Bleeding in Early Pregnancy: 14 Weeks - Causes & What to Do

Question
I am 33 years old, this is my first pregnancy, I am 14 weeks.  The first day of my last menstrual period was October 16.  I have had sort of a rocky road so far - I had bleeding at 7 weeks and found out it was vanishing twin syndrome.  I had spotting then for about a month.  Everything was fine until five nights ago- I stood up and had a sudden gush of blood with no cramping or discomfort (I have no other bleeding now except for spotting left from clotting).  I went to the ER and had an ultrasound.    Everything appeared normal - the placenta was not low, the baby looked fine, moving around, heartbeat of 164.  The ultrasound gave no indication of where or why the bleeding occurred.  I was told this was a "threatened miscarriage" even though everything looked normal.  I'm frustrated because there doesn't seem to be any answers.  I was told it was probably partial placenta abruption, but according to my research that doesn’t occur until after 20 weeks.  On your site I read about a subchorionic hematoma - could that have been what this was?  Is this any different from an abruption?  Also, is there any connection between a hematoma and vanishing twin syndrome?  I would appreciate any information you may have for me.  Thank you very much for your time.

Answer
Any time there is bleeding during pregnancy with a closed cervix, we call it a "threatened abortion". If there was a placental abruption or a placenta previa, it would have shown up on sonogram. If they did not see anything abnormal, it certainly could have been a subchorionic hematoma. See if the bleeding stops. Usually this will stop on its own. As long as there was adequate growth of the fetus and there was a good fetal heartbeat, you need not worry.  By the way, a placenta can abrupt at any time during the pregnancy, not just after 20 weeks. An abruption is a premature separation of the placenta from the wall of the uterus. A subchorionic hematoma is merely some sequestration of blood within the folds of the forming placenta  that usually dissipates on its own within a few weeks. Just observe the bleeding. If you start bleeding heavily with cramps, go back to the ER.If the cervix starts to open, that is a miscarriage.