I have a pt who after many years of ttc, has finally become pregnant. In her fifth week she started to bleed bright red blood. The bleeding then became intermittent, but still enough to be alarming. At a 7 wk u/s, fetal heart rate and gestational sac all looked good. In the next week, bleeding started again and u/s showed blood in the placenta. Has anyone out there had success with treating this? I would really appreciate your knowledge.
Bleeding into the placenta
Subchorionic Haematoma
On September 4th, 2008 rayrubio says:
I'm not sure about this particular patient, because you say that the Ultrasound shows bleeding into the placenta, but there is a very common situation that occurs in pregnancy involving a blood clot that forms at or near the attachment of the placenta to the uterine wall. It's called a subchorionic haematoma, and bleeding accompanies this situation because the expanding placenta simultaneously reduces the haematoma, causing more bleeding.
The bleeding from this situation is actually a good sign that the clot/haematoma is being reduced, and that the baby is growing. It can be very distressing to the patient, but it is quite common, and totally normal to see bright, fresh, intermittent blood - which can be in significant amounts at times. Because it's normal, there is no acupuncture intervention needed unless you want to expedite the reduction of the haematoma by moving xue, i.e. using Spleen 10, Liver 8, etc.
Ray Rubio, D.A.O.M., L. Ac.
President ABORM
www.westlakecomplementarymedicine.com
Chorion
On September 4th, 2008 Webdoktor says:
Very few women miscarry with a subchorionic hematoma, and as Ray said, this is more common than most think. Advise your client/patient to try and kick back, take it easy, no sex, no tampon use, and stay hydrated. In my experience, I had a woman carry on with this bleeding on/off until week 20, and now she has a healthy baby. Sometimes this bleeding may cause some cramping which may display as Blood Stasis. The Spleen, as AcuGuru above said may also be the cause, not keeping the blood within the vessels, so look for other signs of Spleen deficiency. The other cause of bleeding could be heat, so examine your client/patient for other signs of heat, particularly in the pulse and tongue since heat usually trumps in these diagnostic elements. Therefore, in my opinion you could administer acupuncture 1/wk using points to mildly stimulate the Chong Mai to reduce the blood clot, and other points that correspond to your diagnosis (Spleen Qi def., Heat, Blood Stasis). You could also teach the client/patient to moxa daily at home on Spleen 1, empirically used to reduce uterine bleeding. If you plan to administer herbals, make sure you are confident with your diagnosis and then administer a small dosage to err on the side of caution and to see if her nausea is not aggravated by the medicine. If all is well after +/- 10 days, increase dose if necessary. Some medicinals to consider would be herbs that both stop bleeding and quicken the blood, i.e. Pu Huang. Also, whenever treating a woman in early pregnancy, be sure to add herbals that will calm and secure the fetus.
Webdoktor
`a patient is healed when the body is set right or the story is heard to the end`
Thank you
On September 8th, 2008 poker says:
Thanks to everyone for their advice!
The subchorionic hematoma was confirmed. She is most likely Ki and SP Yang deficient. Besides Sp 1 are there any other points that she can moxa at home?
Treating sunchororionic hematoma
On September 20th, 2008 dbetts says:
Hi all
Late reply but have just found this post
Have had 3 women with 1st trimester subchorionic hematoma – all had large bleeds (one was on a airport in the states, missed her connecting flight as she could not leave the toilet – her husband had to come and find her and call an ambulance ! and one was an acupuncturist who bleed through the night – flooding pads, having to change the sheets etc and was convinced she had miscarried, after ultrasound all were told there was a 50 % chance of miscarriage. (Maybe the medics were preparing them for the worst as see below it appears to be more 20 – 33 %)
All responded to acupuncture alone (no herbs) – decreased bleeding immediately after treatment …
So I do think we should promote ourselves as offering treatment to these women ( western medicine just states take it easy and wait and see ) and keep collecting case histories – I did not use points to move blood just because in early pregnancy bleeding like to work on calming shen and like using KID 9 to calm the uterus – but it would be great to keep collecting stories on what practitioners are using……as perhaps we should also be looking at points to move blood?
Have not used moxa but have left GV 20 in one of these women for several hours and she took it out herself .....
And from the internet re incidence of miscarriage ….
The incidence of subchorionic hematoma is 1.3% of all pregnancies. In pregnant patients with first-trimester vaginal bleeding, the incidence increases to almost 20%. Overall, hematoma is associated with a 4-33% rate of miscarriage depending on the gestational age when the complication occurs.
http://www.emedicine.com/radio/byname/Subchorionic-Hemorrhage.htm
One hundred eighty-two cases
Clinical complications occurred in 38.5% of the cases (adverse outcome group). Spontaneous abortion (14.3%), fetal growth restriction (7.7%), and preterm delivery (6.6%) were the most frequent clinical conditions observed.
Concluded
Intrauterine hematoma can affect the outcome of pregnancy. The risk of spontaneous abortion is related to gestational age and is significantly increased if diagnosed before 9 weeks.
Obstetrics & Gynecology 2005;105:339-344
© 2005 by The American College of Obstetricians and Gynecologists
Bleeding during pregnancy
AcuGuru
Hello Poker
I have treated a patient similar to this. She never had heavy bleeding but had mild persistent bleeding that turned to spotting and eventually stopped.
She had lots of signs of spleen Qi insufficiency. I used acupuncture only to raise spleen Qi. If She had continued to bleed or had begun to bleed more heavily I would have treated her with herbs.
What pattern is your patient expressing ?