Twin Pregnancy & Subchronic Hemorrhage: Progesterone Concerns - Seeking Advice

Question
Hi I was wondering if you can help. I am 9 1/2 weeks pregnant I have had a scan which shows twins measuring correctly and both with heartbeats. At 7 weeks I had a moderate red bleed which continued on and off until 9 weeks now just brown spotting and I was diagnosed with a sub chronic hemmorage via ultrasound of 5cm by 1cm by 3cm. Since this happened my progesterone had fallen week on week even though I am taking IM injections and using 2 x 400mg pessaries each day. In the last 2 weeks it has fallen from 480 to 308 UK scale which I think on the US scale is around 70 to today's blood level which was 48. I am very worried that I am slowly miscarrying even though the ultrasounds show everything is ok?  Could the SCH be effecting my levels?
Many thanks

Answer
Subchorionic hemmorrhage is a term used to describe a clot between the uterus and placental wall which is typically found in early pregnancy. Please do note that only 1-3% of women with this common complication have an end result in miscarriage. This stacks the odds tremendously in your favor. That being said, it is certainly normal for your progesterone levels to drop when an SCH is present. As long as your HCG levels are rising normally and your ultrasounds appear to indicate that your pregnancy is progressing, I do not think you have much to be concerned with. I would suggest talking to your doctor about taking a medication called Prometrium. This medication works great in patients with an SCH present. The bleeding is not necessarily a bad thing, as many doctors choose to attempt to bleed the clot to avoid complications. I would discuss, with your doctor, the potential benefits of bed rest and pelvic rest until the SCH is no longer an issue. A pregnancy involving twins is already more complicated than a single birth, thus it requires more monitoring and different protocols in order to ensure a successful delivery. I certainly hope I have answered your questions, should you have anymore questions or concerns, please do not hesitate to ask. I wish you the best of luck. God bless.

Sincerely,
Cheryl Hetherington