Understanding Missed Miscarriage: Symptoms, Scans & What to Expect

Question
I went in for an ultrasound at 6w3d and we saw the heart beat.  The dr also
said there was some blood in the uterus but he said not to worry.  He said it
wasn't much.
I went in again at 7w6d and this time the scan picture was not clear at all.  we
didn't see a heart beat.  He saw the blood had increased.  Not much else.  
I'm going in again this week for another one and.

I did not have any spotting or cramps (only stretchy cramps that I was told
was ok).  I was on progesterone support.

My questions are:
1) Should I have been put on bedrest with blood in the uterus?
2) Could that blood have caused the demise of the baby?
3) I have been very bloated right from the start.  Is this due to the fluid?

Thanks

Answer
Dear Ginger,

It sounds like a bit of subchorionic bleeding may have been what was/is going on. A subchorionic hematoma is simply a collection of blood either within the folds of the developing placenta or between the placenta and the uterine wall. A small to moderate sized hematoma will usually it will dissipate on its own and not have any negative effect on the pregnancy. At times it can cause some vaginal bleeding/spotting. Large hematomas that hemorrhage can carry a higher risk to the pregnancy. Thus, the smaller the hematoma the better.

In the presence of a live embryo, subchorionic hematoma is the most common ultrasound abnormality. It sounds as if yours was fairly small in size. If so, many times the blood should reabsorb and it would resolve itself. During the next ultrasound, they will look at it again and re-measure to make sure that it is the same size or smaller. As long as there is appropriate fetal growth (which it sounds like there was up to the point of the 2nd ultrasound if it measured appropriate for dates) and a strong, steady heart rate, you should have no serious concerns regarding this hematoma at this time. The doctor will likely do more frequent ultrasounds to make sure the size of the hematoma is not increasing to a point of concern.

Bedrest at 6 weeks would likely not have changed anything occurring with this pregnancy. You should obviously avoid heavy lifting and excessive straining (as with any pregnancy) and some doctors, depending upon the size and location of the hematoma, may advise pelvic rest (no sex, tampons, pelvic exams, etc,..).  But that would be a judgement call on the part of the treating physician. The prognosis of patients with 1st trimester hematomas are very good as compared to those with 2nd or 3rd trimester hematomas. Not to mention the fact that it was noted to be "small" in size. Small to moderate sized bleeds do not commonly pose a severe risk in the 1st trimester as compared to large hematomas later in the pregnancy. Large hematomas, which strip at least 30-40% of placenta away from endometrium, may enlarge further, compressing the gestational sac and lead to further complications. Your bloated feeling was more than likely just a pregnancy symptom rather than a symptom related to this condition. Most often this is something that is only diagnosed via ultrasound and the only symptom may be some vaginal bleeding/spotting.

I hope this has helped you and answered your question. I wish you well and will have a good thought for you.

Brenda