Expert: Lawrence Jay Rappaport <B>M.D.</B> - 7/15/2005

Question
I had a miscarriage at 5 wks in early February.  I became pregnant again in April & everything was going well until 7 wks when I started to spot.  An ultrasound at 7 weeks, 3 days showed the baby with a heartbeat of 114, along with a small subchorionic hemorrhage.  Since the hemorrhage was small my doctor didn't seem concerned & just advised me to not lift or strain.  I felt the heartbeat of 114 was low for a 7-8 week pregnancy, but the dr. didn't seem concerned about that either.  The bleeding stopped after a week & then started up again when I was 10 weeks.  It was light bleeding, but red.  An ultrasound at 10 weeks showed no heartbeat & the baby had stopped developing at 8 weeks.  Do you think the subchorionic hemorrhage could have caused this miscarriage?  What causes a subchorionic hemorrhage?  My dr. said they don't start testing until a women has had 3 miscarriages, but I'm concerned there is a problem that can be corrected before I try to get pregnant again.  I am 26 yrs old & have no children.  Thanks...Diane

Answer
Usually, a "subchorionic hemorrhage" does not cause a miscarriage. A subchorionic bleed is caused when blood is sequestered within the folds of the developing placenta. It usually has no relationship with the growing fetus. I believe that you have had two miscarriages. The second miscarriage just, coincidentally, occurred at 8 weeks gestation and was not related to the subchorionic hemorrhage. Miscarriages occur in 15-20% of every pregnany. There is nothing you can do to cause a miscarriage and there is nothing you can do to prevent a miscarriage. They occur due to some problem between the sperm and the egg, or with the growth of the embryo. Since the rate of miscarriage is so high, we usually do not start any workup until you have had three miscarriages in a row. Even if a workup was started, it is unlikely that any cause would be established for your previous miscarriages. You have a very good chance of having a viable normal pregnancy and the recommendation is just to get pregnant again, right away. There is nothing that can be corrected, unless you have phospholipid syndrome, lupus, or a coagulation defect. Discuss all of this with your doctor.