Understanding Subchorionic Hematomas During Pregnancy: Symptoms & Management

Question
Dear Dr. Rappaport,

I am 28 years old with 2 children and am 14 weeks pregnant with #3.  The first day of my last period was 8/22/05.  Last week I was in the toy store with my kids when I felt a gush of fluid.  I immediately went out to the car only to find I had started bleeding.  Fearing a miscarriage I went to my doctor and found the baby was doing fine, but I had a giant clot behind the placenta (it looked about the size of the baby).  

I was prescribed bed rest until the bleeding stopped, which the fresh blood did after 2 days, but was told by my nurse that I was to stay on bed rest until even my spotting (brown) stopped for 24 hours.  With 2 children under 4 that's impossible.  What are your thoughts?  

Answer
A subchorionic hematoma is a sequestration of blood within the folds of the developing  placenta. It usually has no effect on the growing fetus or on the pregnancy and usually dissipates on its own within a few weeks. We always used to place women with bleeding on bedrest. However, recent studies show that bedrest has no effect on the course of anything. If your bleeding is stopping, you do not  have to be on bedrest.