Expert: Lawrence Jay Rappaport <B>M.D.</B> - 6/3/2005

Question
Dear Dr. Rappaport,
I am 28 y/o, no children. 1st day of my last menstrual period was March 20. I am currently almost 11wks pregnant. My last pregnancy ended in an unexplained missed miscarriage at 12wks (slight spotting and no fetal heartbeat), they believe the baby stopped developing at 8wks. I had a D&C Jan 15th, 2005. I had my second ultrasound yesterday which showed a HB of 148, measuring 10wks 5days and good placental blood flow. My OB informed me today that I have a subchorionic hematoma just outside the amniotic sac and seemed surprised that I have had no bleeding so far. My next scheduled ultrasound is in 2 weeks and I see my OB in 3 weeks.

My questions are:
Do I have an increased risk of miscarriage?
Should I be resting or avoiding any activities?
How soon should I have a follow up ultrasound?
How likely is it that I will bleed and is it necessary to bleed for the problem to resolve itself?
Could this have caused my previous miscarriage and could this now be related to getting pregnant soon after a D&C?

Sorry this is so long, I'm just so worried after having one miscarriage. Any information you can provide would be greatly appreciated.

Best Regards,

Autumn

Answer
A "subchorionic hematoma" is merely a sequestration of some blood within the layers of the forming placenta. It usually dissipates and disappears on its own. Sometimes you can have some vaginal bleeding (slight) and sometimes it does not cause bleeding. It usually does not interfere with the pregnancy and does not cause a miscarriage. There is a 15-20% risk of miscarriage in every pregnancy. There is nothing you can do to cause a miscarriage and there is nothing you can do to prevent a miscarriage. You do not have to rest or stay in bed. Studies have shown that bedrest does nothing to prevent miscarriage. If you start to bleed, I would refrain from heavy lifting or sexual intercourse until the bleeding stops, but you do not have to curtail any other activities. You should get a follow up ultrasound at 20 weeks unless you start to bleed heavy prior to that time. The hematoma will resolve itself by dissolving. The blood is not required to come out of the vagina. A subchorionic bleed is not related to getting pregnant soon after a D&C. There is no problems in becoming pregnant immediately after a D&C. Once the D&C is performed, the uterus is clean and empty and you can conceive again with no problems. A subchorionic hematoma does not cause miscarriage. Don't worry. All appears fine with your current pregnancy.