Subchorionic Bleed & Miscarriage: Understanding the Connection | Dr. Rappaport

Question
Dear Dr. Rappaport:
I was hoping that you could help me out. I was twelve weeks
pregnant and five days when I had a subchorionic bleed. I bleed
heavily for three days and then it curtailed off for a half a day.
The next morning I started bleeding heavily again and that night
I went into labor. I lost the baby. I am so confused because
everything I read about subchorionic bleeds say they heal
themselves. Mine didn't. I don't understand what caused it. I am
30 years old and it is my first pregnancy. I have a few questions
that I was hoping you could help me with:
1. What causes a subchorionic bleed?
2. Are there any test I should do before or during my next
pregnancy to try and limit the chances of losing another baby?
3. Two days after I delivered the baby cramping and contractions
began again. I had to go in for a D & C. I have just gotten my
first period after the D & C and have had it for 12 days. Is this
normal? Should I be worried?
Thank you so much. I really appreciate it. I have been searching
for answers online for over a month. I am anxiously awaiting
your response.
Jackie

Answer
A subchorionic bleed is a sequestration of blood within the folds of the placenta which occurs during the formation of the placenta. It usually has no effect on the pregnancy. I believe that you probably had a subchorionic bleed at 12 weeks, which stopped. The second episode of bleeding that you had (with cramps) was a miscarriage. It had nothing to do with the subchorionic bleed that occurred a few days prior to the miscarriage. The risk for miscarriage is 15-20% of every pregnancy. There is nothing you can do to cause a miscarriage and there is nothing you can do to prevent a miscarriaghe. There are no tests you can do to  prevent miscarriage. If you had a D&C, the uterine cavity should be cleaned out by now. If you continue to bleed for longer than 14 days, you should call your doctor to make sure that the uterus was, indeed, emptied. If there are any products of conception remaining in the uterus, you will continue to bleed until they are removed. You may have a "subinvoluted" uterus, which can be treated with pills.