Subchorionic Hemorrhage - Treatment Protocol

Subchorionic hemorrhages are very common and most of them resolve, however it does increase the risk of miscarriage.\n\nVery small data demonstrates possibility of improving resolution of subchorionic bleeds:\n\nThe study describes this combination that was found to be helpful in helping this group of women who had subchorionic hemorrhage. The bigger the hemorrhage, the increased the risk of miscarriage.\n\nVery small ones are <2 cm. Medium size ones are up to 4 cm and large ones are larger than 4 (based on clinical experience).\n\nSTUDY (Department of Obstetrics and Gynecology, University of Perugia, Italy):\nOBJECTIVE: Test contribution of oral alpha Lipoic Acid (ALA) supplementation to standard progesterone treatment in healing subchorionic hematomas in threatened miscarriage.\n\nMETHODS: 19 pregnant women in first trimester with threatened miscarriage and ultrasound evidence of subchorionic hematoma. Controls: 400 mg Progesterone (200 mg 2x/day) vaginal suppositories. Case study: same Progesterone plus ALA 600 mg oral (300 mg 2x/day, DAV®). 16 patients completed trial. Treatment until complete resolution.\n\nRESULTS: Both groups improved significantly, but better and faster evolution in subjects treated with ALA and Progesterone. Speed of resorption of subchorionic hematoma significantly (p<0.05) superior in ALA group. ALA group showed faster decrease/disappearance of all symptoms (difference not significant).\n\nCONCLUSIONS: ALA supplementation significantly contributes to speed up restoration of physiological conditions in threatened miscarriage and ameliorates medical conditions of mothers and fetus, probably modulating networks of cytokines, growth factors and other molecules.\n\nADDITIONAL CONSIDERATION: IM rocephin for SCH >4 cm\n250 mg IM twice weekly x 2 weeks when she gets IM progesterone (200 mg IM 2x/week). Patient needs to be aware this is off label and thought to help due to possibility SCH is from infection