Understanding Perigestational Hemorrhage & Pregnancy Concerns

Question
Hi,

My LMP was 20th April 06. I have two living children and have had two miscarriages in the past.

I had a bleed on the 28/05/06.  It lasted 1/2 hr then stopped. on the 29/5/06 I went for an ultrasound which showed a 5 week gestational sac.  The report stated that there was a large perigestational hemorrhage within the uterine cavity.  I am very concerned about this as I've read that this almost always leads to miscarriage.  Is this the case?

My HCG levels on the 29/5/06 were 3300 and 6000 46 hrs later (31/5/06).  

the report also stated there was a moderate amount of free fluid in the pouch of douglas.  what does this mean?

I have had no further bleeding but I do have some back ache and sometimes cramps.

Is there hope this pregnancy could continue?
Thanks  

Answer
There is always hope. If the sonogram showed a 5 week pregnancy, it would only show an empty gestational sac but no fetus or fetal heartbeat. Depending on where the fetus is in relationship to the bleed will determine if it will be affected by the bleed. If your bleeding has stopped,you may be in the clear. It is true that intrauterine hemorrhage can lead to miscarriage. Most of the bleeding is due to a "subchorionic bleed" which is merely sequestration of the bleeding within the folds of the developing placenta. I believe it to be too early to be a subchorionic hematoma. Repeat the sonogram in around two weeks. After 6 weeks gestational age, we usually see a fetus and a fetal heartbeat. If you  were 5 weeks 5 days on May 29, you last period started on April 20 and you ovulated on May 3. You could have conceived if you had sex on May 15,16,17, or 18.