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Pregnant And Ultrasound Showed Thick Bloody Line On Sac. What Could It Be?
Question: Hi, Iam 10 weeks pregnant and just done the ultrasound .baby showed to be fine, developing well and moving but dr also said she could notice something like "bloody slightly thick line" on sac that might indicate XXXXXXX bleeding .... why is this happening and what does it mean .should I be worried ? I am very stressed and concerned now , dont know what to think .... please advise. XXXXX
Brief Answer:
It Is A Subchorionic Hematoma. Repeat Scan Needed.
Detailed Answer:
Hello,
Thanks for writing to us on XXXXXXX
Bloody thick line or XXXXXXX bleeding on sac is more suggestive of Subchorionic Hematoma (SCH).
It is a most common hematoma in first trimester of pregnancy. It is located between chorion & endometrium (on gestational sac). It can cause vaginal bleeding or brown discharge occasionally. However, most patients remain asymptomatic with small or mild hematoma & few are present with threatened miscarriage. Most of them regress naturally.
Current statistics shows that chance of pregnancy loss or miscarriage is near about 1-3% with SCH after 12 weeks & mostly associated with large hematoma. Most of them resolve within 20 weeks of gestational age without any further complication. But few percentage has greater risk of development of placental abruption in later months. In such case, urgent medical attention is required.
As per present scan, your baby is quite well developing and moving. Therefore, I think this hematoma will regress automatically. Here, I suggest to undergo one trans vaginal ultrasound (TVS scan) after 2 weeks to evaluate the prognosis.
There is no useful treatment for SCH pregnancies. Wait and watch with serial ultrasound scan and avoiding strenuous activity are the key element in such case. Here, you would need to take all prescribed medication by your doctor. It helps to support pregnancy & prevents possible miscarriage. Kindly, proceed follow-up visit to your OBGYN in periodic manner.
You must follow these advice strictly:
1) Avoid heavy work/ long journey/ lifting heavy objects/ high heal shoe/ walking on uneven surface/ more ups & downs etc.
2) Take complete bed rest till the problem is resolved. Non-prescribed medication should be avoided.
3) Take healthy protein XXXXXXX diet and drink more water for better feto-placental circulation. Maintain genital hygiene properly.
Hope, it helps for your information. If you need any clarification, you can freely ask me.
Wish your good health and successful journey of pregnancy.
Regards,
Dr Soumen
It Is A Subchorionic Hematoma. Repeat Scan Needed.
Detailed Answer:
Hello,
Thanks for writing to us on XXXXXXX
Bloody thick line or XXXXXXX bleeding on sac is more suggestive of Subchorionic Hematoma (SCH).
It is a most common hematoma in first trimester of pregnancy. It is located between chorion & endometrium (on gestational sac). It can cause vaginal bleeding or brown discharge occasionally. However, most patients remain asymptomatic with small or mild hematoma & few are present with threatened miscarriage. Most of them regress naturally.
Current statistics shows that chance of pregnancy loss or miscarriage is near about 1-3% with SCH after 12 weeks & mostly associated with large hematoma. Most of them resolve within 20 weeks of gestational age without any further complication. But few percentage has greater risk of development of placental abruption in later months. In such case, urgent medical attention is required.
As per present scan, your baby is quite well developing and moving. Therefore, I think this hematoma will regress automatically. Here, I suggest to undergo one trans vaginal ultrasound (TVS scan) after 2 weeks to evaluate the prognosis.
There is no useful treatment for SCH pregnancies. Wait and watch with serial ultrasound scan and avoiding strenuous activity are the key element in such case. Here, you would need to take all prescribed medication by your doctor. It helps to support pregnancy & prevents possible miscarriage. Kindly, proceed follow-up visit to your OBGYN in periodic manner.
You must follow these advice strictly:
1) Avoid heavy work/ long journey/ lifting heavy objects/ high heal shoe/ walking on uneven surface/ more ups & downs etc.
2) Take complete bed rest till the problem is resolved. Non-prescribed medication should be avoided.
3) Take healthy protein XXXXXXX diet and drink more water for better feto-placental circulation. Maintain genital hygiene properly.
Hope, it helps for your information. If you need any clarification, you can freely ask me.
Wish your good health and successful journey of pregnancy.
Regards,
Dr Soumen
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you very much for your reply.
I have another question if you can please assist with answer which will help me make my decision...
My OBGYM told me yesterday when I had my 10 week ultrasound that because of my age and history of 1 miscarriage I have to have screening tests for chromosomal/ genetic complications (Dawn syndron and some more) . One test is already booked in 2 weeks time when i will be 12 weeks and that is USG scan for nuchal translucency measurments and all other relevant measurements and potential implications of genetic disorders. This is something I will deffenetly do as will give some indication, and something that is an issue it is finances and this one is acceptable price while another blood screening test my dr want me to do is ridicolously expensive and that is Non invazive prenatal test where is my blood taken and babys DNA is extracted so it gives very good inication if any complications .another option is Double marker test which is slightly less costly but still expensive can also give indication but the new test NIPT is much better . But I been doing some reserach on internet and there are so many contraindictive discussion on this new blood screening test in medical profession . Some says it is great as it is not invasive and new method that can replace CVS and Amnicentesis but again it is just a risk assesment it is not a result and diagnostic test such as CVS and Amnio. Again I dont want to sound negative I am just very scared because I had 1 miscarriage that this is too early stage in pregnancy to do this expensive test that is just trieal one and not reliable (NIPT) and then , with all my prears and Gods help NOT, but what if I miscarry again and gone threw all this xpensive blood test which if shows positive I would probably be refered to do Amnio which is also expensive (none insurance covers this special extra tests) and last time I paid ridicilously expensive D&C prcedure .... I know I sound like its all bouat fynances ...the helth of my fetus is the most important thing and will do anything that takes but do I really need all those expensive test so early in pregnancy (I do understand finding out in earlier stage is emotionally and physically better the finding out later ) and still dont know for sure (nothing will be sure till the end of full term) if pregnancy will sustain.I am terrified and simply not in fynancial position to pay all this (as already expensive doing every 2 weeks ultrasound ). Please advise on this Non invasive screening tests and is it wort it doing expensive risk assesmant not obteining result and then if I need to follow up with amnio which I would preferably not have as it is invasive. But how to be smart here and decide ? can you help with advise . Is it USG ultrasound that I am doing in 2 weeks time sufficiant for now and then just pray God my baby is good and after pregnancy progress to do NIPT instead of Amnio instead ? as with 20 weeks also anomaly scan is done isnt it ? + I have so much fear now for this SCH you explained in last quiry... I know I should make my own decision but please assist with best possible answer which will benefit my baby and its safety but also if I can save unecessary expenses .Thank you sooo much in advance
I have another question if you can please assist with answer which will help me make my decision...
My OBGYM told me yesterday when I had my 10 week ultrasound that because of my age and history of 1 miscarriage I have to have screening tests for chromosomal/ genetic complications (Dawn syndron and some more) . One test is already booked in 2 weeks time when i will be 12 weeks and that is USG scan for nuchal translucency measurments and all other relevant measurements and potential implications of genetic disorders. This is something I will deffenetly do as will give some indication, and something that is an issue it is finances and this one is acceptable price while another blood screening test my dr want me to do is ridicolously expensive and that is Non invazive prenatal test where is my blood taken and babys DNA is extracted so it gives very good inication if any complications .another option is Double marker test which is slightly less costly but still expensive can also give indication but the new test NIPT is much better . But I been doing some reserach on internet and there are so many contraindictive discussion on this new blood screening test in medical profession . Some says it is great as it is not invasive and new method that can replace CVS and Amnicentesis but again it is just a risk assesment it is not a result and diagnostic test such as CVS and Amnio. Again I dont want to sound negative I am just very scared because I had 1 miscarriage that this is too early stage in pregnancy to do this expensive test that is just trieal one and not reliable (NIPT) and then , with all my prears and Gods help NOT, but what if I miscarry again and gone threw all this xpensive blood test which if shows positive I would probably be refered to do Amnio which is also expensive (none insurance covers this special extra tests) and last time I paid ridicilously expensive D&C prcedure .... I know I sound like its all bouat fynances ...the helth of my fetus is the most important thing and will do anything that takes but do I really need all those expensive test so early in pregnancy (I do understand finding out in earlier stage is emotionally and physically better the finding out later ) and still dont know for sure (nothing will be sure till the end of full term) if pregnancy will sustain.I am terrified and simply not in fynancial position to pay all this (as already expensive doing every 2 weeks ultrasound ). Please advise on this Non invasive screening tests and is it wort it doing expensive risk assesmant not obteining result and then if I need to follow up with amnio which I would preferably not have as it is invasive. But how to be smart here and decide ? can you help with advise . Is it USG ultrasound that I am doing in 2 weeks time sufficiant for now and then just pray God my baby is good and after pregnancy progress to do NIPT instead of Amnio instead ? as with 20 weeks also anomaly scan is done isnt it ? + I have so much fear now for this SCH you explained in last quiry... I know I should make my own decision but please assist with best possible answer which will benefit my baby and its safety but also if I can save unecessary expenses .Thank you sooo much in advance
Brief Answer:
Don't Be Worried. Do The First Screening Test.
Detailed Answer:
Hello,
Thanks for giving additional information to give you better opinion. Followings are my comments regarding your queries:
1) For SCH, there is no therapeutic intervention is available. Serial ultrasound scan at 2 weeks interval (until it is resolved) and wait & watch are the best modality to assess the prognosis of the condition. Most of SCH regress automatically. Your baby was quite fine and active as per last scan. So, you don't need to worry.
2) In advance maternal age and H/O previous miscarriage, some screening tests for fetal well being are must. Here, we need to rule out Down's syndrome (trisomy 21), Neural tube defect, XXXXXXX syndrome (trisomy 18) and other fetal gross anomaly. For your information sake, no diagnostic test can give you 100% fruitful result or detect every abnormality.
Generally, I prefer a systemic way for prenatal screening test. It is most reliable, economical and safe method. This is the following:
First choice: 1) Combination of Fetal Nuchal Translucency (FNT) and Double Marker test (beta-hCG and PAPP-A): It is done in 10-13 weeks (first trimester) of gestation. It is non invasive and early screening test. It has Sensitivity rate around 70% to detect Down's syndrome.
Best Choice: 2) Quadruple test (AFP, beta-hCG, unconjugated estriol & Inhibin -A): It is done in 14-20 weeks (2nd trimester). When it is combined with FNT and additional ultrasound scan (USG) in 2nd trimester, it has sensitivity more than 95% to detect above said anomaly including down syndrome. It is also non invasive.
I think above two choices are quite affordable to most patients and quite reliable. Hopefully, you can undergo those tests.
If any abnormality is detected in above test results, only then we consider to undergo amniocentesis or NIPT (Non Invasive Prenatal Test). These are specific for chromosomal disease. NIPT is best in comparison to amniocentesis due to having reduced the risk of miscarriage in advanced maternal age. However, it is more indicative if you have positive family H/O Down's syndrome or previous aneuploidy baby. The test is done in 2nd trimester and highly expensive.
If you have good test results in hand and negative family history, then you do not need to undergo NIPT or amniocentesis. Instead of those, you can do one TIFFA (Targeted Imaging For Feta Anomaly) scan at 18-23 weeks to rule out gross or minor fetal anomaly. It is mostly cost effective and highly reliable.
Till then, you would follow suggestive measures that I have mentioned in my previous reply. Don't be worried or stressed. Just enjoy your pregnancy. Wish you for successful motherhood.
Hopefully, I have explained everything what you need to do at present. If you do not have other query, you can close the discussion.
Good luck.
Regards,
Dr Soumen
Don't Be Worried. Do The First Screening Test.
Detailed Answer:
Hello,
Thanks for giving additional information to give you better opinion. Followings are my comments regarding your queries:
1) For SCH, there is no therapeutic intervention is available. Serial ultrasound scan at 2 weeks interval (until it is resolved) and wait & watch are the best modality to assess the prognosis of the condition. Most of SCH regress automatically. Your baby was quite fine and active as per last scan. So, you don't need to worry.
2) In advance maternal age and H/O previous miscarriage, some screening tests for fetal well being are must. Here, we need to rule out Down's syndrome (trisomy 21), Neural tube defect, XXXXXXX syndrome (trisomy 18) and other fetal gross anomaly. For your information sake, no diagnostic test can give you 100% fruitful result or detect every abnormality.
Generally, I prefer a systemic way for prenatal screening test. It is most reliable, economical and safe method. This is the following:
First choice: 1) Combination of Fetal Nuchal Translucency (FNT) and Double Marker test (beta-hCG and PAPP-A): It is done in 10-13 weeks (first trimester) of gestation. It is non invasive and early screening test. It has Sensitivity rate around 70% to detect Down's syndrome.
Best Choice: 2) Quadruple test (AFP, beta-hCG, unconjugated estriol & Inhibin -A): It is done in 14-20 weeks (2nd trimester). When it is combined with FNT and additional ultrasound scan (USG) in 2nd trimester, it has sensitivity more than 95% to detect above said anomaly including down syndrome. It is also non invasive.
I think above two choices are quite affordable to most patients and quite reliable. Hopefully, you can undergo those tests.
If any abnormality is detected in above test results, only then we consider to undergo amniocentesis or NIPT (Non Invasive Prenatal Test). These are specific for chromosomal disease. NIPT is best in comparison to amniocentesis due to having reduced the risk of miscarriage in advanced maternal age. However, it is more indicative if you have positive family H/O Down's syndrome or previous aneuploidy baby. The test is done in 2nd trimester and highly expensive.
If you have good test results in hand and negative family history, then you do not need to undergo NIPT or amniocentesis. Instead of those, you can do one TIFFA (Targeted Imaging For Feta Anomaly) scan at 18-23 weeks to rule out gross or minor fetal anomaly. It is mostly cost effective and highly reliable.
Till then, you would follow suggestive measures that I have mentioned in my previous reply. Don't be worried or stressed. Just enjoy your pregnancy. Wish you for successful motherhood.
Hopefully, I have explained everything what you need to do at present. If you do not have other query, you can close the discussion.
Good luck.
Regards,
Dr Soumen
Above answer was peer-reviewed by :
Dr. Mohammed Kappan
Dear Dr Soumen,
Greatly appreciate your thiral answer , which calms my mind and helping me decide and specially on fanancial side of all of it
You have explaind everything very clearly , I would just like to ask you to clarify and confirm what are you exactly suggesting me to do (you gave me first and best choce, please kindly suggest what to be done 1st trimester and what second and which week) - which test in first trimestar which is ending in 2 weeks time (12 weeks ) and which test should I do in second trimester (at what point - what weeks of pregnancy) so at the same time my babys health is looked at and I can save financilly quite considerably
(We live in Dubai , which is more expensive then UK ,for example just double marker costs about GBP (Great british pounds) 1100 , and in UK in private clinics cost less then double .... so at the same time I want to do the best for my baby and find out best possible results (but hopefully not repetative and uneccecary needed) from this screening tests but also have to think economic side as simply cant do them all and again something that I mentioned in my previous email which my husbant call me being negative , but I call it realistic and just have huge fear ....I dont want to do all ridicilously highly expensive genetic screening tests first trimester (preferebly if not neccecery not even early in second one) as I look at it as still way too early in pregnancy to be sure if my pregnancy will sustain ...
with God help it will , but I am just scared and just dont want to do all the test now ...
If I understood well, please correct me if wrong (thats why I am writing you again as not sure which test you recomend next 2 weeks (when I will be 12 weeks) and which later in second trimester
FIRST TRIMESTER (at 12 weeks) As i already have boooked USG Ultrasound for 29th august and Nuchal translucency is this sufficiant test to be done for now or sth else need to be done (as previusly mentioned my Dr expects me to get beck to her today or tomorrow to tell her weather I want double marker or NIPT to book for me same day as I go for USG) which I dont want to do so early in pregnancy and waaaaay out of my financial abilities and again I dont want to do all this too ealy in pregnancy
2nd trimester : you are suggesting quadraple test (which weeks would be the best ?) and again TNT and USG ? or ? sorry if you can clarify
Again just trying to look at it as most benefiial for my baby to see if it is healthy buat also economically ...(I am just praying God all TNT, USG and quadraple test would show good and you said this is sufficiant to know if baby doesnt have any genetic disformalities- no other test would be required such as amnio or NIPT). Both my husbandand and myself dont have family history of any genetic desorders (and my husband is 3 years younger then me 33 yo so his sperm is "young" so hopefully thats good and when I misscaried last time there was not enough tissue collected to analyse what caused and if anything chromosomicaly was wrong with fetus .
Bay the way , my OBGYN told me I dont have option to say NO, it is MUST that I have to choose beetwen double marker and NIPT to be done at 12 weeks .But this is my choice , not sth I HAVE to do right ?
Please dear Dr, If you can just advise and specify clearly what you suggest to be done 1st and what 2nd trimester
Thand you so much for all your answers above
Greatly appreciate your thiral answer , which calms my mind and helping me decide and specially on fanancial side of all of it
You have explaind everything very clearly , I would just like to ask you to clarify and confirm what are you exactly suggesting me to do (you gave me first and best choce, please kindly suggest what to be done 1st trimester and what second and which week) - which test in first trimestar which is ending in 2 weeks time (12 weeks ) and which test should I do in second trimester (at what point - what weeks of pregnancy) so at the same time my babys health is looked at and I can save financilly quite considerably
(We live in Dubai , which is more expensive then UK ,for example just double marker costs about GBP (Great british pounds) 1100 , and in UK in private clinics cost less then double .... so at the same time I want to do the best for my baby and find out best possible results (but hopefully not repetative and uneccecary needed) from this screening tests but also have to think economic side as simply cant do them all and again something that I mentioned in my previous email which my husbant call me being negative , but I call it realistic and just have huge fear ....I dont want to do all ridicilously highly expensive genetic screening tests first trimester (preferebly if not neccecery not even early in second one) as I look at it as still way too early in pregnancy to be sure if my pregnancy will sustain ...
with God help it will , but I am just scared and just dont want to do all the test now ...
If I understood well, please correct me if wrong (thats why I am writing you again as not sure which test you recomend next 2 weeks (when I will be 12 weeks) and which later in second trimester
FIRST TRIMESTER (at 12 weeks) As i already have boooked USG Ultrasound for 29th august and Nuchal translucency is this sufficiant test to be done for now or sth else need to be done (as previusly mentioned my Dr expects me to get beck to her today or tomorrow to tell her weather I want double marker or NIPT to book for me same day as I go for USG) which I dont want to do so early in pregnancy and waaaaay out of my financial abilities and again I dont want to do all this too ealy in pregnancy
2nd trimester : you are suggesting quadraple test (which weeks would be the best ?) and again TNT and USG ? or ? sorry if you can clarify
Again just trying to look at it as most benefiial for my baby to see if it is healthy buat also economically ...(I am just praying God all TNT, USG and quadraple test would show good and you said this is sufficiant to know if baby doesnt have any genetic disformalities- no other test would be required such as amnio or NIPT). Both my husbandand and myself dont have family history of any genetic desorders (and my husband is 3 years younger then me 33 yo so his sperm is "young" so hopefully thats good and when I misscaried last time there was not enough tissue collected to analyse what caused and if anything chromosomicaly was wrong with fetus .
Bay the way , my OBGYN told me I dont have option to say NO, it is MUST that I have to choose beetwen double marker and NIPT to be done at 12 weeks .But this is my choice , not sth I HAVE to do right ?
Please dear Dr, If you can just advise and specify clearly what you suggest to be done 1st and what 2nd trimester
Thand you so much for all your answers above
Brief Answer:
Do FNT & USG In 1st and Quadruple In 2nd Trimester.
Detailed Answer:
Hello,
Thanks for your response and additional queries. Don't be worried much. I am trying to simplify my previous reply.
First of all, I have already mentioned the necessary tests to be done in first and second trimester including choices. However, I think that you do not catch my points of justification.
Here, I give you a very simplified thing to understand properly:
1) First, Do one ultrasound scan & FNT within 10-13 weeks (First trimester) as per your schedule. Here, you can omit double marker test if you get positive result in both tests. You have the option for Quadruple test.
2) Next, Do Quadruple test within 14-20 weeks (Second trimester) and one additional ultrasound scan with 4 weeks gap from last one. Quadruple test is more sensitive and specific than double marker test to detect Down's syndrome and other anomaly.
3) Lastly, Do one TIFFA( Targeted Imaging for Fetal Anomalies) scan within 18-23 weeks (Second trimester) to rule out gross and minor anomaly if you can afford & earlier test reports give positive result.
Hopefully, you can do these tests which are less expensive, reliable and trust worthy for carrying a healthy pregnancy. If any abnormality is detected in test results, you have to undergo either amniocentesis or NIPT(Non-Invasive Prenatal Testing) for confirmation and to decide whether you can continue this pregnancy or not.
In addition, double marker test will give you just early result in detecting Down's syndrome in first trimester. However, Quadruple test is more superior to that but it is done in 2nd trimester. I think that I have clarified these two tests.
Kindly, consult with your gynecologist regarding this and take proper guidance for above mentioned tests.
Hope, I have assisted you better with my experience and your thought. Best wishes for you.
Regards,
Dr Soumen
Do FNT & USG In 1st and Quadruple In 2nd Trimester.
Detailed Answer:
Hello,
Thanks for your response and additional queries. Don't be worried much. I am trying to simplify my previous reply.
First of all, I have already mentioned the necessary tests to be done in first and second trimester including choices. However, I think that you do not catch my points of justification.
Here, I give you a very simplified thing to understand properly:
1) First, Do one ultrasound scan & FNT within 10-13 weeks (First trimester) as per your schedule. Here, you can omit double marker test if you get positive result in both tests. You have the option for Quadruple test.
2) Next, Do Quadruple test within 14-20 weeks (Second trimester) and one additional ultrasound scan with 4 weeks gap from last one. Quadruple test is more sensitive and specific than double marker test to detect Down's syndrome and other anomaly.
3) Lastly, Do one TIFFA( Targeted Imaging for Fetal Anomalies) scan within 18-23 weeks (Second trimester) to rule out gross and minor anomaly if you can afford & earlier test reports give positive result.
Hopefully, you can do these tests which are less expensive, reliable and trust worthy for carrying a healthy pregnancy. If any abnormality is detected in test results, you have to undergo either amniocentesis or NIPT(Non-Invasive Prenatal Testing) for confirmation and to decide whether you can continue this pregnancy or not.
In addition, double marker test will give you just early result in detecting Down's syndrome in first trimester. However, Quadruple test is more superior to that but it is done in 2nd trimester. I think that I have clarified these two tests.
Kindly, consult with your gynecologist regarding this and take proper guidance for above mentioned tests.
Hope, I have assisted you better with my experience and your thought. Best wishes for you.
Regards,
Dr Soumen
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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