misc.kids FAQ on Miscarriage, Part 1/3
broo...@mc.duke.edu
Posting-Frequency: monthly
Misc.kids Frequently Asked Questions
Miscarriage
Part 1 of 3
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Collection maintained by: Laura Brooks (http://scalos.mc.duke.edu/~brook006)
Last updated: March 16, 1997
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A Little History
In the spring of 1994, I had my second miscarriage in a row. Anxious to
learn more, I posted a message to misc.kids, asking for information and
moral support. I got a lot of both, along with the suggestion that I look
at this FAQ.
After awhile I consolidated the mail I had received into a large addition
to the FAQ, and the woman maintaining it at the time asked me if I would
consider taking it over, so I did. I added my changes and made it available
over the WWW (http://wdg.mc.duke.edu/~brook006/miscarriage.html). Since then
I've occasionally made revisions to the Web version, but not as frequently
as I'd like.
I have recently made an attempt at reorganizing the FAQ, by breaking it
into sections. One section has words of support, one has technical
information, and there are also smaller sections dealing with bleeding,
molar pregnancies, and how long to wait before trying again. By far,
though, the largest section is made of personal stories, sent in by other
readers of the FAQ. This brings me to a dilemma. Every story is different,
and each deserves to be told. Reading other peoples' stories, I know, is
one thing that helped me to not feel so alone when I was going through my
own miscarriages.
However, the FAQ file has grown so large that it could only be posted to
the Usenet in 7 or 8 pieces. Furthermore, it continues to grow, and change,
and I don't want to have to limit that growth. Therefore, I have decided to
break out the personal stories into their own file. You may access this
file at: http://wdg.mc.duke.edu/~brook006/stories.html, or send mail
to me at: broo...@mc.duke.edu and I will send it to you.
Occasionally people send me mail asking for advice or with specific
questions. This is OK, but the only information I'm qualified to give is
an account of my own experience, and a little moral and emotional support.
I don't have any medical training or special "insider info". I'm just someone
who's been there, twice, and lived to tell about it.
I'm also happy to report that my third pregnancy was successful, and our
daughter Sarah was born in March of 1995. As a result, I'm a lot busier
now than I used to be, and wouldn't mind passing the maintenace of this
FAQ on to someone new. If you are interested, please e-mail me at
broo...@mc.duke.edu. Thanks a lot...
How to Contribute
If you have information not covered in this FAQ that you feel could be of
use to others, please send e-mail to me at broo...@mc.duke.edu, and ask me
to add your comments to the FAQ file. Unless otherwise requested, your name
and e-mail address will remain in the file, so that interested readers may
follow-up directly for more information/discussion. To contribute your story,
see the instructions in the personal stories file (http://scalos.mc.duke.edu/~brook006/stories.html).
Other Resources
There are some very good other resources on the net, which may be able to
provide you with more specific data, or interactive support.
* The Miscarriage Support & Information Resources page
(http://www.pinelandpress.com/support/miscarriage.html)
* The Recurrent Pregnancy Loss Testing page
(http://www.pinelandpress.com/support/rpl.html)
* The SPALS mailing list (Subsequent Pregnancy After Loss)
(http://www.inforamp.net/~bfo/spals.html)
* The SANDS Home Page Stillbirth and Neonatal Death Support (Western Australia)
(http://hedgehog.highway1.com.au/~lawtbm/sandshome.html)
* The Growth House Miscarriage page
(http://www.growthhouse.org/natal.html)
* The Grief, Loss & Recovery page
(http://pages.prodigy.com/gifts/grief.htm)
* The Usenet group soc.support.pregnancy.loss
* The Usenet group misc.kids.pregnancy
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A Rough Table of Contents
* Words of Support
* Causes and Technical Info
* Bleeding During Pregnancy
* Molar Pregnancy
* How Long to Wait Before Trying Again
* Other Resources
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Words of Support
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Just Those Few Weeks
For those few weeks-
I had you to myself.
And that seems too short of time
To be changed so profoundly.
In those few weeks-
I came to know you...
And to love you.
You came to trust me with your life.
Oh, what a life I had planned for you!
Just those few weeks-
When I lost you,
I lost a lifetime of hopes,
plans, dreams, and aspirations...
A slice of my future simply vanished overnight.
Just those few weeks-
It wasn't enough time to convince others
How special and important you were.
How odd, a truly unique person has recently died
And no one is mourning the passing.
Just a mere few weeks-
And no "normal" person would cry all night
Over a tiny, unfinished baby,
Or get depressed and withdraw day after endless day.
No one would, so why am I?
You were just those few weeks my little one
You darted in and out of my life too quickly.
But it seems that's all the time you needed
To make my life so much richer-
And give me a small glimpse of eternity.
By Susan Erlin
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My friend gave me the most valuable perspective on miscarriage and I would
like to share it with those who could use it most. Most people believe that
when they miscarry they lose out on ever knowing "that child." My mother,
who miscarried before having me, always told me that I wouldn't be here if
she had not lost her first. My friend feels differently. She says that the
souls of children find their way to the right parents, and that miscarriage
occurs when the soul of the child was not ready, for some reason, to enter,
or renter, the world. When a healthy baby finally arrives, it is the same
spirit as the one that was lost, finally ready to join its family. I know
it is unorthodox, but it helped me tremendously after my miscarriage. I
just wish our child would do what it has to to get ready! Good luck to all
of you.
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I was very sorry to hear that you have lost your baby. I can't imagine what
it must be like for you and your husband. You had a little being that was
growing closer than anything had ever been to you before, and now you mourn
because it is no longer there. You will probably be blessed with another
child in the future. It will not be the same as this first one that you
have lost; no other child will be the same. Time and the closeness you have
with your husband will probably help to reduce the hurt. I'm sorry.
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I know the combination of pregnancy and miscarriage and finally my daughter
has changed me, deepened me, more than I ever thought possible. I can't say
that I'm glad that I lost a child, but I can say that I believe that people
who experience life intensely, both the good and the bad, are luckier than
those who just drift through. And in that sense we women are lucky, far
luckier than men. Men will grieve, and will sorrow, but it's not the same.
When I had my miscarriage I think I was most worried about whether there
was something "wrong", about whether I would ever be able to carry a child
to term. I thought about the IUD I had in for my wilder years. I thought
about the years I was too serious about swimming and didn't have periods. I
thought about the stretch where I was too thin. I thought about everything
I'd ever done that was less than healthy. I suppose the bottom line was
that I haven't failed at many things in my life and I didn't like it very
much. But then along came my daughter and the misery drifted away, with
only a little bruise to show for it. And for some reason I wasn't worried
at all during the second pregnancy. I guess the statistics about
miscarriages and first babies really don't lie.
But in some sick way, it has all helped. When my brother's baby died this
year, I knew what to do. And that ability to empathize, to experience all
the ups and downs, is what life is all about. Really and truly.
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People say the strangest things when they are trying to comfort me. I
suppose you got that too. Why would people tell me it is for the best? How
can this possibly help me? Why would they go out of their way to say it
isn't so bad for me since I hadn't been pregnant a long time? I know I will
get better; I hope I will get pregnant again soon, but I think these things
are for me to say, not for them. I know they are trying to be nice, but I
don't care if my baby wasn't viable: it hurts just as much either way. I
don't care to have my pain minimized or swept away.
Someone helped me yesterday: I talked to a wonderful doctor right after I
lost the baby (she just happened to be on call). I told her it was quite
ironic, but though I had never met her, I was scheduled to talk with her on
Tuesday because I was interviewing doctors for OB care. She told me to come
on in anyway, even though I lost the baby. I did. She was great. She spent
half the time talking to me about this loss, and half the time telling me
about her philosophy of labor and delivery and preparation for birth. After
I left, I realized that she got me back to concentrating on the future in a
very gentle but practical way. She told me I would probably be nervous and
antsy when I first get pregnant again and she encouraged me to come in
early just to get confirmation and a feeling that someone knew I was
nervous and was going to watch me and be aware of my concerns.
Don't get me wrong: I am not saying this woman magically fixed everything,
but she did help some. I still cried last night, but I feel positive
potential in my future. I worry. I will worry. But I hope too.
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I talked a lot to my sister-in-law when I had my miscarriage. She kept
telling me the same thing over and over:
"Remember, it's nothing you did. If lifting heavy things could cause a
miscarriage then there would be an epidemic of 14-year-old female
weightlifters in New York City."
It's true. If there were anything at all that could cause a miscarriage,
desperate people would have found it. And if any sort of bad health habits
could set you up for this kind of thing, then the birth rate in inner
cities wouldn't be so astronomical. Your body's fine, and you'll be
pregnant again before you know it.
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Just thought I'd let you know that my sister-in-law had two miscarriages in
a row, and did the same as you, had the fetal tissue tested. For her, it
was also the trisomy-16 problem. The doctors told her the same thing your
doctors told you. Her third pregnancy was just fine (yea!), and she now has
a 9-month old daughter.
Hope this makes you feel a little better!
(it DID!!!)
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I don't know if this will help you or not, but something you may want to
add to the list.
I have had several family members and friends who have had problems with
pregnancies. One thing that seems to be common is that when a child was
lost (still born, cord accidents, etc.), the woman had a miscarriage less
than a year later. In some ways, I've always wondered if it was a way of
her body just "making sure" since all these women went on to have a healthy
child about a year later.
It is hard and tragic to lose 2 children in under a year. Support groups
and counseling have been what kept some of my friends & family going. The
things that were most valuable to them were: a) take time to grieve. You
lost a child. It doesn't matter if it was born or not, YOU STILL LOST A
CHILD. b) Remember life goes on. If the doctor says there are no problems,
wait and try again. Almost everyone who has had a miscarriage hears from
women who had one (or more) or knows someone else who had one. An example I
use a lot in comforting friends is my mom. There are 6 kids in my family.
In 1946 (or 47) my mom had a tubular pregnancy and lost her right fallopian
tubes. The doctor told her she'd be lucky if she ever got pregnant again.
Eight pregnancies later (6 kids, 2 miscarriages), she asked the doctor to
put her on the pill since she felt she was "too old to deal with baby
shit." ;) When my youngest sister was born, they brought a bunch of med
students/interns in to marvel at the two of them.
In my family alone was my mom & her problems. My brother Steve & his wife
had a blue baby who died the day after he was born. Mari miscarried 6
months later. They adopted a boy and she gave birth to their second son 1
year to the day after Adam came home with them. They currently have 4 kids
ranging from 5 to 13. My brother Gerry's wife miscarried and later had a
wonderful and healthy boy (Nicky the human noodle). I contracted rubella in
the first trimester of my pregnancy and lost that baby. I now have a
healthy 2 year old and I am due in February. My husband's sister miscarried
3 times before they had their first son. They currently have 3 kids (ages 2
to 6) who are healthy and normal.
One of my good friends describes herself as "not built for pregnancy." She
had several miscarriages and had to have an abortion once when the fetus
was literally killing her. Her pregnancy with her daughter left her
hospitalized several times in her first trimester, but her daughter is a
thriving 3 year old now. Last year, she gave birth to her son and had a
hysterectemy immediately after. She claimed it was an easy pregnancy since
she was only hospitalized once before her due date.
My best friend from college lost her first son. He died as the result of
massive birth defects 2 weeks after he was born. She miscarried 9 months
later and a year after that had a beautiful baby girl.
I could go on, but I won't. I just want to pass on examples of
encouragement. I hope they are useful. They seem to have been for some
friends. ("Please tell me you know someone who survived this and has
children," tends to be the biggest request from them.) One thing that helps
too (at least with my friends) is breaking things. Buy a bunch of "yard
sale china" and smash it. Take out your anger and frustration on something
like that instead of your husband & family.
MOST IMPORTANT: The man is grieving too. Many people make sure the woman is
fine and forget about the man. My brother Gerry said the best thing that
happened to him was receiving flowers from me to him. Everyone seemed to
have left him "outside" when it came to comforting. I remembered how much
he helped me when I lost my first and wanted to do something for him. When
one of my friends had an ectopic pregnancy recently, I sent her husband a
plastic fish full of goodies. She said it made a big difference to him.
Men grieve too. While the wife goes through medical and emotional trauma,
the man feels the sense of loss and helplessness as well. Make sure they
don't get ignored.
karla Shapiro ka...@shiva.com
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I too had three miscarriages in a row. May 93 (12 weeks LMP), December 93
(10 weeks LMP) and March 94 (10 weeks LMP). Now I have a 15 month old. I
had the 4 standard tests as well in the spring of 93. I have no advice,
just some reassurance that for me, and lots of people I think, the problem
resolved its self. I remember how horrible it was to try not to have your
hopes up and try not to analyse every symptom or missing symptom. And I
hated it when people told me to relax. But what I can say is that the
pregnancy that resulted in my daughter was totally unplanned (we were
taking a break for the workup and moving to another city/job etc) and I
didn't worry about it at all because I didn't know until 8 weeks LMP. Good
Luck!
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Causes and Technical Information
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**The following is from an actual M.D. on the net, but he did not give
permission to use his name**:
First let me express my condolences at your loss. It makes no difference
what the gestational age is, there is still the loss of a pregnancy, and
this will result in grief and the need to work that through. Trying to find
out 'why' is part of the grief work.
Let me reassure you that your experience is VERY common. I see similar
cases every month in my practice. The problem is that experience with the
vaginal probe ultrasound is very limited, and to extrapolate the presence
of fetal cardiac activity on vaginal probe ultrasound to previous
reassuring statistics about discenment of cardiac activity by abdominal
ultrasound (doppler) or earlier auditory auscultation (stethescope) are not
valid. Most spontaneous abs occur prior to the 12th week, and a very short
time ago, cardiac activity was not discernable prior to the 12th week with
any degree of regularity, so the common statement was "Once we hear the
fetal heart we don't worry about miscarriage."
But now we are using a more sensitive technology and this trueism will not
hold up.
So I can only encourage you to work thru the loss of this one, and have
confidence that you will conceive again with success. And another bit of
advice is to wait at least 4 months before trying again. We have good
studies that indicate the risk of repeated SAB is much greater in the first
three months after a previous miscarriage.
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> I would like to find out more about what the chromosomal test actually
> involves, and what they might be able to find out from it.
They will count the chromosomes to see if there is the right number (46).
They will look to see if the chromosomes are complete, with no missing
parts. They will look to see if part of one chromosome has broken off and
rejoined another chromosome. They will look for any kind of abnormality
they can find. Chromosomes in eggs and sperm are at a somewhat higher risk
for getting things screwed up because they undergo a process called
"crossing over" where, for instance, chromosome 1 from your father and
chromosome 1 from your mother may swap equivalent parts, leading to a new
combination of genes on the resultant chromosome 1's. This is good for the
species, but when things don't go quite right, it's bad for the individual
that will inherit those chromosomes. Most of the time when this happens,
the conceptus or zygote is completely incapable of normal development, and
either never implants or dies within a few days of doing so, and you never
know about it. But some limp along until some critical gene that has been
damaged is needed, and then they die in a first trimester miscarriage.
Because the chromosomes can be seen with an ordinary microscope, any large
rearrangements or duplications/omissions can be easily detected, and the
cause for the miscarriage known.
> Also I would like to talk to other people who've had tests run on
> themselves and/or their spouses. I would also like to hear from people
> who's progesterone levels were too low to support a pregnancy (my OBGYN
> doesn't think it was that but hasn't ruled it out - I keep wondering about
> it because it happened to my sister-in-law).
It would be helpful to know when your miscarriages occured. Through most of
the first trimester, progesterone is produced by the corpus luteum---the
"scar" left behind when the egg popped out of the ovary. It produces
progesterone because it detects chorionic gonadotropin (HCG) in your blood.
The HCG is produced by the part of the embryo that later becomes the
placenta---the trophoblast, in scientist-speak. For the first 10 or 11
weeks, a progesterone insufficiency would be due to either the trophoblast
not producing enough HCG, or the corpus luteum not responding with enough
progesterone. For instance, my mother miscarried all three times between 8
and 11 weeks, and never had any morning sickness with any of those
pregnancies, but she did get it when she had her four children. My personal
opinion of this is that the first 3 embryos were not producing enough HCG
to sustain the pregnancy for whatever reason, since the first trimester
nausea is often correlated with HCG levels. It's difficult to use morning
sickness as an indicator though, because women vary enormously in their
sensitivity to it. Some women can have raging levels, and have no morning
sickness, and some will still be vomiting from the low maintenance levels
in the 2nd and 3rd trimesters. Anyhow, getting back to established fact,
HCG levels in a normal pregnancy rise dramatically until about 2 months
(this does vary though), and then begins to drop off as the corpus luteum
ages and becomes incapable of producing hormones anymore. The placenta by
this time has become mature enough and large enough to produce its own
progesterone, and it ramps up production as the corpus luteum is winding
down. If these two events are not quite in sync, you can experience a
slight dip in progesterone levels, and since rising progesterone levels
(absolute level doesn't matter, it is the rate of change of levels, which
is why progesterone levels continue to rise throughout pregnancy) keep the
uterus relaxed, contractions that expel the fetus can result, just like at
birth. Rates of miscarriage decline the further along in pregnancy you get,
except that there is a slight spike right at the end of the first
trimester, when this switcheroo maneuver is underway.
> And finally, I would appreciate hearing from anyone with any information
> about women developing antibodies to their fetuses, and how common (or
> rare) this is. And basically, just anyone else who has anything to tell me
> at all that might be helpful.
It's very rare. It's not precisely known why all pregnant women don't
develop antibodies to their fetuses, since they are, after all, foreign
tissue. The theory is that the placental interaction between the cells
derived from the baby (placenta) and the mother's cells in the uterine wall
induces the fetus to produce an enzyme that damps the immune response at
the interface. Theoretically, certain "markers" are used to determine where
the immune response is supposed to be dampened, and the cells do a little
comparison between themselves and their neighbors on these markers and if
they are different, then they produce the enzyme. The difficulty (again,
theoretically) is when the father coincidentally has the same set of
markers as the mother, then the fetus' cells look just like the mother's
cells when the comparison is done, and no enzyme is produced. The mother's
immune system could care less about these markers, however, and the other
differences between mother and fetus trigger an immune reaction and
antibodies are produced. Again, this is all theory, nobody knows what the
markers are even if they exist, but what is known is that a woman who
consistently has an immune reaction against fetuses fathered by one man
will be able to carry a fetus fathered by another man (say by artificial
insemination) to term quite nicely. The man will also be quite capable of
having children with another woman.
Your practitioner probably did a blood test that included a white cell
count, and possibly other measures of immune system function. If you are
rejecting the fetuses, you may experience similar symptoms to an immune
reaction to just about anything else---a fever, feeling sick (not
necessarily nausea, but the same feelings you get whenver you're battling
the flu, a cold, or other infection---being very tired, loss of appetite or
a ravenous appetite, etc.), and the evidence of your immune system fighting
an invader may show up on your blood test. But it also may not unless it is
being explicitly looked for---if some of the theoretical enzyme is being
produced because at least one of the markers is different, then the immune
response may be weak enough not to show any symptoms, but still strong
enough to kill the fetus.
I hope this hasn't been too dry and technical for you, and I hope it's been
helpful. Myself, I cling to the example of my mother, who had so much
heartbreak and then was rewarded with four wonderful kids (if I may say so
myself :).
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Ok, so, if we're going to try to look for an answer to why these
miscarriages occured, we'll consider the facts. On a gestational age basis,
the first embryo died somewhere around 5 weeks old (LMP is approx. 2 weeks
longer than gestational age). At this age, the embryo is about 1 centimeter
or 4 tenths of an inch long. The second embryo died at about 6 weeks old,
and is a little over half an inch long at this age. Important to note is
that the embryos died well in advance of being expelled. If there were a
hormonal problem, the embryos would have been alive and well, but the
uterus would have expelled them anyway. Usually (though not always) in
cases of the mother's immune system attacking the fetus, the placenta
suffers the most damage, because it is the part directly connected to her.
Bleeding from the damaged placenta almost always precedes such a
miscarriage. So this is unlikely to be the cause.
When the embryo just up and dies like this, it is usually because something
has gone wrong (either chromosomally or developmentally), and the embryo is
simply incapable of continuing on. It's pretty amazing that development
ever goes totally right. The first weeks are an incredibly fast and furious
process of cells dividing, migrating, bending, making seams, all having to
be highly orchestrated to happen at just the right time. If something
doesn't happen quite right, the embryo may die or be born with profound
defects later on.
However, it's quite unusual to have 2 miscarriages in a row with this
cause. There's about a 1 in 20 or 25 chance of this happening in any given
pregnancy, and to have it happen twice is like drawing a ball from each of
two bags of 25 numbered balls and having both balls be number 25. It's a
very low chance, but somebody has to be the unlucky one, I suppose.
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[I sent eMail to someone on the net whom I knew from earlier postings to be
a geneticist, asking him about the chromosomal test - his answer:]
I am really sorry to hear about this situation with you and I hope that my
notes can expand your information base so you can ask better questions to
your doctor. To begin with, I would double-check my statements with your
doctor/genetic counselor in regards to the SPECIFICS of your INDIVIDUAL
case. When a miscarriage occurs, a cell tissue is taken for this test and
grows for a period of several days which can vary according to cell type:
blood, bone marrow, amniotic fluid. This is called "growing a culture"
which will take a number of days. For example, I am learning the procedure
this week and last Friday, I took my own blood and let it grow until
Tuesday. On tuesday, I activated the cells to grow at the same rate by
adding certain chemicals. After that I blew up the Red Blood cells and
removed the waste to leave behind only the White Blood Cells. This is done
because Reds do not contain any DNA while White do. Thursday, I will take
this purified blood sample and fix it onto a slide where I can analyze it.
By using a microscope with a computer screen, I cut apart the chromosomes
and sort them according to type. This results in creating my 'karyotype'
which I will print out & in the case of other people return this data to
their doctor.
WHAT CAN THEY TELL?
Good question. I do not know your age but most expecting mothers over 35
take this to find out if their child has Downs. This is detected by an
extra 21 chromosome in the cells fixed to the slide which reflects the
baby/patient depending on source. Other errors are able to be detected are
extra chromosomal numbers such as 69 or 92 but this is VERY unlikely and I
highly doubt this is your situation. I suspect you can not help but suspect
the worst but well..wait for the results.
In regard to why, they may test you and the father? Well, sometimes about 1
in 200 people have balanced translocated chromsomes which in simple english
means that no genetic info was lost but people have a chunk of their
chromosome 3, for example, attached to chromosome 5, for example. This
looks odd compared to others in a 'karyotype' but the cells do not care so
long as all the genes are present. If the baby has a balanced translocation
in the test, they will want to know if it was new for the baby or you have
it as well. I won't be that surprised if I have this myself so don't panic.
But most likely, their is no genetic reason for this miscarriage but a
result of other reproduction factors. I MUST STATE THAT I AM ONLY A
BIOCHEMISTRY SENIOR AND AM LEARNING THIS PRODEDURE but I hope that this
info makes you feel more informed with your situation.
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The hardest thing is finding that there is often no one or no thing to be
blamed--it just happens and nobody knows why. Give yourself lots of time,
as recovering emotionally is not unlike recovering physically--just because
wounds are felt rather than seen doesn't mean that there hasn't been damage
that will take a while to recover from. In a real sense, this is a death,
so you may need to mourn and grieve for a while. Take lots of time with
yourself emotionally as well as physically. And, by all means, if you are
uncomfortable with your OB-GYN--you're not getting answers to your
questions, etc.--find another one immediately.
> And finally, I would appreciate hearing from anyone with any information
> about women developing antibodies to their fetuses, and how common (or
> rare) this is.
This is all very new stuff, so there isn't a whole lot of data around. As I
understand it, in order to strengthen the blocking response of the
placenta, white blood cells (a half unit) from the (prospective) father are
administered to the mother, and then they try to conceive again. While some
reports of the succes rate are as high as 70%, I don't know that the sample
is large enough yet to be significant. There are, for example, other
studies that have shown that psychological counselling was also
effective--again, the data sample is small, so it's hard to tell how
significant a result this might be.
My wife and I had the white cell stuff done in Richmond VA and we now have
an 18 month old son. Clearly, *something* worked--even though we didn't
have the full course of treatment that the Richmond people wanted. But now,
we're having troubles even conceiving again--which wasn't the slightest
problem before.
> And basically, just anyone else who has anything to tell me at all that
> might be helpful.
It's not your fault. Even though it happens in your body and to you, it's
not your fault. It hurts like hell, but these things just happen, the way
asteroids sometimes slam into the Earth. Boom. Stuff flies. Things get
killed. It's nobody's fault. It just happens. We pick up and try to go
on...
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Last week my husband and I suffered through the pain and disappoinment of a
"missed" miscarriage. Simply put, this condition is caused when the body
fails to recognize that the cell cluster which has implanted has not become
a viable embryo and so continues to go through the motions of supporting a
pregnancy. For about a month after the pregnancy test was positive, my
husband and I thought about and planned for our baby. The fact that our
dream was shattered so soon didn't make it any less heartbreaking.
The reason I thought I'd write you, though, is to publicize the method used
to help us move on. You see, it was awful enough to try and accept the news
that the growing pregnancy sac we kept seeing on the ultrasound monitor was
empty and that it always would be. Still worse was the fact that we had to
select the method for ridding my body of the pregnancy support system still
growing in my uterus.
Option one was to let nature take its course. It might have been weeks,
though, before my body recognized there was a problem. The choice would
almost certainly have ended in a trip to the hospital for an emergency D&C.
We did not need the expense nor the trauma of this option. The second
option was having a scheduled D&C. We believed that this choice sounded
good because of the fact that it would be done under safe, controlled
conditions and under the peaceful sleep general anesthetic provides. By
contrast, the third option of a reletively new office procedure would cause
all the cramping and bleeding normally associated with a miscarriage,
induced by a drug not FDA approved for the purpose.
We were prepared to choose the scheduled D&C when we arrived at the
doctor's office for a final ultrasound. We said that we wanted to make the
choice which would be best for my physically AND mentally. He was certain
that the office procedure fit the bill. He went on to list the risks of a
D&C: perforation, infection, extensive bleeding, and a 2% chance that it
would have to be repeated. The office procedure also had a 2% chance that a
followup D&C would be required, but there was no chance of perforation or
infection since the procedure was non- invasive... and he was ready to do
it then and there. (It was a real blessing that we didn't have to go home
and dwell on it for a day or two.)
At about 6:00 PM the painless, five minute procedure was performed. A small
pill was broken into four pieces. (This drug IS FDA approved for other
uses, but it was explained that no matter how much pain, suffering, mental
anquish and money this procedure would save women, it was still technically
an abortion and no drug would be approved for abortion use. The doctor went
on to say that the FDA has never approved any drug for use during pregnancy
either - not Tylenol, not TUMS, nothing. He added that if doctors had to
wait for the FDA to approve everything obstetricians would have nothing to
use at all! Procedures and drugs, then, are chosen based on results found
in medical journals. This one has been used with increasing frequency and
with excellent results.) The pieces of the pill were placed around my
cervix - painlessly - and held in with a tampon. I was sent home with a
prescription which we filled immediately. I ate a small dinner, took one of
the prescription-strength Motrin, and waited. About 8:00 the cramps
started. By 10:00 I had become very uncomfortable, but my husband gave me
lower backrubs which helped immensely. I was further diverted by a good
movie on TV. The cramps were no worse than the intense ones I'd suffered
through during my teenage menstrual cycles. (I only took that one Motrin.)
I went to bed at 11:00 and slept soundly.
In the morning it was over. I was amazed to discover that the bleeding had
already tapered off to little more than spotting. At my recheck that
evening, the doctor found signs (through ultrasound) of only a small bit of
tissue remaining, which he was almost certain would pass on its own.
(Sometimes a second treatment is needed, but it results in much less
cramping since the uterus is almost emptied and nearly back to normal
size).
I will have to have weekly QHCG (blood) tests until my level returns to
zero (indicating that a D&C will not be necessary). In the meantime, my
husband and I are on StressTabs with Zinc and prescription-strength Folic
Acid to prepare for our next try. I'll be filling my new Clomid
prescription soon, and I already have an appointment for mid-June so my
period can be started by injection if it hasn't already done so on its own.
In short, we might be pregnant again by the end of next month! (There is no
good medical evidence, according to the doctor, that suggests that waiting
more than one cycle will improve our chances for a healthy pregnancy. In
fact, he believes that the knowledge that we can try again so soon greatly
enhances our emotional well-being, a factor that is also very important.)
There isn't anything that anyone could have said to make this experience
any less heartbreaking for us. We knew we didn't do anything to cause the
miscarriage, nor could we have done anything to prevent it. Still, we can't
deny the fear that it might happen again. We know that the people who told
us "it was for the best" and "at least you know you both work" were only
trying to help, but we wanted to scream each time we heard that. In fact,
the only good thing about all this was how fast and easy the doctor made it
to move on. No hospital visit, no paperwork, no recovery room. It was fast,
it didn't hurt (other than the cramping, which is short-lived and not too
terrible), we saved a fortune, and my husband and I went through it
together in the privacy and comfort of our own home. I don't know under
what circumstances the procedure can replace a D&C, but having had both
now, I can say that this is DEFINATELY the way to go. We will always be
grateful to this doctor for coming as close as any man can to understanding
what it's like to be a woman in this position.
Elizabeth Foss nfn0...@naples.net
broo...@mc.duke.edu
Posting-Frequency: monthly
Misc.kids Frequently Asked Questions
Miscarriage
Part 2 of 3
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Causes and Technical Information (cont.)
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I read your post to misc.kids about having 2 miscarriages in a row, and
really feel for you. Unfortunately, I had 3 miscarriages in a row (after
having a previous normal pregnancy, which made it all the more puzzling). I
will be glad to share my experiences with you, but I want to relate a some
things first: You said you realized there is not always a reason. Not true!
I said the same thing, and our doctor (a specialist in recurrent
miscarriages) said there is always a reason, the problem comes in finding
the reason. Also, it may be helpful for you to contact RESOLVE. RESOLVE is
a support/education/advocacy group for infertile couples. I'm not saying
you are infertile, but someone like me (after 3 in a row, I am considered
infertile - unable to carry a pregancy to term) is. They have lots of good
information on miscarriages, and there are lots of opportunities to get in
contact with people you have or are going through similar experiences. I
don't have their phone number with me right now, but will get it to you if
you want it.
Now to our situation. We have a little boy who will be 4 at the end of May.
I got pregnant in April of 1992, and everything seemed to be going fine.
The ultrasound we had at the time of the amnio showed a beautiful, normal
miniature baby. Then, inexplicability, the baby died in utero. I began to
get nervous after a while, because a friend at work was pregnant at the
same time (we were due 2 weeks apart), and she was feeling lots of
movement. I was actually standing in front of the mirror in the mornings,
looking at my breasts, asking myself - "Are they getting smaller?" I didn't
say anything to anyone, thinking I was exhibiting hysterical pregnancy
fears. Well, the water broke at 19 weeks, and I aborted. Thankfully we got
to the hospital in time, and it happened there. The pathology showed
nothing abnormal, and all my OB could tell me was a guess - a cord
accident. A rare, random event. That reasured us somewhat, so we tried
again. We lost that pregnancy at about 8 weeks, and lost the third at 10
weeks (that was May of 1993). Well, by that time we said "Enough is
enough!" and we found an excellent doctor in Boston who specializes in
recurrent miscarriages. My mother in law sent me a newspaper article after
the second miscarriage in which the reporter interviewed this particular
doctor. I hauled it out and read it after the 3rd loss, and that gave us a
name. I then talked to people at RESOLVE, and he was highly spoken of. He
is Dr. Joseph Hill, a reproductive endocrinologist at Brigham and Womens
Hospital.
Here is a description of the tests he ordered for us:
1. Chromosomal analysis of my husband and myself. He said that a
chromosomal abnormality in one or both of us could result in recurrent
losses, but that this was not too common. This involved drawing a blood
sample from both of us. Everything was normal.
2. Endometrial biopsy. This involved removing a sample of the lining of the
uterus just before my period started. The development of the lining was
assessed to determine if I had a leutal phase defect (ie levels of hormones
not right to support a pregancy). By the way - I am not a medical person,
and do not have my reference materials with me as I write this, so my
explanations my be off somewhat! This was uncomfortable, but not overly so.
Some women feel more discomfort than I did. I believe they told me to take
motrin before the procedure to minimize discomfort. This was normal.
3. Hysterosalpinogram (spelling?) also called a 'Tubogram' - during this
procedure, a dye is injected into the uterus, and the radiologist takes
photos to assess the condition of the fallopian tubes (open, closed) and
the uterus. Abnormalitites in the shape of the uterus can cause recurrent
miscarriages. This was normal. Some women have quite a bit of discomfort
with this, but it was not too bad for me. They had me take antibiotics
prior to and after the test. This was done to prevent infection.
4. Blood tests for anticardiolipid antibodies and lupus anticougulant
antibodies. This was also normal!
Tests 1-4 are the standard tests that are performed during an assessment of
recurrent miscarriages. During our initial visit, Dr. Hill said that a
large proportion of couples are not diagnosed by these tests. He then
proceeded to say that he has developed a theory of recurrent pregnancy
loss, in which the women's body views the early placental tissue and/or the
early fetal tissue as foreign objects. The white blood cells then attack
and cause a miscarriage. He has developed a blood test that detects what he
calls 'embryotoxic factors'. It is my understanding that these 'embryotoxic
factors' are proteins given off as part of the process of attack by the
white blood cells. Please remember my previous disclaimer! He said that of
the couples who test negative during the standard tests, 80% test positive
for the embryotoxic factors. Well, I tested postive for the embryotoxic
factors, followed his treatment, and am now beginning the third trimester
of a healthy, normal pregnancy. I will be glad to send you details of the
treatment, but it is basically rather high doses of progesterone during the
first 20 weeks of pregnancy. There is no danger to the fetus. Doctor Hill
said that physcians have been prescribing progesterone for recurrent
miscarrianges for years, without really knowing if it would work. The
thinking was that it couldn't hurt. Well, they may have been treating this
condition without realizing it.
We naturally asked him about our normal first pregnancy, and the fetal
demise. His theory on this is that when the baby died and stayed in the
uterus (for as long as 2 weeks, maybe) that my body became sensitized to
pregnancies and attacked the subsequent two. He said a normal pregnancy
changes the women's immune system to keep itself from being attacked as a
foreign object (which it is, being composed of half your partner's genes).
Doctor Hill said his treatment has not had the benefit of a double - blind,
placebo controlled study because he has not been able to get the funding
for such a study. He does believe there is "something to it", though. The
women at RESOLVE said he has a high success rate, and that 4 or 5 years
ago, when he was just getting started with this, that his waiting room
would be clogged with frantic women looking for help. He has modified his
office procedures a lot since then, and the situation is busy, but much
more orderly. Another empirical verification came from a doctor at the same
hospital who is using a special ultrasound technique to study blood flow
around the fetus and placenta of women who suffer recurrent losses. Her
subjects come from Dr. Hill, and are under his treatment, and she said a
problem (for her, not for me) is that there are very few failures
(miscarriages) so she doesn't have much data! That was reassuring.
I don't know how much reading you have done on the subject of recurrent
miscarriages, but a recent theory says that the woman and man can be too
close to each other genetically, and that some sort of injection into the
woman can help (I don't know too much about this theory). Anyway, Dr. Hill
said that has recently been debunked. This theory was promoted by a doctor
in Philadelphia.
Another thing - Dr. Hill has said that if a couple is in their 30's and has
had 2 miscarriages that they should consider having a workup. I don't know
your situation, but it is something to keep in mind.
Yet something else - Don't hesitate to go to a specialist! You may like
your OB/GYN just fine (like I do), but don't feel you are being disloyal by
going to a specialist. After the 3rd loss, by OB/GYN said "I can't help you
with this". So off we went, and are we glad!
Please pursue this with as much vigor as you can muster, and don't give up
hope! I have just dealt with the medical aspects of my experience here, not
the emotional. Please let me know if you care to exchange notes on the
latter. Best of luck and let me know how you are doing!
---------------------------------------------------------------------------
Got your message. I'm glad you are seeing a doctor who wants to start
testing soon. The tests on me took 1 cycle to complete, which was much
faster than I had thought. I should think that your body has to readjust a
bit before the more invasive procedures are done, though.
In the newspaper article on Dr. Hill, he said progesterone was described in
the '70's as 'nature's immune supressor', and that is why they looked at it
as a possible treatment for this condition. We asked him why he chose the
dosage he did (50 mg progesterone twice a day via vaginal suppositories
(ugh)). He said that in the lab they added progesterone equivalant to that
dosage to the blood of women who tested positive for the toxic factors, and
they (the factors) disappeared. He said there is no guarantee that the
levels of progesterone in the women's blood would be the same, however,
because each women's body is different. He said if the woman miscarries
under his treatment they increase the dose of progesterone in hopes that
will deactivate the toxic factors.
The blood test he uses is, to my knowledge, different from the usual tests
for antibodies (I *think* the usual tests are for the anticardiolipid and
lupus anticougulant antibodies - may want to ask your doctor on this). I
think he is the only person doing this test, and do not know if he does it
'long distance'. Dr. Hill and another doctor co-authored a chapter of a
book, and it deals with miscarriages (causes, treatments). He gave us a
copy to read, and I his theory is described there. I'll try to get the
reference for you (and your doctor?) if you want.
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Here is the information on the book:
Kistner's Textbook of Gynecology. 1990.
It will be updated this year. Hill's secretary got the information for me,
and when I asked her if she had the publisher, she just laughed. I guess
she considered herself lucky to get that information from him (he's busy!).
It has been good to correspond with you. Please keep me updated on how you
are doing, and how the results of the tests come out. You are doing the
right thing by being an active participant, because you and your partner
have the most to gain and the most to lose.
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Dreams and Realities
by Nancy P. Hemenway
Reflecting back on a hot morning in early August, I distinctly remember the
eager anticipation of the long awaited culmination of my hopes and dreams
in my marriage to David. I was 38 and I had kissed a lot of frogs before my
prince came along. Hearing the loud ticking of the biological clock was
enough to throw caution to wind (along with our birth control) a whole 2
months into our marriage! My only concern at this point was that I might
get pregnant too fast and our "honeymoon" would be cut short! When nothing
happened the first year I became concerned but realizing we were both
healthy, active individuals, I pushed that thought as far away as possible
attributing it to works schedules and bad timing. Another two birthdays and
no pregnancy.
Then in July while on vacation in Florida I realized my period was late.
David and I rushed to a local drug store for our first of many home
pregnancy tests. Postive! ! I couldn't believe it! We were finally going to
have a baby. Unfortuanately, we were both a little naive and innocent about
pregnancy. At about 7 weeks I started spotting so we rushed to the Dr. and
had an ultrasound. The results were alright and everything looked fine. He
told us 20% of pregnant woman bleed. The spotting continued and the
cramping began. The next sono revealed a problem with the sac and the
doctor told us I was "threatening a miscarriage". My heart was in my knees
but I managed to pull myself together and push these negative thoughts out
of my head. At almost 10 weeks we had another ultrasound. The doctor told
us the baby was growing again and the sac looked ok. We lost the baby the
next day in the hospital emergency room. Having come from a background in
nursing, I asked for genetic testing of the fetus. I was told because it
was only my first pregnancy they would not do this. I also believe they
attributed the loss to my age (41). The genetic testing I never had could
have been a major diagnostic link with the problems we have now been
diagnosed as having.
Several months after my first miscarriage I referred myself to a
reproductive endocrinologist who tested both of us for every disease know
to man (and woman). Over the next two years, we went through ovulation
induction with all the drugs, had numerous IUI's (intrauterine
insemination) and finally three cycles of IVF. We were again, overjoyed,
when I got pregnant on the second cycle. This pregnancy ended at about 6
weeks.
The Quest For a Diagnosis
Through all the testing I never had a diagnosis. The doctors never found
anything wrong with either my husband or me. "Unexplained Infertility",
that's what they call us. We're healthy, active people, "the perfect
couple" except we can't do what 90% of the rest of the couples can do. I am
not the kind of person to settle for "unexplained", so I set out on my own
personal quest to, at least, explain why I couldn't get pregnant or stay
that way once I achieved a pregnancy. I searched the internet for articles
and read everything I could on infertility. I commiserated with my
"sisterhood of infertility" on the medical support bulletin board of
Prodigy. One of the women on the bulletin board had a similar history to us
and sent me some research studies. I couldn't believe what I was reading.
Dr. Alan Beer of the Chicago Medical School in North Chicago Illinois had
been studying the immune system as it relates to reproduction for about 20
years. I read about women (just like me) in many parts of the studies. I
gathered up the information and took it to my doctor. He told me this was
rare and he didn't think I had these problems. I decided to refer myself to
Dr. Beer.
After a review of my chart, he told us we were indeed candidates for
problems in this area and ordered blood tests to be done. Not only did we
have these problems but Dr. Beer told us they were about as "bad as he
knows they can get!" My new diagnosis was : Habitual Aborter. Dr. Beer had
discovered we have three major problem areas: Blocking Factor Problem,
Antiphospholipid Antibodies, and Natural Killer Cells.
Blocking Antibodies
One out of every 200 - 300 couples who marry and start a family will share
similar tissue types to their spouse. Basically this is a white blood cell
(WBC) problem. In the WBC system symbols relate to different types of
cells. The last 4 symbols are called the DR / DQ numbers . these DR/DQ
numbers are inherited . Couples who lose every pregnancy are matched for 3
out of 4 of these number (symbols). David and I found out that we are an
"unlucky match". Our DR / DQ numbers are 1.1, 1.2, 1.3 and a 4 . There is
little more than one amino acid's difference between us. This means we are
75% alike.
As you know the WBC system is our defense against disease. Each of the
above numbers within the WBC system have little antennae which when touched
by a certain virus or bacteria sends signals to make antibodies. These
antibodies take care of any foreign interlopers (bacteria) entering the
body. The man has all the genes (in his sperm) to blueprint out the
placenta. He starts to build the placenta . This sends a message from
outside of the woman's body (from the genes within the sperm) to alert the
mother's body to prepare for a baby. The message sent from the man is
called "g". All the cells of the placenta that line up around the egg have
the genes that will be needed to construct the placenta and the message
sent is also "g". The mom and dad are now in a partnership together
building the placenta. The dad's "g" should be different from the mom's
"g". The mom is responsible for making antibodies to dad's "g". This will
provide a camoflage for the baby making it a sort of "wolf in sheep's
clothing". The "g" of the husband acts liks a fertilizer, a growth molecule
telling the placenta to grow and divide. When a couple is similar (as we
are) there are too few antibodies to "cloak" the fetus. The placenta
doesn't grow and divide like it should, beta tests don't double,
ultrasounds may be "up and down" , the sac may disappear and the pregnancy
is pretty much doomed.
There is hope for this problem. Dr. Beer extracts the WBC from the husband
(or a donor if the couple is too similar). The lab takes the WBCs and feeds
them wheatgerm . After a couple of hours of breakfast the cells grow and
divide. Dr. Beer theorizes at this point the "g" comes out of hiding. A
concentrated serum is made (10,000 times stronger than what would be found
in the placenta) and it is injected under the skin of the forearm (of the
wife) much like a skin test for allergies. After two lymphocyte
immuniztions (two sets of injections) the couple ought to be capable of
producing the blocking antibodies necessary to take the pregnancy to term.
Antiphospholipid Antibodies
There are consequences for every action. Pregnancy is no different. Each
time a pregnancy doesn't make it inside your body, there are conseguences.
This includes even the act of fertilizing an egg. A 20% chance exists with
each pregnancy and/or pregnancy loss that one problem make create another.
In all probability, this is why we now have the antiphospholipid antibody
problem. The phospholipids are a sort of glue necessary in every pregnancy.
They look like little snowfalkes (of fat) which have a sticky end to hold
the cells together. They fuse into other cells and act like a membrane .
Think of them like a swimming pool filter. The phospholipids filter the
nourishment from your blood and than in turn filter the baby's waste back
through the placenta which feeds the baby and produces the BHCG throughout
pregnancy.
Phosphlioids necessary in pregnancy are: cardiolipin, ethanolamine,
phosphatidic acid, glycerol and serine . In our particular case I have
developed an immunity to ethanolamine (this is the "glue" which also sticks
the sperm to the egg). Just like being immune to chicken pox and measles (I
no longer get them) I now am immune ethanolamine so I no longer get
pregnant. Ethanolamine and serine are also the "glues" which are necessary
to build the placenta, so even if I were to get pregnant I still wouldn't
be capable of building the placenta. Couples with this problem are good
candidates for multiple failures at IVF / GIFT / ZIFT cycles. Once you have
developed an immunity to one of the phospholipids there will be an attack
on the baby even in a donor cycle! This problem is 97% efficient in the end
to a pregnancy.
However the key which locks this glue in place is your own body's natural
heparin. Most people think of heparin as a blood thinner but in the case of
combating the phospholipids, heparin acts in a way to lock the glue in
place and keep the organs attached. The heparin must be taken preconception
because the cells are already functioning as they are lining up around the
egg. If there is a pregnancy 86% of the woman will become mothers. If they
wait until after a postive pregnancy test 75% will lose their babies again.
After the immunizations, treatment with heparin and baby asprin
preconception 30% of Dr. Beer's patients have been successful without the
use of ART.
Natural Killer Cells and "Unexplained Infertility"
It seems like years since we sat in Dr. Beer's office on a very cold, snowy
Chicago morning in December. The consultation lasted almost two hours and
Dr. Beer saved the "best" until last. The problem with my natural killer
cells was the "icing on the cake" and probably the most difficult thing for
me (us) to deal with. Everyone has (circulating) in their body something
called natural killer cells. They secrete a substance called TNF (tumor
necrosis factor) and lately the "powers that be" have been looking at the
body's own immune system (these NK cells) as a way to fight cancer. The
overactivity of these cells producing their TNF is deadly to a pregnancy.
Unfortunately for us, I have an overactive immune system. Remember the DR
/DQ numbers? I inherited a "4" from my father which puts me on the "Olympic
Team of Immune Responses". Unless we can get this problem under control
ther may be no way to complete a pregnancy. Treatment involves infusions of
IVIG (intravenous immunoglobulin). The drug is called Gammamune and it is
administered through an IV over a period of three days each month
(preconception). Dr. Beer arranges to have this given through a home health
care agency. the latest studies concerning this treatment are more than
encouraging. Woman who have unexplained infertility are able to conceive
with this treatment. Preliminary studies in recent clinical trials are
showing as high as 80% are able to conceive with the use of IVIG.
Light at the End of the Tunnel
Our consultation with Dr. Alan Beer although hard, was a breath of fresh
air. Dr. Beer with his impecable credentials and extensive knowledge of
immunology exudes compassion for his patients . For many of us this is our
last stop. Dr. Beer did both his residency and Genetics and a fellowship in
Obstetrics and Gynocology at the University of Pennsylvania. He is a board
certified OB/GYN who is also a joint Professor in the Department of
Obstetrics and Gynocology and Microbiology and Immunology at the Chicago
Medical School. Dr. Beer has been researching the issues associated with
the question of why a mother does not reject the newly formed child in
utero since 1970. I hope David and I will have a "Beer Baby" but whatever
happens I will forever be grateful to Dr. Alan Beer and his dedicated staff
for turning on that light at the end of the tunnel. For there truely is
hope now that didn't exsist before.
Addendum:
Dr. Beer started treating us in November of 1993. We went back to IUI and
then again to IVF. We were again successful on our FET (frozen embryo
transfer) but this time the pregnancy is well underway. At this writing I
am almost 26 weeks pregnant. We are due August 13, 1995. Our little "Beer
Baby" is indeed on the way and that light at the end of the tunnel is very
bright indeed now!
Nancy P. Hemenway inc...@mnsinc.com
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It has been my experience that the miscarriage process has not been
adequately covered by books or by doctors, especially, the emotional
distress afterwards. Besides the understandable grieving process, I think
that there is also a hormonal aspect that has caused me to experience "PMS
times 10" for a month after each miscarriage. I had never had a PMS problem
before I had the miscarriages, so I was not prepared for the emotional
rollercoaster that followed. While some of it was natural mourning, and
therefore a process that is necessary, even spiritually beneficial, to
undergo, some of it was simply distressing and non-productive. I am
starting to research literature on reducing PMS symptoms to see if it would
also reduce the post-miscarrage syndrome.
While I have not found much on herbal or vitamin recommendations for post
miscarriage there are several for the traditional PMS. The whole B complex
- especially B-6 has been shown to be useful for alleviating symptoms.
Folic acid is also recommended. Supposedly, one of the reasons for the
chocolate cravings that occur with PMS is a need for magnesium, which
should be taken with calcium. I don't even like chocolate that much but I
found myself wolfing down candy bars after each miscarriage. Herbal
treatments include: St. John's Wort for depression, Valerian for anxiety
and Dong Quai (there are numerous spellings) for disorientation.
From the readings, I gather that Valerian should only be taken before
bedtime, but the other two can be taken during the day. In fact, St.John's
Wort not only has an immediate soothing effect, but supposedly has some
enzyme-like positive effects that can only be felt after a few months of
usage. Please research these before taking there are some medications that
can't be taken with St. John's Wort, like asthma medicine. I took it during
my pregnancy, along with Skullcap, to help sleep. There is a book that
mentions these herbs called "Relief from PMS" by Pamela Patrick Novotory,
published by Dell. I hope this helps.
Deborah Pastor DAnnP...@aol.com
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Bleeding in Pregnancy
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The question came up about bleeding during pregnancy and whether or not
that indicates miscarriage. The summary of what I have to say is that I
have been told that more than half of the women who bleed during pregnancy
go on to deliver a full-term child, but pay attention and don't take it
lightly if you find yourself bleeding.
When I miscarried, I spotted for three days, lost the baby, and then
continued to bleed for another week. I read like mad before I lost the
baby, so I found all sorts of information. The three best books I had were
"The Well Pregnancy Book," "A midwifes Guide to Pregnancy and Childbirth,"
and "Preventing Miscarriage: the Good News." I also talked to about 5
doctors in the course of being given 2 ultrasounds and some phone advice in
the face of various changes. Things I learned (this is graphic):
All vaginal bleeding *OF*ANY*KIND* should immediately be reported to your
doctor. Don't wait until lunch, don't wait until morning, don't wait to
make the drive: call and report what you can to whoever is in a position to
advise you.
Heavy bleeding is more likely to indicate miscarriage than spotting, but
even women who bleed heavily do carry to term. One book said some women
shed the uterine lining that is not near the embryo's implantation site.
Bleeding accompanied by cramping or any kind of abdominal pain is more
likely to indicate miscarriage. It is also an indicator for an ectopic
pregnancy--especially if the pain is more on one side than the other.
(Ectopic pregnancies will lose you a fallopian tube if you don't catch them
*very* early.) Don't panic if you do have cramps, because digestive
distress and stretching of uterine ligaments can cause abdominal pain too.
Bright red blood is much more likely to indicate miscarriage than dark
brown blood. Anything gray or pink is a very, very bad sign, since it
usually indicates embryonic tissue or placenta. In my case, the fetal sack
itself was unmistakable and left me no room for doubt (or hope).
Bleeding that continues for three days or more is more likely to indicate
miscarriage than some spotting that stops.
Bleeding that occurs when you would have had your period is much less
worrisome than bleeding that occurs during what would have been mid-cycle.
Implantation bleeding is *very*common*, and it occurs around when your
first period would have been. Many women will have bleeding at their normal
menstrual points for up to three months.
If you have a fever, faintness, or nausea markedly worse than it has been
until you started bleeding (especially if it is accompanied by worsening
abdominal pain), you may have an ectopic pregnancy that needs emergency
treatment: don't wait to make that call--you need to receive further
instructions based on your case.
Two of my books told me that women who bleed and can get an ultrasound
should be totally reassured once they see a strong regular fetal heartbeat.
One book told me that 90% of the women who are bleeding but have a fetal
heartbeat shown with ultrasound will carry to term. You have to be careful
though, because those statistics are for abdominal probe ultrasounds, and
apparently seeing a heartbeat using the trans-vaginal probe is not so
reassuring. (I only found that last out because I lost my baby after seeing
a strong heartbeat on the ultrasound monitor.) So I guess the amended rule
is that if you are far enough along to see the heartbeat with an abdominal
probe (and you see the heartbeat), stop worrying.
The last, and most depressing thing I have to say is that if you do start
losing anything gray or pink (or anything solid), you need to save it and
give it to your doctor. What you lost can tell them if you have miscarried,
if you might need a D&C to make sure no tissue is left behind, and (in very
rare cases) clues to the cause of the miscarriage. Mostly, you will never
know what caused it, but if you are like me, you have a tremendous need to
try to find out how this happened.
In my case, the fetal sack was a good clue because it was much too small
for my stage of pregnancy. Even though I had a baby with a beating heart,
something was wrong. Two doctors suggested that even though the
cardiovascular system of my little one was showing signs of working well,
the baby was not getting enough in the way of nutrients. They suggested
that it might be an implantation problem. This is all conjecture, but even
having a plausible scenario helped me. I needed an explanation of how I
managed to violate the maxim about no longer worrying about the bleeding
once you see the heartbeat.
Tracy Larrabee larr...@cse.ucsc.edu
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Tracy, thank you for a very informative article on bleeding in pregnancy,
however, I would like to point out one thing about the statistic above. The
fact that over 50% of women who bleed during pregnancy go on to deliver a
full-term child doesn't mean (and you didn't imply this, either, but I'm
sure someone will read this this way) that if you do bleed you have a 50%
chance of miscarriage.
I am currently 24 weeks pregnant with my second child, and with both
pregnancies I bled and had cramps at the beginning. The first one was worse
and I spent three months thinking a miscarriage was imminent. I had
intermittent, heavy, bright red bleeding accompanied by sometimes severe
cramps. Fortunately, everything turned out fine, and I delivered a big
healthy baby boy. If I had read this article during those first three
months, however, I would have freaked out.
Anyway, maybe you could add a note to your FAQ article pointing out that
every pregnancy is different and that although bleeding is a signal that
you should get checked by the doctor, it doesn't necessarily mean
miscarriage is likely, or even indicate a 50% chance of miscarriage for any
particular woman.
BTW, in my case it turned out that I wasn't bleeding from the uterus after
all, but that I have what they call a "friable cervix," which means that it
has a lot of blood vessels in it that bleed easily. So despite all my
worrying, I probably wasn't in any more danger of miscarriage than in any
non-bleeding first-trimester pregnancy.
Anyway, this is just my experience.
Thanks,
Judy Drake ju...@pendragon.cna.tek.com
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I first want to preface this by telling you that I had a perfectly healthy
baby boy - 8 lbs 11 oz, 23 1/2 " long! At 7 weeks, before my first Dr.'s
visit, I had spotting of the dark brown kind. This was over the weekend, so
the Dr. told me to schedule an ultrasound on monday morning to see if
everything looked normal. The baby's heartbeat and growth all looked
perfectly normal, so he said I could continue all regular exercise. Don't
take up a new sport, but he specifically said my horseback riding was
perfectly fine, just no jumping. At 10 weeks, I tried out a friend's horse
for only 10-15 minutes, but when I got off the horse, I had floods of blood
running down my legs. I was hysterical, and my friend rushed me to the
emergency room. I assumed I had miscarried because I couldn't believe there
could be so much blood and the baby could live. They called in an
ultrasound tech, and the ultrasound showed a healthy baby with a normal
heartbeat. 10 weeks is before the placenta is completely formed, but they
guessed that I had a low lying placenta and had torn off a piece of it. I
was given strict orders for bedrest for a week, but before the week was
out, I had hemorrhaged again. This heavy bleeding continued off and on
until 14 weeks even with bedrest. For no apparent reason, I would stand up
and the floods would just start. It went away on its own. Later sonograms
confirmed that I had a small piece of placenta that had torn off. They
explained that the danger passed because as I got bigger, the placenta
moved up with my expanding uterus. At the time, all they could tell me as a
diagnosis was "threatening to miscarry". Any unexplained vaginal bleeding
during a pregnancy gets this label. I carried my pregnancy to term, but the
next time I am pregnant, I will not ride a horse regardless of what the Dr.
says!
Michelle Schott MB...@psuvm.psu.edu
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I think when you start to bleed in the first trimester, this is not good,
but not always bad. My doctor had me check the color (bright red is bad),
as well as the amount of bleeding. I was in my 8th week when I started to
spot.
My doctor told me that if bed rest doesnt slow down my bleeding they would
have me take a quanitative pregnancy test. The test showed that my HCG
level was down very low and this is why I was bleeding and if it continued
to drop that meant that I was miscarrying. I miscarried after 1 1/2 days of
bed rest. I got pregnant 4 months later and gave birth to a healthy baby
boy in May. I feel that my first pregnancy that ended in miscarraige was
not meant to be. It took some time to get over, but I did. I do think about
it, I did all through my second pregnancy, and I thank God for giving me
Zachary.
I think its important that women who are pregnant be aware of what may or
may not happen. I went into my first pregnancy thinking that every thing
would be perfect, I had no worries, then boom it happened. With my second
pregnancy I knew what could happen, so I took it one step at a time. I
didnt tell anyone until I was well into my third month. Then when I started
to show and I heard the baby's heartbeat I just sat back and enjoyed being
pregnant.
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I had spotting with both my pregnancies (one ended with a lovely girl, the
other was a miscarriage at around 6 weeks) and the only difference I could
see was that the spotting was a little heavier for the one that miscarried.
So spotting may not be a definite indicator of an impending miscarriage.
I also disagree with the doctor who said to keep on with normal activities
even with the spotting. My doctor recommended taking it easy the first
trimester (the spotting ended after that) because that's the time when you
are most likely to miscarry and a little extra care (no heavy lifting, no
athletic exercise beyond walking, etc.) would go a long way to prevent any
sad endings.
Joanne Petersen joa...@hpcc01.corp.hp.com
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