Management of Subchorionic Hemorrhage in Pregnant Women on Anticoagulants

Risk Factors and Management Approach

Women on direct oral anticoagulants (DOACs) should be switched to alternative anticoagulation if pregnancy is planned or immediately if pregnancy is discovered, as recommended by the American College of Chest Physicians 1, 2
Early ultrasound examination should be performed to assess fetal viability, evaluate for evidence of subchorionic/retroplacental bleeding, and measure the size of the hematoma, with a focus on women on anticoagulants 1, 2
For women on anticoagulants who develop SCH, discontinuation of DOACs and switching to low molecular weight heparin is recommended, along with early obstetric review and fetal monitoring 1, 2
Monitoring for signs of hemodynamic instability is essential in large SCH requiring hospitalization, with consideration of blood transfusion if significant blood loss occurs 1

Serial ultrasound examinations at 7-day intervals are recommended until bleeding ceases, subchorionic hematoma disappears, or pregnancy outcome is determined, with particular attention to women on anticoagulants 1
Umbilical artery Doppler studies should be performed for second and third trimester SCH, as part of a comprehensive monitoring protocol 1