the rest of your pregnancy is uneventful.

[justKate]

Thanks for all of the info and thoughts ladies.  I did decide to tell them. I called and talked to a midwife, who didn't seem too concerned.  She told me that as long as there was no "fresh looking" blood, I didn't need to follow up with an appt before my next scheduled one, but that i can go in any time to have a listen for baby if I need to.   I went in about 5 days after the first bleed just for a listen, and baby sounded fine. 

Its been a week and a half now, and I'm still spotting, but it's a lot less.  I'll take the ER paperwork with me at my 16 wk appt to give the midwife.  Hopefully the SCH will be resolved by then! 

[Meleroo]

I had a SCH on my first dating ultrasound (but no bleeding that I noticed).  Midwife was unconcerned (Canada) and said it would likely heal.  I had another ultrasound at 20 weeks and it was not there anymore.  I haven't heard a mention of it since except I saw a very un-VBAC supportive OB last week for a consult on an ovarian cyst and he mentioned it in passing as one of the many reasons that I would be high risk.  When I asked him how it could make me high risk if it was no longer there he didn't have an answer.  I also caught him in several other lies while he was trying to convince me to schedule a c-section so I think it is a load of hooey.  From what my midwife said, they are common and commonly heal up.  I suppose if they continued to see it through the pregnancy it might move you into another risk category but I would be upfront with your midwife team.  

All the best!