I'm dealing with a subchorionic hematoma. I am now 8w2d pregnant with twins after a long road of IVF and early miscarriages. Even though I'm only 31, this felt like a last-chance pregnancy for me, since I was near the end of my rope going through multiple IVF failures.

I have spotted since the start of my pregnancy, in fact I did an HPT because I had started spotting. For the most part, it was light brown until around 6 weeks. At 6w3d (after sitting in therapy talking about how I could start to believe in this pregnancy), I had a little orange/red blood, while it had been mostly a tiny bit of brown for at least a week. As the day wore on, the blood got heavier, and I was bleeding bright red blood that would drip into the toilet when I sat. I was also having regular cramps, though they were not quite as severe as the ones I had in my previous miscarriages. Sometimes clots would come out with the red blood. I had been through this before and was sure I was miscarrying. We had found out that there were two sacs a little less than a week before (too early for heartbeats at that point), and the best I could hope for at that point was losing a twin. After a lot of talking to my RE's office (an RE is an infertility specialist), we decided I should contact my local OB, since my RE's office is 2 hours away and I would just end up in the ER there anyway.

My OB took us in for a scan, and amazingly, we saw both heartbeats, though one looked a lot smaller and less strong than the other. The next day the u/s tech came in and did the scan again, and measured the heart rates. One was at 128 and the other was 116, which was pretty good for 6w4d. The bleeding tapered off to spotting by late that night. At that point the u/s tech told us she saw a clot, and I think it measured about 2x2 cm at that point. It was all white and gray on the screen, and sat between the two sacs, but below them.

Then three days later, at 7w exactly, which was the date of my latest miscarriage, the bleeding started again. The communication between my OB and my RE had not been great (no fault of my OB's office, but the RE is in a big hospital), and they still hadn't really given me any clear information about what this was. I had heard the words "subchorionic hematoma," but couldn't get a clear answer that this was definitely what I had. So, with the second bleed, they had us come in again for another scan. At 7w1d, we still had two heartbeats, and both had grown. The doctor we talked to (not my RE) was very reassuring and said that the hematoma was not a major concern and would probably resolve by 12 weeks. He did warn us that I might bleed again, but said we shouldn't worry about it unless we passed placenta or a sac (unfortunately I know the difference, since I've done the gory m/c thing before). He disagreed with my OB who said I should be on bedrest, and said nothing would change the outcome. He still cautioned that we might lose one, but this was more because of the fact that one had a slightly slower heartbeat than the other at that time and was measuring a day or so behind. At this point the clot had grown somewhat (2x3 cm), but he still didn't worry.

We had a regularly scheduled ultrasound with my RE for the following Wednesday (8w0d), and despite the relaxed RE's suggestion that we cancel it and not come back for another 2-3 weeks, we decided we would not want to pass up an opportunity to see them growing and be reassured that they were still alive. The bleeding stopped again by 7w2d, and brown spotting continued, which I hoped was the clot starting to break up. Unfortunately, it had not shrunk, but we were relieved that it hadn't grown either (though we got 3d measurements this time--2x3x3). The hearts were both beating away and the babies had both grown substantially--they actually looked like babies a little bit, instead of blobs (ok, they were still prett blob like, but my imagination has more to work with now!). They were also now exactly the same size, and had very similar heart rates that were both over 160, which is great. Now, instead of being white/gray on the u/s, the hematoma was mostly black, with a gray outline and some gray structures inside it.

So we had the u/s with the radiologist (and the u/s tech and the incredibly young radiology resident), and went upstairs to meet with the RE. We sat down with him and found out no one had told him a THING about any of this. He never knew I had bled, that I had had 3 emergency ultrasounds, or that any of this had happened. So he was a little shocked and kind of upset with his staff, and was a lot less reassuring than the other doctor.

He said he wanted me on bedrest, or at least restricted activity (he said more "reclining" than lying down). He's not releasing us to the OB yet (though they have been great and the nurse has called a few times to check up on me), and will be doing weekly ultrasounds until the clot reabsorbs. The report said that the hematoma is "surrounding 50% of both sacs," which seems worrisome to me, and the fear my RE expressed is that my uterus will get irritated from activity, will start to contract, and the clot will pass, tearing both sacs with it. It's hard to even think about that right now.

My game plan is to spend lots of time reclining. I've gotten note from the doctor, and will be getting a parking permit for work so that I can go in 1-2 days per week for meetings without having to hike from the regular parking area. I may also pursue a temporary handicapped parking permit from the town so I can go to appointments without having to walk too far. But for the most part I'm trying to stay home, take it easy, and hope for the best. This is a scary time, but I have heard MANY stories with happy endings from other women who have gone through this. I'm also relieved to know that I will be able to get an update next week. Right now, it's still brown spotting, and I've noticed less of the slight cramping I tend to get when I spend more time reclined.

Well, we're still hanging in there. The babies are doing great, and we have found out that we're having a boy and a girl! We're both completely thrilled.

It has been a rough couple of months, though. It definitely got worse before it got better. I took it relatively easy from 8-9 weeks, and then since I didn't bleed again, they told me I could go back to normal activity, just take it easy. At 11 weeks, I was standing in the middle of the campus where I work (after walking up a hill--it probably had nothing to do with it, but I'll always wonder) and I felt a gush. I rushed to the bathroom to find red blood everywhere, positively gushing out of me, along with a clot about the size they said my subchorionic hematoma was. I called the OB and was told to go home to bed, and hope it was just the clot passing. My partner was out of town, so I was on my own.

I was bleeding incredibly heavily. About a cup of blood was gushing out of me at a time, and clots were coming out as well. I went through pad after pad. I called the OB again when more clots came, realizing it was a real bleed. He gave me an u/s, which showed both babies doing fine, and checked my cervix, which was closed but soft. That was a rough night. In retrospect, I can't believe he didn't admit me to the hospital. I could easily have passed out due to the amount of blood I was losing, and he knew I was home alone. Thank goodness I was ok through the night.

I spent the next few weeks on bedrest. I pretty much stayed on the couch, even though the bleeding went away almost as abruptly as it started: it was brown spotting by the end of the next day. I continued to "spludge" (my own made-up name for it--spotting sludge), but was actually able to relax about it a little. The Babybeat I had rented was a godsend during this period. I was attentive to every little cramp or change in discharge, and the Babybeat helped reassure me that both babies were ok.

At 16 weeks, I woke up in the middle of the night with that awful feeling: blood. I went to the bathroom and a huge clot fell into the toilet. It was about the size and shape of an unevenly used bar of soap. I used the Babybeat immediately and found the heartbeats. Luckily, this time, although the clot passed with a large gush, the blood tapered off very quickly, and by morning I was merely spotting. I called the OB first thing, and got in for an u/s that afternoon. The big clot near my cervix was gone, but there was still some clotting in between the sacs. It seemed like an improvement.

Unfortunately, my OB didn't seem to think so (this is a rotating practice, so we're now talking about a third doctor from the other two I've mentioned in this update, but this one is my main doctor). She gave me a terrifying lecture about how I could have stillbirths, a million things could go wrong, the babies might not be getting enough oxygen, and even said that after everything, I might need a hysterectomy at birth because the clot might cause me to hemorrhage! It was pretty horrible, and I went home in complete shock. Once again, my partner was out of town so I was mostly alone with the terror. That was one of the worst nights of my life.

In retrospect (and I actually suspected this at the time) the motivation for the "scared straight" talk seemed to be because she seemed to want to justify referring me to a perinatologist. She didn't know that I had asked for a referral the month before. Also, she had a med student with her, even though it's not normally a teaching program, so she might have been showing off. Anyway, I have mixed feelings. For now I don't have to deal with her, but I'm not sure how I'll feel about seeing her again.

Anyway, seeing the perinatologist was a huge revelation! He came in and looked at our level II, and spent quite a bit of time trying to figure out the source of the bleeding and the location of the clot. For the first time, we actually got some input about what exactly was going on. I had been wanting this from day one. He told us that "if you're going to have a clot, this is the place to have it." The clot was basically between the twins' sacs, so it wasn't cutting off the blood supply from the uterus, just separating them from one another. I had a "placental lake" in one placenta (now gone) which he said was totally normal and after a lot of looking at it he was pretty sure it had nothing to do with the bleeding. He found the source of the bleeding above the membrane, and was able to comment that it was quite small and not threatening. He agreed that I should stay on bedrest with limited activity (I was allowed to go to work one hour per week to pick up materials to work from home on).

Since that visit I've seen him weekly. We have a quick u/s at every visit and I had another level II 3 weeks after the first one. At 19 weeks, the spotting/spludging stopped altogether, and I haven't seen blood since then. While the clot is still there between the membranes, he says it's smaller and that the tear that was causing the bleeding is gone. I'm still on restricted activity (very limited walking), but I'm now allowed to go into my sedentary job 20 hours a week. I'm still being very careful, but it feels amazing to be feeling more like a normal pregnant woman and not like a prisoner or an invalid! Mentally, I'm just feeling so relieved as well, since my thoughts are less about how I would cope with a stillbirth and more about believing things are going to be ok. Next week we will reach the early stages of viability. I have not had any pre-term labor, and my doctor is checking my cervix every week just to keep me from getting too worried about things (and it has always been long and closed).

We have a long way to go until term, and I hope we make it that far. At 22.5 weeks, the babies are kicking up a storm and it's a wonderful feeling. Rhys (my partner) felt a kick for the first time last night! It's certainly a difficult transition to go from total terror to hope and joy, but I'm so grateful to have the chance to make it.

My best advice for anyone going through this is to go on bedrest immediately, and to go see a perinatologist. I have actually been called "boring" a few times lately by my peri's nurse, which is music to my ears. For me at least, it has been better to be a boring high-risk patient than to be an interesting low-risk patient. It has been really reassuring to get care from people who have seen it all before.

Best of luck to all! I hope to update again with two healthy full-term babies. Knock wood!

The rest of the pregnancy was relatively uneventful, at least for a twin pregnancy. The perinatologists were extremely careful (you could also call it paranoid, LOL), and monitored me closely. At 27 weeks I was hospitalized overnight because I had some contractions that made me and the doctor nervous, and when they did a fetal fibronectin test (a test that can show if you are *not* going to deliver with a great deal of accuracy, but that has a large margin of error in saying that you might soon deliver, if that makes sense), it didn't reassure them that I was safe from an early delivery. So to be safe the put me in the hospital overnight and gave me steroids to mature the babies' lungs in case they came early.

I remained on modified bedrest, going into work occasionally, for the rest of the pregnancy. Around 36 weeks, my blood pressure started spiking here and there. It was fine as long as I was lying down, and if I had it to do over again I would have just spent the next couple of weeks lying down, but they decided I was at risk for pre-eclampsia (which a friend of mine nearly died from), so we induced at 37w1d. The induction took over a day, so my twins were born on 3/29/02, at 37w2d gestation. It was a vaginal birth, but both babies were assisted in coming out (Henry with forceps and Eleanor with a vacuum). Eleanor needed to be reminded to breathe, but they were both healthy and were able to room in, breastfeed right away, and come home with us, and that was incredibly important. The only repercussions of their being slightly early were a little bit of jaundice and some anemia as toddlers.

They're now 16 months old and the light of my life. When I think back on the road to meet them, I'm amazed at all of it, but so very grateful to have them in my life. I remember the doctor coming in after they were born and saying that he was more worried than he let on when he first got me as a patient. He said they must have a lucky star looking over them. Sounds about right to me.

Hugs,

~ Cate