This one is for those of you with degrees from Google U., Message Board U., Blog U., personal experience, or actual medical degrees in miscarriage.
Background facts facts:
Dec. 22: LMP
Jan. 7: LH surge (Day 16- normal for me)
Jan. 8-9: Ovulation (dates for this exercise will assume Jan. 9, to be conservative)
Jan. 20: Positive HPT (11 dpo)
Jan. 28-Feb 1: Moderate bleeding (19-23dpo)
Jan. 29: Ultrasound shows nothing except “maybe some thickening of the lining”
Jan. 29: Beta- 282 at 20dpo (Reference: Median- 837; Range- 29-10,000)
Feb. 2: Beta- 464 at 24dpo (Reference: Median- 3,328; Range- 144-28,000)
Jan-29-Feb 2: “doubling” time: 113 hours (Reference: Median- 39.58; Range- 12.46-311.62)
Since Feb 2: No bleeding, no cramping, some dizziness (normal pregnancy symptom for me)
Your assignment
Part 1: Present a hypothesis as to what’s going on here. Ectopic? Blighted ovum? Doomed embryo located in uterus? Other? Please show your work/explain rationale behind your hypothesis. Please pay extra attention to the fact that there was blood and now there’s not, but the HCG is still going up, if way too slowly.
Part 2: What should I be aware of going into Thursday afternoon’s ultrasound? I figure three things can happen. 1) He can see an ectopic; 2) He can’t see anything and “presumes” ectopic; or 3) He can see something in my uterus. Am I leaving out any other possibilities? What questions should I ask based on any of the above scenarios? What should I know about treatment options? (Wait for it to resolve on its own, D&C, methotrexate, anything else?)
I’m most scared of the uncertainty around option 2. I’m also terrified of being prescribed methotrexate since I’ve read the horror stories of people lying on the bathroom floor cramping, bleeding, and vomiting. I especially hate this idea since my doctor doesn’t work on Fridays and, while I can reach a colleague on Friday, I think I’d be stuck with the local emergency room (notoriously terrible) if there is a problem over the weekend.
Responses are due no later than Thursday, 3:00 p.m. EST. Partial answers permitted. Thank you for participating.
Updated to add: Thanks for all the responses so far. Keep ‘em coming! Also, to clarify: I *know* there’s nothing viable going on in there, so no need to hope for good news in the form of a quadrupling beta and a heartbeat or anything. I realize that even if I see those things, I am almost definitely just dragging out an inevitable miscarriage of a chromosomally abnormal fetbryo, like Kathy McC’s comment. Good news this week is a declining beta and, failing that, something definitively located in the uterus.
OK, here is my answer based on my first miscarriage. I had bleeding off and on for three weeks. Starting at 8 weeks and ending at 10. I *did* see an embryo on the ultrasound at 8 weeks, but it was measuring just under 6 weeks and had a very faint hb. The bleeding stopped the day before my second ultrasound at 10 weeks. This was anything from brown to bright red bleeding. At 10 weeks, I saw a 9 week sized fetus with a strong heartbeat. It was not moving, though. No more bleeding. Started to show and grow out of my clothes. Uterus also measuring two weeks behind. At 12 1/2 weeks I had another ultrasound that revealed baby had died right after my 10 week ultrasound. No bleeding, no cramping, pregnancy symptoms galore.
My theory is that you have a doomed pregnancy because of an embryo with chromosomal defect. Chromosome defects are about 80% or more of miscarriages, and an embryo and sac that is growing way behind schedule is a big indicator. So if you had an ultrasound at 5-6 weeks that showed nothing, it doesn’t mean nothing was in your uterus. You might see something this time since it’s been some time. So if you were 6 weeks and baby was measuring behind, you wouldn’t have seen anything. Does that make sense.
And do not rely on your pregnancy symptoms or bleeding /lack thereof as any sign. It can be very misleading. I had every sign of a healthy pregnancy when I stopped bleeding including a growing belly, and my pregnancy failed.
I am not trying to dash hopes or sound morbid. I am just speaking from my experience. Yours may be different. Either way, if you know you are miscarrying and ultrasound confirms it, but you don’t miscarry by yourself, I would opt for a D&C. It was a much better option for me than the uncertainty of waiting or taking methotrexate.
(((hugs)))
I agree with Kathy (above) on the theory, but not on the D&C. I’m fairly good at miscarrying all on my own, and I would rather wait it out than having an invasive procedure that could potentially compromise future baby making. However, I have no, zilch, zero, nada experience with needing help to miscarry/finishing the job/sounds morbid and GAH! I also second the hugs, you can’t go wrong with a few of those.
Trying not to sound like an ass, but take care of yourself please. Either way, your body is going through things and needs nourishment and rest (when possible) and less stress (also if possible).
I just posted about a friend of mine who is going through something similar right now, although I certainly hope yours turns out differently and we are all wrong thus far. It would be great to hear some good news this week!
Anyway, she got a positive pregnancy test and made her first appointment for around 7 weeks. About 10 days after her positive result, she began spotting. She had just miscarried last Fall, but she bled through her first pregnancy, which was successful, so she didn’t know what to think. She had an ultrasound and they told her the exact same thing they told you, possible thickening of the uterus, no sack, etc. They said it was most likely a miscarraige and she was to go home and have another HCG to see if the numbers were going down. (I don’t know what her original numbers were.)
The next HCG revealed raised numbers, but not enough to have everyone apparently breathe a sigh of relief, so she went back for an ultrasound. Still nothing visible. One more HCG and one more ultrasound revealed a higher HCG and the same visual result. She ended up having a D & C a few weeks ago and they tested the material they gathered from her uterus – it tested negative for fetal tissue, so they gave her a shot of methotroxate and sent her on her way. She had zero effects from the shot, no cramping, etc. and bled for another few days.
Her last HCG this week shows her HCG has dropped significantly, but still isn’t to zero, and now there is some blood near her ovary. The doctor’s thoughts are that it was indeed ectopic and that her body is still trying to reabsorb tissue, etc. So, she is playing the waiting game. Another ultrasound I think next week.
I will keep thinking good thoughts, regardless.
Dx: Ectopic. Doubling time in early pg, when beta is less than 1200mIU/ML, is 48 – 72 hours. Normal range doubling time slows down only after beta is greater than 1200. In this case, doubling time is too slow for viable pregancy. I suspect low P4 which resulted in the bleeding, continued rise in beta subsequent to bleeding due to embryo placement in tube.
This bites. Sorry you have to “wait” through this.
Metho is not nearly as bad as ruptured tube so do the metho. So sorry. Take care of yourself.
Ah, Cat. I just feel so bad as I read all of this. Although I continue to be amazed at the wit in your writing. Always such a clever girl. The ways we cope when things look grim…
I’m wondering, too, if the development is behind schedule, and thus, nothing visible on the ultrasound. And so, on Thursday, perhaps you will see something, but not the way you’d want it to be.
If it’s ectopic, from what I understand, methotrexate would likely be recommended. I haven’t heard much of horror stories with cramping, etc, but my dr. was mostly concerned with potential liver damage, but apparently the patient does a test before taking it to make sure liver is all ok. And quite often, things are.
If not ectopic but still doomed (sorry, I hate to use that word, but no worse than the stiff “nonviable” term), if you don’t want to wait for things to progress naturally, then I’d recommend asking about misoprostol (essentially, the abortion pill), and it’s supposedly effective in clearing out ‘products of conception’ for 85% of users. (This was NOT effective for me – I took it twice last spring with my miscarriage and still ended up needing a D & E, but I unfortunately kept falling into that “exception” statistic for nearly everything). But it works for many people, first time ’round. And it’s ridiculously inexpensive (like $10!) and non-invasive compared to surgery.
BUT, I know you’ve had a D&C before, so you know what to expect with that. And I certainly can understand wanting to deal with things promptly, too.
I’d like to believe that your pregnancy symptoms are promising. And, perhaps they are. But as others have experienced, (myself included), it’s awful to raise hopes over such symptoms, only to find out that they’re all in vain. What a mean trick the body can play on our minds, I know.
Call me foolish, but in the back of mind, I am hoping that somehow everything miraculously turns out okay. Still thinking of you…
Dear Cat,
I have no medical knowledge about anything other than a septic miscarriage and lots of IVF, but I do know that you are feeling great sorrow and stress, and I second what the other poster said about taking care of yourself. I know that you will make the best decisions possible.
I’m thinking it’s a chromosomally-challenged embryo in the uterus trying its best to hang in there. The bleed? Implantation (suppositories could also have been the culprit). I’m for natural resolution or D&C – depends on how far this thing goes. If your betas start falling in the next week or so, then natural might be the way to go…your body really does know how to absorb it and move on, though that of course is time-consuming. Until all this shakes through though, your symptoms are very real – it’s nature at her cruelest.
I am really sorry about all this.
I know nothing, but I’m so sorry you’re going through this.
I had this same scenario. Exactly. At the same time of year, almost (LMP at the beginning of December, 2003). Because nothing really showed up on the u/s until about 6 weeks past ovulation, we kept waiting to see what was happening. It was the above suggested case of development being behind schedule, so at about 6WPO we finally saw a sac, but nothing else. Within a week after that, I naturally miscarried, at home, with no medical intervention. It was not fun, but SO SO SO much better than being in a hospital. Because there was never any confirmation that (wow, I don’t know how to say this, so I’ll just say that the baby was dead, even though I know at that point it was more of an embryo/collection of cells/whatever) my doctors and I just waited it out for a few weeks, even though I felt from the beginning that things were doomed. All I can say is I’m sorry. Take care of yourself, keep chocolate on hand, and a heating pad if the cramps start. Also, I recommend you not move to a new house in the middle of this, because holy crap that sucked.
My experience: spotting at 4.5 weeks, red bleeding at 5 weeks, empty sac, but growing at 5.5 weeks. Presumed ectopic. Methotrexate. Horrible diarrhea but no bleeding. D&C found villi in the yoot, so no ectopic. Scarring from D&C that had to be fixed prior to conception of Mimi.
This is to be differentiated from your experience by the following:
unusually high hCG levels (which also characterized my pregnancy with Mimi as did the bleeding) (but I understand the risks are the same for too high & too low).
Also, ultrasound tech post-methotrexate saw a “flicker”, which was mentally excruciating. She also said the “mass” the ER tech saw was an ovarian cyst, not an ectopic.
I just hate that you’re in limbo. As I understand it, from Dr. Asshat, who clearly was incompetent, they don’t know if it’s ectopic unless they go in there and look.
I hope this ends quickly and without further drama for you. ((hugs))
I know you’re not me, but the whole “is it ectopic” thing was so hard for me and they kept warning me I could die any minute if I blow my tube (hence my several day stay in the hospital), that I would just take the methotrexate. But my numbers at 5 weeks were around the 8 week avg, as they were with Mimi.
If they can determine that it’s ectopic, I think methotrexate is probably your best bet regardless of the s/e. If it’s in the ute, you’re sure it’s nonviable, and not showing signs of I think I’d go for the D&C to get it over with. But I really don’t know.
Thinking of you.