High Risk Consult

I was referred to a high risk specialist this week for a consult.  Finally!  I had been waitng for that referral for quite a while.  I am in Canada, so I cannot just book an appointment with a peri - I had to wait until my OB felt that it was justified.  She wanted to wait until 20 weeks.  This, by the way, is one of my biggest pet peeves ever - that so many doctors do not seem to take a pregnancy or any possible complications in a pregnancy seriously until you hit that magical 20 week mark.  Even then, most are not willing to intervene or try to save a pregnancy until viability (24 weeks).  It drives me nuts.  I mean, it seems to me that the fact that the baby will not make it if he is born that early should be all the more reason to try to prevent early delivery.  Anyway, moving on...

I saw the high risk doctor yesterday.  There is both good news, and confusing-potentially-concerning news.

The good news is, the hematoma is gone.  Yay, right?!  

But wait a minute....so why am I still bleeding then?  And why do I still have these cramps everyday?  

I saw the high risk doctor for all of thirty seconds after the ultrasound.  He told me the good news, and then said, "But, your placenta is unusual."  What does that mean, I asked?  "It is unusually thick.  That could be why you are still bleeding."  Again I asked, what does that mean?  He then said I should speak to my OB.  Great.  Thanks.

I called my OB's office and explained what happened, and asked to make an appointment.  My OB called me back personally within 10 minutes.  She was able to access the ultrasound report, and explained that she was "not concerned."  The baby is fine, the hematoma is gone.  My placenta was normal on all other ultrasounds.  She made it sound as if its thickness is just on the high end of normal.  She will give me another ultrasound, but said that I am now "low risk".  

So why am I still bleeding??????

According to my OB, it might just be my cervix.

So I am left with two different opinions from two different doctors.  One who I trust very much, but who is not herself a specialist, and who has not yet read the specialist's report.  Another who is a specialist, but who gave me very little in the way of meaningful interpretation, or any indication of a prognosis.

So, being the person I am, I could not stop myself from googling,  BIG mistake.  Apparently, a thick placenta is a sign of many scary things, most notably placenta abruption.  The exact thing I have been worried about for months.  Bleeding is of course also a sign of that, and so are these cramps.  The hematoma itself could have been caused by it.  Obviously not a full abruption, but perhaps a partial one.  Apparently, they are not easy to see on ultrasounds unless there is a large retroplacental hemorrhage.  Otherwise, it may present only as an unusually thick placenta.  Great.

I have another appointment with my OB in a few weeks, at which point she should actually have the high risk doctor's report (which will presumably contain an explanation for why he thinks the thick placenta was concerning, and that he suspects that it might be the cause of the bleeding).  I will have another ultrasound at that point, and we will go from there.  In the meantime, I am going to try to listen to my OB on this one, and not worry too much or freak out (I swear).  Bug is still with me, and doing great.  I feel him everyday now.  We both love him so much already.  

17 1/2 Weeks - The SCH is Smaller

The SCH is finally shrinking again!  It was 2.4 x 2.5 x 0.4 cm as of last Tuesday.  While the numbers don't seem much lower, if you calculate the volume, it is actually 75% smaller than it was two weeks earlier! :) I am scared to allow myself to get too excited - after all, the last time it shrunk this much, I had a massive hemorrhage a week later.  I am obviously praying that that does not happen again, and that this actually is a sign that the damned thing is finally going away!

I don't know much about how Bug is doing, except that he is still there, with a very strong heartbeat (160).  The ultrasound tech refused to even measure his crown-rump-length because my OB didn't specifically write it down on her requisition.  I tried to explain that tracking the baby's growth is an important part of tracking the hematoma (which WAS on the requisition), since knowing whether the baby's growth is being affected provides a strong indication of whether the hematoma is causing problems with the placenta (which it is right beside).  She wouldn't budge.  So now, while I am trying to tell myself that there is no reason to think that Bug is doing anything other than growing like a weed as he has been, I can't help but wonder and worry.  Because you know, I needed something else to worry about with this pregnancy!  :S

Overall though, I am very happy, and increasingly optimistic.  I haven't had any real bleeding in weeks, and am barely spotting at this point.  My cramps did ease up for a while, but have gotten a bit more persistent these past few days.  They did this right before the hematoma became tiny last time though, so maybe it is caused by the hematoma breaking up and resolving?  A girl can always hope.  :)

I am definitely showing now, it is kind of crazy actually.  We have had no choice but to start coming out, which has been both exciting and terrifying.  Our families are ecstatic. :). We have been pretty tight-lipped about the complications, and have only told people about the issue on an ad-needed basis (for example, when I need to explain my absence at a wedding).

I have to say though that I am actually increasingly scared too, despite the fact that the hematoma seems to (hopefully, maybe) be resolving.  I am falling more in love with this little baby every single day! I talk to him/her on a daily basis.  I think I can feel movement sometimes, though it's hard to tell for sure.  Sometimes it's a fluttery feeling, sometimes I feel like something little rolled over inside me (very strange feeling!), and just yesterday I felt a "pop" against the inside of my belly.  Could be in my head - who knows.  But regardless, it is making me feel that much more bonded with this little creature.  I know that at this point, he can hear my voice, and will recognize it when he is born.  How amazing is that?  He is sucking his thumb.  I have seen him on ultrasound screens 9 or 10 times now, and hear his heartbeat every few days.  How can I possibly NOT be absolutely in love with this child, this little human who is growing inside me?  I have had losses before, but this one will be different.  I can't even fathom how I will make it through losing him.  It terrifies me so much that I can't let myself think about it.

I will try to focus on the good news, and not worry about what might happen tomorrow.  Today I am pregnant, and I love my Bug.  That is all I need to know.

An Experiment

My symptoms really began to pick up last week following my ultrasound on Tuesday.  I started actually bleeding, whereas I had only really spotted prior to that point.  Well, with the exception of the massive hemorrhaging incident of course.  Anyway, the blood last week was mostly still brownish, but it seemed to have a reddish tinge, which totally freaked me out.  My cramps also became stronger.  

As my symptoms picked up, so too did my fear.  Also, while I do trust my doctor, I can't help but notice that my symptoms do seem to be more pronounced when I am moving around.  So, while she swears left right and centre that full-on bed rest will not help, I am still skeptical.  

My solution (hopefully)?  Vacation time.  My husband and I had a trip tentatively planned for late October - we were going to go south for a week (or maybe to Greece, but that was less likely).  I was convinced that a week away would help us heal if the worst happens.  It probably would have.  But, the time is much better spent trying to PREVENT the worst from happening in the first place.  So, with my employer's blessing, I moved the vacation time up last minute.  I have been off since Friday, and do not go back to work until the 24th. 

 While on "vacation", I will be giving bed rest a shot.  My hope is that whatever is torn or bleeding inside of me will be given some time to heal.  I am actually somewhat optimistic in this regard.  In fact, after only two days, there is a very stark difference in symptoms.  My bleeding has stopped - I am back to extremely light brown spotting (I have had this almost daily for almost 8 weeks).  Cramps are still there, but maybe after a few days, they will ease up too.

I am already bored out of my skull!  :). I have been doing partial bed rest for weeks (ie. in bed at all times when not at desk job), so it is already pretty old.  I am running out of ways to occupy myself.  It  goes without saying that it will be worth it though, if it helps.  I would do a LOT more than bed rest to protect this baby.

I will probably just end up working remotely all week.  I really do love my job, and it is certainly more interesting than staring at the walls. :)

Anyway, that is my update.  I am doing everything I can to save this baby.  Hopefully, it will be enough.

10 Weeks, 3 Days - the Hematoma is Shrinking

I had another follow-up ultrasound yesterday at 10 weeks, 2 days.  The hematoma has gotten much smaller! It went from 3.6 x 1.4 x 4.0 cm on August 13, to 1.6 x 1.6 x 0.6 cm yesterday!  That is great progress, and a really good sign.  The doctor that I saw yesterday (my RE was out of town) said that it is consistent with the SCH being reabsorbed and hopefully, going away. 

 

I guess it's also consistent with my symptoms lately...the spotting has really let up.  In fact, I didn't spot at all for 6 days last week!  It came back a bit yesterday, but barely.  I could only see it on the prometrium applicator, if I looked very closely.  The cramps have also let up.  They seem to be milder, and less frequent.

 

As for Bug, he is doing famously.  His heart rate was perfect at 182.  We saw him dancing on the ultrasound!  He was kicking his little legs, and flailing his arms - it was the most prescious thing I have ever seen in my entire life.  :)  He is still measuring one day ahead.  Here he is:

I was discharged from my fertility clinic today.  I will continue to see my RE though, as she has a dual practice as an OB.  I like her, and I like the idea of staying with someone who knows our history, and who is familiar with the fertility issues as well.  So, I have another ultrasound and follow-up appointment with her next week. 

 

I am starting to let myself hope, which to be honest, scares the sh!t out of me.  I mean, I have always hoped - it is what has gotten me this far.  I have hoped that the hematoma would get smaller; and hoped that Bug would still be there, healthy and strong, at my next appointment.  I have hoped and prayed that I will not miscarry.  I have not, however, let myself actually believe that everything might be okay - that I might hold Bug someday, and see him/her smile.  I have not allowed myself to picture that happy ending.  And well, I am starting to now. 

 

Don't get me wrong, I am still terrified.  I will probably continue to live with that fear at least until the hematoma is gone, and until I make it to 2nd tri unscathed (1 1/2 weeks!).  But now, I can see that maybe, just maybe, everything will be okay.  Maybe. 

 

Bug and I might just make it through this, together.

 

Subchorionic Hemorrhage

I had my follow up ultrasound today, at 8 weeks.  The good news is, Bug is still here.  He has grown by exactly one week, in one week. :)  His heartrate is high at 186 - my RE said that she is not particularly concerned.  He is otherwise perfect.  Here he is:

Now for the not-so-great news.  I apparently have a subchorionic hemorrhage.  The doctor was working off of draft ultrasound report, and couldn't tell me how big it is, or exactly where it is.  She tried to call the ultrasound tech to get that information while we waited, but she couldn't reach her.  This information is pretty critical in terms of the prognosis.

Based on the information that she did have, she said that things could go either way at this point.  It could be related to the lost twin (who is no longer visible on the ultrasound (?)), or it could be related to the otherwise healthy pregnancy.  If the latter, it increases my chances of miscarriage.  As I understand it, the risk is that the hemorrhage could grow and essentially cause the embryo to become dislodged from the uterine wall. 

I am scheduled for yet another ultrasound on Monday.

Meanwhile, the spotting and cramping continues. 

And I am still praying for my Bug. 

Viability Ultrasound

I had my viability ultrasound this morning.

Apparently, I conceived twins, but only one has made it this far.  :(  The other one is still in there, but there is no heartbeat, and the sac is tiny.

There is also a healthy baby in there, with a strong heartbeat (146).  :) He is measuring at 6 weeks 5 days.  I am 7 weeks along according to when I ovulated.  My RE was adamant though that being off by 2 days is completely normal, and does not in any way suggest that there is a problem.

My husband is super-excited about the fact that there is a healthy baby in there. He actually cried when he saw his little heart beating, it was so sweet. :) It was the first time I have ever seen him cry, after more than 9 years. 

I am extremely excited and relieved as well.

I can't help also being sad for the one that I lost though. Does this count as miscarriage number 2? :(

My RE says that what usually happens now is that the lost twin will be re-absorbed into my body, and the remaining healthy pregnancy should be unaffected.  They are having me come in for another ultrasound next week to follow up and see how things are progressing.

As to the cramping and spotting that I have been having, my RE says that it is to be expected.  The spotting was probably caused by either the ultrasound I had right before it started, the progesterone suppositories, or the loss of the other baby.  The cramps are also normal, and are apparently particularly common when a woman's ovaries look like mine - they are absolutely FULL of large cysts.  I over-responded to the gonal-f, and my ovaries therefore look like an IVF patient's normally would.  I am not complaining - at least this provides a possible explanation for the cramping!  The cysts should resolve themselves over the next few months.

So anyway, good news for the most part.  My Bug is still okay.  It is so weird to be so sad, and so happy, all at the same time.
Please keep growing little Bug!

Hoping for the Best

Well, the spotting stopped.  It really didn't last very long, just about two days.  It was also actually extremely light, notiwthstanding my initial melodramatic description of it as "bleeding."  It really started tapering off within hours of appearing.  The cramps are still coming and going, but I think they were there last week as well - I can't remember at this point.  They feel just like period cramps.  Anyway, I am trying not to assume the worst, but I am terrified.  I know that either spotting or cramps can be normal, but the two together are rarely a good sign.

I finally convinced my RE to move my viability ultrasound up by a week, to next Thursday, when I will be 7 weeks.  Hopefully, at that point I will see a strong heartbeat, and be told that everything is on track. 

In the interim, I went to the clinic that saw me through my last miscarriage, and had a beta drawn.  It was 12,600.  It had been 4,323 a little less than 5 days prior.  That gives me a doubling time of 75 to 77 hours, depending on how precise I am about what time the tests were taken (75 hours is precise).  I get that this is actually perfectly normal, given how high the betas are (1,200 - 6,000 should double every 72 to 96 hours, >6,000 can take >96 hours).  I still hate that it is not less than 48 hours though, even though I know that it is not expected to be at this point.

But yeah, the apparently normal doubling time is a good sign, and gives me some relief for sure!  With my last miscarriage, falling betas were my first real sign of trouble after spotting.

I'm not doing another beta, because I don't know what the upper limit of normal is at this HCG level, and I think I will probably just stress and worry if it is above 96 hours at all (as it apparently should be).

So now, all I can do is wait for that ultrasound, and hope, and pray. 

I have never prayed so hard for anything in my life.

I mean, everything could be okay.  I did start spotting brown a couple of days after an extremely invasive and uncomfortable internal ultrasound (seriously, she had it at like 90 degree angles at times).  That is normal, right?  And so are the cramps...right?  It could be okay.  Maybe, just maybe, I won't lose this baby too.

PgAL

I honestly didn't think that I would be this scared.  But, I can't get seem to get my prior loss out of my head now, and I can't stop worrying that the same thing is going to happen again.  See, I have had cramps on and off for a few days.  Nothing severe, but sometimes they are sharp.  I keep trying to tell myself that they are gas pains or something, because they have moved around a little and that seems odd to me.  Today I have consistent, sharp-ish pain on my lower right side.  As much as I really am trying not to worry, it's kind of freaking me out.  I know that cramps can be normal, and I know that they may not be a big deal, especially since I am not spotting.  That said, I just can't seem to stop over-analyzing this and worrying.  *sigh* 

My first beta on Thursday was 135 at 14 DPO.  I am just hoping and praying that my second beta on Monday is where it should be - which is at least around 540.  If so, then I think I will be able to relax a little bit.  Until then, I guess I will just try to keep my mind off of it.  There really is nothing that can be done to prevent a loss at this point anyway - if it going to happen, it is going to happen.