A Threatened Miscarriage, a Subchorionic Hematoma, and How United Airlines (Nearly) Ate My Baby

Three years ago, sitting with my 15-month-old son and my husband during a long layover, on our way back home from Norway, I felt a sudden gush of warm blood.

So much for my miracle pregnancy, I thought. I was only six weeks along and certain I was miscarrying.

Our return trip was already off to a poor start. United Airlines had cancelled our original flight from Newark home to San Francisco. Then, to rub salt in the wound, they refused to refund our first-class tickets.

We never fly first class, but had made an exception for this trip. We were travelling overseas with my 15-month old son and facing a 9-hour jet lag. The chance of sleeping on route, we decided, was worth the extra cash. We had bought our tickets a year in advance to lower the cost.

But United, being United, told us we would have to request a refund, and then maybe they would grant it. And–perhaps just for kicks–they refused to let us access the first-class lounge while in Newark, because our replacement tickets were now in Economy.

My husband–who nevers argues with anyone behind a counter and hates it when I do–spent half an hour arguing with their “customer service” that they should give us passes to the first class lounge. After all, we had paid for first-class tickets even if we no longer had them. But no dice.

So there we were, exhausted and enraged. I had not slept in over 24 hours. My son, sick for the last 3 days with a high fever, had nursed continuously the entire flight from Oslo to Newark. And then I started bleeding.

At that point, I contemplated tweeting, “United, you ate my baby,” but decided against publicly sharing my pregnancy or what I assumed was an impending miscarriage.

The pregnancy had been a surprise, but a welcome one. We had taken over a year to conceive my son. This time we had not been trying. I was still breastfeeding, and my cycles had only resumed a month earlier. We were planning to wait a few more months and then start trying for #2, expecting that it could easily be another 6 to 12 months before we conceived.

The bleeding tapered off by the next morning. I had no pain or cramping, so little fear of an ectopic pregnancy. And I still felt pregnant: nauseated, tired, and lightheaded.

I called my OB,  but they could not fit me in for another 5 weeks. Until then, they told me, just sit tight. Oh, and assume that I was still pregnant, because a miscarriage would have caused several days of heavy bleeding.

I found another OB.

My new OB ran tests. My HCG levels were normal, but my progesterone was low, perhaps because of the nearly constant breastfeeding, the lack of sleep, and the stress. She could not say for sure. She prescribed progesterone supplements for the rest of my first trimester.

Progesterone helps build up and maintain the uterine lining for implantation of the fertilized egg. High levels of progesterone are required to sustain an early pregnancy. But taking progesterone supplements during the first trimester to prevent a miscarriage is controversial.

Over half of miscarriages result from chromosomal abnormalities, and no amount of progesterone will save these pregnancies. A 2013 review of randomized trials, however, found that while progesterone supplements did not alter the risk of miscarriage for pregnant women as a whole, they did significantly lower the chances of miscarriages for women with 3 or more prior miscarriages.

And for women like me, with a threatened miscarriage (defined as any bleeding within the first 20 weeks of pregnancy), who have more than double the normal odds of a miscarriage*, progesterone supplements appear to cut the risk of miscarriage in half, and oral progesterone, as opposed to suppositories, may be especially effective.

So, although I will never know for sure, my OB may have saved my pregnancy.

A Subchorionic Hematoma

At that initial visit, she also performed an ultrasound. The fetal heartbeat was loud and clear, fast and reassuring, racing along like a rabbit’s. When I heard my baby’s heartbeat, I fully exhaled for the first time in days.

Less reassuringly, the ultrasound revealed a subchorionic hematoma–a blood clot next to the placenta and the cause of my bleeding.

Pregnancies with a subchorionic hematoma are considered high risk. They have a higher risk of miscarriage (17.6% versus 8.9%), stillbirth (1.9% versus 0.9%), and placental abruption (3.6% versus 0.7%). They have a slightly higher risk of preterm delivery (13% versus 10%) and for the waters breaking before labor starts (tv-style labor).

The risk varies by the location of the hematoma. Pregnancies with recurrent bleeding or with hematomas located between the placenta and the uterine wall (retroplacental hematomas) have a higher risk of miscarriage and other pregnancy complications like placenta abruption. Because of the risk of placental abruption, bleeding in the second and third trimesters require immediate medical attention.

As worrisome as these statistics sound, most subchorionic hematomas resolve on their own, as mine eventually did. By 11 weeks, we could no longer see the hematoma on an ultrasound. And thankfully, rest of my pregnancy was uneventful. I gave birth to healthy baby girl, who in a few months will turn 3.

Do you have a story of bleeding in early pregnancy? Was a cause detected, and how did things turn out?

Footnote

*About 20% of women experience bleeding during early pregnancy. Figuring out their chances of a miscarriage is far from simple.

One commonly cited statistic states that roughly 50% of these women eventually miscarry. Some digging reveals that this claim derives from a 1981 obstetrics textbook rather than recent research. (Lots of researchers cite papers that cite papers that cite this textbook, and I am willing to bet that none of them have read the original research behind this claim.)

If bleeding starts after detection of a normal fetal heartbeat, most prospective studies find a much lower rate of miscarriage, of 3.4-5.5%.

References

Haas DM, Ramsey PS. Progestogen for preventing miscarriage. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003511. DOI: 10.1002/14651858.CD003511.pub3.

Nagy S, Bush M, Stone J, Lapinski RH, Gardó S. Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy. Obstet Gynecol. 2003 Jul;102(1):94-100.

Sotiriadis A, Papatheodorou S, Makrydimas G. Threatened miscarriage: evaluation and management. BMJ : British Medical Journal. 2004;329(7458):152-155.

Trop I, Levine D. Hemorrhage during pregnancy: sonography and MR imaging. AJR Am J Roentgenol. 2001 Mar;176(3):607-15.

Tuuli MG, Norman SM, Odibo AO, Macones GA, Cahill AG. Perinatal outcomes in women with subchorionic hematoma: a systematic review and meta-analysis. Obstet Gynecol. 2011 May;117(5):1205-12. doi: 10.1097/AOG.0b013e31821568de.

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About Amy Kiefer

I am a research scientist and mother of two. I was born in Chicago, but for the past 10 years I have lived in the San Francisco Bay Area with my software engineer husband (a cliché, I know). I love digging into the scientific literature and summarizing research findings. In this blog, I try to present an unbiased and sane take on research topics of interest to soon-to-be and new parents.
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19 Responses to A Threatened Miscarriage, a Subchorionic Hematoma, and How United Airlines (Nearly) Ate My Baby

  1. Hello there! I am not yet a mother but I find your blogs very informative (for my future reference). Wish you well, Amy. 🤗

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  2. Erin says:

    I had three bleeding incidents so far (I’m 10 weeks and finding your site so helpful!). The first time, at 5 weeks, lasted 24 hours and was full fledged bright-red bleeding like a period. I could see the blood in the toilet and at one point there was a dime sized clot. I was sure the pregnancy was over. At 7w2d I had more bleeding that lasted about 6 hours, and again at 8w3d (lasted just a couple hours that time). After each bleeding incident I had ultrasounds that showed the baby is fine. (I did IVF so was able to quickly get into my reproductive endocrinologist’s office for the ultrasounds). My doctor was not concerned at all and said it’s common. However I kept seeing that 50% statistic, including in my go-to reference, the Mayo Clinic Guide to Pregnancy.

    I started searching on pubmed and found a good research paper that indicates that there is no increased risk of miscarriage (week-by-week) for women who experience spotting or light bleeding, compared to women with no bleeding (paper here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828396/ )

    That paper finally calmed most of my anxiety, as all my incidents could be considered light bleeding. Heavy bleeding (more than a period) combined with pain and lasting more than a day is associated with an increased miscarriage risk, but even in those cases the majority of women do not actually miscarry. I’m curious to hear your take on these results.

    I think it’s unfortunate that most references gloss over the actual statistics or worse, use incorrect ones. I mentioned the 50% stat to my doctor, who looked at me like I was crazy and said that’s totally wrong. It’s odd that it’s still perpetuated, and I think it causes a lot of unnecessary anxiety for women who experience bleeding. It’s always alarming to see blood and even knowing the stats, I still feel panic in those moments. But at least now I can talk myself out of the anxiety by reminding myself of these findings.

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    • Amy Kiefer says:

      Great reference. Thanks for sharing.

      Before writing this post, I spent a long time looking at the chances of miscarriage given bleeding, and eventually gave up on finding a range I would feel comfortable stating as reasonable, other than to say that the 50% figure is way too high. The risk estimates vary considerably from study to study, with the type of bleeding, whether accompanied by pain, and when the bleeding occurs, as the study you cite makes clear.

      Anyway–congratulations on your pregnancy! I hope everything goes smoothly from here on out. Very reassuring that all your ultrasounds have looked good, and nice that they would see you right away. Incidentally, did they see a subchorionic hematoma on any of the ultrasounds?

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  3. Erin says:

    Thank you! My doctor thought he saw a very small subchorionic hematoma when I had a 5w6d ultrasound (they had me come immediately after the first bleeding incident, and then again in a few days to track the progression–a perk of going through IVF is the very thorough monitoring they provide). But it did not show up on the later ultrasounds (6w5d and later). I think it’s possible I had a small one that caused the first issue, and maybe even the subsequent bleeds, but small enough that it was hard to see. It would be nice to know for sure that was the cause, but the doctor told me every time that they usually have no idea why bleeding happens, and it’s hard to predict if it will be a continued issue throughout pregnancy or if it will stop.

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  4. Sam says:

    I really appreciate the thought, reason and grounded approach present in your blog. Thank you for providing posts that are well-researched and free of alarmist language. As a mom-to-be I cannot stand most of what’s out there–much of it is so condescending and so often feels like a ploy to suck me in to buying something or somehow take advantage of fears and questions of during a particularly vulnerable time. Anyway–thanks again.

    Oh! And did you get a refund for your tickets (those bastards!)?! I’m dyin’ here!

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  5. Jenn says:

    This post was so helpful. Thank you!
    I had a subchorionic hematoma last summer in my first pregnancy and unfortunate after four weeks of ultrasounds confirming heartbeat after significant bleeding and pain, near bedrest, it was confirmed that we lost the baby at 10 weeks. A heartbreaking situation as many know. Today I am thankful to be pregnant again but worried with what seems to be a similar issue of early bleeding despite progesterone supplementation. I have my first OB apt today and am hoping the bleeding is due to suppository irritation and not another SCH. Here’s to healthy heartbeats! Thanks again for your reassuring, updated science based outlook. 😉

    Like

  6. Mammy Shelly says:

    Really informative post on subchorionic Hematomas which are hard enough to come by. Had lots of bleeding up to 20 weeks, still have the hematoma now at 25 weeks but bleeding has stopped so praying it’ll all work out. So happy everything worked out for you.

    Like

  7. Lydia says:

    Thank you for sharing your story! I had a large SCH in early pregnancy that thankfully resolved as well. We are trying to decide when to start trying for our second, and our first is 9 months old. We are waiting until a year at least, though my husband would like to try sooner. Were you able to continue breastfeeding during the pregnancy? That’s really the thing that is holding me up the most. I am still nursing her very frequently and we love it. Weaning would make me really sad.

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    • Amy Kiefer says:

      Hi Lydia, I breastfed my son until I was 4 months pregnant, at which point it became extremely painful. He was also nineteen months by then, so I felt I had paid my dues, as it were. It was hard to wean, but we spent lots of time cuddling afterwards, and for me it was kind of nice to have a break before #2 arrived.

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  8. Hi Amy,
    Love your blog. Am thinking of starting my own that includes a collection of all the things I researched while pregnant.

    I had a subchorionic hematoma at 12 weeks. We were expecting twins and I was convinced I had lost the babies. I had been flying cross-country that week for work and rushed to the ER. Fortunately the ultrasound showed 2 heartbeats and I was able to breath a temporary sigh of relief. I wonder if there is a correlation between air travel and bleeding? My OB insisted no more flying after that event.

    You mentioned increased risks with SH. Well I had all of it — pre-term labor at 32 weeks. Water broke TV style. And I had placental abruption with Twin B. Fortunately they stopped the labor at 32 weeks and I gave birth at 34 weeks 6 days to two healthy babies. We all came home 3 days later.

    Alex

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  9. Rebecca Ryan says:

    Great post and blog – I had an SCH diagnosed in early pregnancy and monitored (via ultrasound) each week of first trimester. It had gone by about my 20th week. I am also a scientist by training and had access/experience to chase up the paper trails of research but got completely lost! This and the other posts in your blog are great – have answered a lot of questions for me about other issues – forums, google, Web MD just don’t have enough of the answers and evaluations you want – I’m so glad someone finally did this!

    Like

  10. Anonymous says:

    This is a useful and medically accurate blog. It’s been helpful for me and my daughter who has a SCH. THANK YOU

    Like

  11. Kris says:

    I was wondering if you kept nursing once your Sch was diagnosed. I am 9 weeks and just diagnosed with an Sch and my daughter is still nursing.

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    • Amy Kiefer says:

      Hi Kris,

      The short answer is that I continued nursing for another couple of months. The longer answer is I am not sure that was the best idea. My ob tested my progesterone right after I began bleeding. It was low. She put me on supplements, which may or may not have helped me maintained the pregnancy. My son also chilled out about nursing after recovering from roseola and not being on an airplane, so I was only nursing a few times a day, with long stretches in between sessions. Still, I suspect that all that nursing may have caused the Sch, and I would, if I had to go back, have stopped nursing as soon as I learned I was pregnant.

      Like

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