Early Pregnancy Loss - 1
Thursday, March 15, 2007
Kenneth F. Trofatter, Jr., MD, PhD
I went into the room, introduced myself, and picked up another transducer to ‘lay my hands’ on the patient before giving them the bad news. They were a young couple, neither one more than 19 years old, and had “just gotten married the week before,” probably because of the unplanned pregnancy. But, they were also very excited about the prospects of being parents, and almost immediately asked me the same question they asked my sonographer, “Is it a boy or girl?” I told them that “I can’t tell because the baby is too small” and at that point, as so often happens, they opened the door with the question that almost always inevitably follows, “Does that mean there is something wrong?” Then, in a routine I have had too many opportunities to rehearse through the years, with the transducer focused on the tiny embryo so that they could see the baby on the viewing screen, I told them, “You are supposed to be 12 weeks by your last period and the baby appears to have stopped growing at about 8 weeks. Here (using the pointer) is where we should easily be able to see the baby’s heart beating, even if the baby was only 8 weeks, and there is no heart beat. I’m so sorry.”
At that point, also as so often happens under these circumstances, she sat straight up in the bed, the tears streaming out of her eyes and, hoping she had misunderstood my words, she asked, “Does that mean there is something wrong with my baby?” “Yes,” I responded, handing her the box of tissues we always keep in close proximity to the exam table, “The baby is not alive, you have lost this baby, and we are 100% certain of that diagnosis. I am very sorry.” Since most patients are in a ‘state of shock’ after hearing this news, and are not receptive to any kind of ‘input’, I also said at that point, “Let me give the two of you a few minutes alone together and then we can talk about all this…”
I left the exam room, still within earshot of the heart-wrenching sounds of anguish that I have never gotten used to after all these years; the conversation we had when I returned will be continued in our next post…
131 Comments:
At Tue Apr 03, 02:36:00 PM 2007,
Anonymous said…
I've had several miscarriage (lost the baby before 12 weeks), the baby would start growing and then stop. We have 2 healthy girls now, but after so many tests, never found out the reason for the 4 losses. I'd love to know why?
At Wed Apr 04, 03:20:00 AM 2007,
Anonymous said…
I too have had two miscarriages within the space of a year. The last one being in December last year. They say that they cannot do any tests until I have gone through another miscarriage. What is it about the third miscarriage that is so important that they couldn't do for the second one? Also what do you suggest could be the resons why I lost them when I am young, fit, healthy, don't smoke and have no genetic abonormalities within my family? I'd love to know. Thanks.
At Thu Apr 05, 04:22:00 PM 2007,
Anonymous said…
I also lost my so expected baby before 12 weeks, he or she didn't grew up after the 7 week. But my question is why the bleeding start right after the first vaginal ultrasound, and 2 weeks after they had to do a second vaginal ultrasound to confirm the bad news and again at doctor's office I had to stop walking since bleeding increased.
At Fri Apr 06, 03:38:00 PM 2007,
Anonymous said…
I had an incomplete miscarriage almost identical to the one you described. 8 weeks old fetus, 12 weeks along. Same reaction too. Had a D&C 4 days ago and still have period cramp like pain - is this normal? When should the pain go away?
At Sun Apr 15, 06:49:00 AM 2007,
Anonymous said…
please give a detailed information on diagnosis of spinal bifuda, meningomylocele & hydrocephalus during pregnancy. And also wheteher it can be diagonised between 10 to 14 weeks, by ultrasound where a rod in inserted through vagina
At Thu Apr 26, 05:49:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
All of you, thanks for reading and for your comments. I am sorry for the losses you have had. The first three pregnancies I fathered were also lost and I remember to this day the anguish we felt, even though I knew the most likely reasons the babies were lost...they were still our babies that I would never see or hold. To answer some of your questions, please read the other posts I have written on this subject over the past month and please, keep up your HOPE. Chances are that ALL of you will eventually succeed in having your babies.
With regard to the questions related to "spina bifida, myelomeningocele, and hydrocephalus", it is possible to make the diagnosis of a neural tube defect (NTD) early by vaginal ultrasound, but unless the problem is suspected, or there is a family history of the same, it is not something that is typically looked for early in pregnancy. These re often only suspected after having had an elevated maternal serum alpha-fetoprotein screen at 15-18 weeks or at the time of a later ultrasound. If you have had a baby with a neural tube defect, it is recommended that you begin high dose folic acid (4 mg per day) prior to another pregnancy. This can reduce your risk for another baby with an NTD substantially. Also, you should discuss the findings of the previous pregnancy with a genetic counselor to evaluate your risk for other problems that might have a higher risk for recurrence due to chromosomal or genetic conditions. If you are a diabetic, that should be tightly controlled before embarking on another pregnancy. Good luck!
At Wed May 09, 09:48:00 AM 2007,
Anonymous said…
Hello i had a miscarraige at 12 weeks. didnt kno i was losing it until i went for my first scan.. had no bleeding until they gave me tablets to bring it on.. had a D+C a week lter and it really helped the bleeding and pain.the doctors never told me why i miscarried i would love to know the reason why as im 21 young fit and healthy and i dont smoke. thank you
At Thu May 10, 09:59:00 AM 2007,
Anonymous said…
hi my daughter is 17 and on her first pregancy she went for her first scan at 12 weeks and they found no heartbeat they told her to come back a week later still no heartbeat but the baby had moved its arm to sucking its thumb hows that happened also she had no pains or bleeding could a scan be wrong
At Fri May 11, 11:34:00 AM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To the two "anonymous" posts above...We will probably never know why you (the 21 year old) lost your baby. But if this was your first pregnancy, it may well have been nothing you did or didn't do. Please see my post after this one and check out a later post in this series on "immunologic causes" of early pregnancy loss. Odds are in your favor, and a big 'workup' probably is not indicated at this time. Start a prenatal vitamin and try again in a few months.
With regard to the woman whose 17 year old daughter lost a pregnancy... it is VERY unlikely the ultrasound exam was wrong. It can take awhile for her body to realize the baby is not alive because the placental tissues will continue to make 'pregnancy hormones' for some time...that's why she did not immediately start bleeding and cramping.
At Mon May 14, 12:48:00 AM 2007,
Anonymous said…
The story above is almost identical to what I have just been through. I had a dating ultra-sound that showed our baby at 8 weeks a strong heart beat and they said everything surrounding the baby looked really good. We returned for our 12.5 week ultra-sound, excitied to see how our baby had developed since we last seen him/her, watching our baby on the screen in front of us I knew I couldn't see the heart beat but I thought I must be looking in the wrong place (after all I'm not trained to know where to look) The baby was clearly there and I had no spotting or bleeding to make me think anything had gone wrong. The lady left the room and returned with another staff who look and the screen. They asked us how far along I am supposed to be today, I replied "12.5 weeks" they told us the baby has seemed to have stopped growing after 8 weeks and no heart beat could be found. They left the room to allow myself and my husband try to process the news. Two days later I had a D&C (2ND MAY), still slightly bleeding now (14th). I wish I knew what it was that caused this as I am a healthy 29 yr old, non-smoker who took vitamins and stayed away from all the foods the Dr told me to. Is there any research being done to try to find out why this happens? My Dr told me it happens to 1 in 3 women.
At Mon May 14, 12:21:00 PM 2007,
Anonymous said…
I went in for an ultrasound and found out the baby had stopped growing. After my D &C thy analzyed muy pregnancy tissue and found out the baby had an extra chromosome 8. My doctor said that was rather rare and that most babies dont survive the pregnancy. I do have encephalomalacia, but haven't had any seizures in several years. Do you think we should be concerned of having problems with chromosome 8 again or is it likely that we will be able to have a healthy baby? We are going to see a genetic counselor...
At Wed May 16, 02:40:00 AM 2007,
Anonymous said…
I recently had a D&C after being told my baby had not survived the first trimster, does using an electric blanket during pregnancy increase the chance of a miscarriage? I usually have it on high. This is the only thing I could think of that may have contributed to this.
At Wed May 16, 06:11:00 AM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
Responses to the last two "anonymous" comments:
Your dooctor is correct. Far more pregnancies end in miscarriage than most folks realize. As I have said before, it is very likely that there is nothing you did or didn't do that caused you to lose this pregnancy. Either the baby had a chromosomal problem or your body had just not yet figured out how to carry a pregnancy. The former is more likely if you have carried a baby before and the latter if this was your first.
With regard to the miscarriage of a baby with a trisomy for chromosome 8, this is fairly unlikely to occur. Trisomy 8 occurs in about 1% of all chromosomally abnormal first trimester miscarriages. Having had a trisomy confirmed, you are probably at slightly greater risk than your 'age alone' for another baby with a trisomy of some sort, some would say as high as 1 in 100. By the way, it would be VERY unlikely to actually carry a trisomy 8 baby past first trimester and more than 80-90% of all trisomy babies, including Down syndrome, are miscarried early in pregnancy
At Wed May 16, 10:12:00 AM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
It is not likely the electric blanket contributed to your miscarriage unless you substantially raised your core body temeperature above normal.
At Tue May 22, 03:24:00 AM 2007,
Anonymous said…
I think I may have had a miscarriage at about 2-3 weeks but I'm not sure...the reason I think this is that my period was 4 days late and I am NEVER late even by 1 day...you can set your calender by my cycle....for the whole 4 days I had cramps that I kept thinking were menstrual cramps which woke me up a couple of times but no bleeding....then after 4 days the bleeding started and the cramps stopped....for 2 days it was heavy with quite a bit of clotting then nothing on day 3 and light bleeding on the 4th day...nothing since.........just wondering if I should see my doctor......I feel fine
At Tue May 22, 09:54:00 AM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
At this point, you probably don't need to see your doctor. But, if you have anymore abnormal bleeding (even with the next cycle), develop pain, or fever, you probably should. Bet you did have a very early miscarriage.
At Tue May 29, 07:49:00 AM 2007,
Anonymous said…
just home from sonohysterogram operation for recurrant miscariages 13 in all in 3 years nothing wrong with wombhave had blood test both husband an my self all fine though i was on asprin 75mg a day to thin blood because one of the tests was a bit over.it has been 7 weeks from my last pregancy which to my and doctors horror was an ectopic had to have tube removed doctors saying that had nothing to do with other miscarriages but im not sure as i have read u can have ectopic but they are at the end of tube and just look like miscarrage is this true.alos we have a 14 year old my husband and i i was very sick threw out my pregancy body was fighting against it.just would love answers can i try again this month r should i i feel fine
At Tue May 29, 07:47:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
Whoa, slow down girl! 13 miscarriages in 3 years is a lot to put on your body. I think you need to see someone who specializes in recurrent early pregnancy loss and I would recommend a specialist in Reproductive Endocrinology and Infertility. By the way, because you have had one ectopic pregnancy, you are at much greater risk for having another and NO, they are not just like having a miscarriage. Ectopic pregnancies are still one of the leading causes of death during pregnancy. Like I said, slow down, take a big breath and find an expert before you try to get pregnant again! Thanks for reading!
At Wed May 30, 03:17:00 AM 2007,
Anonymous said…
i have 2 healthy children. had a misscarriage last june 2006. went for scan , i was 10wks but scan showed baby had stopped developing at around 6-8wks. i was feeling all the lovely pregnancy signs at that time and even until around a week after a d+c until things slowly went back 2 normal. i was working in a very tiring and physically heavy job and wonder was this a factor? i am a healthy 28yr old. and still have days when i cant forget what happened and would love some answers, thanks
At Wed May 30, 09:58:00 AM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
The most common reason for a miscarriage in someone who has previously had healthy pregnancies is that the baby had a chromosomal abnormality. This occurs much more frequently than folks realize and most chromosomally abnormal babies do not survive the first trimester. This is not something you have any control over and it is unlikely that your work caused you to lose the baby this early. Thanks for reading and good luck in the future.
At Sat Jun 02, 10:14:00 AM 2007,
Anonymous said…
I had a miscarriage recently, I came home from work ligtly spotting blood so it scared me so I called my doctor and told him I was on my way to the ER he advised me to stay there and get checked out, so I did. They did a number of test pelvic exam, blood test urine test with a cather and an unltrasound the used in my vagina the ultrasound showed I was 5 weeks and 3 days when according to my last period I should have been 12 weeks they could not hear a heartbeat I thought maybe I wasn't as far along as I thought because I had a healthy daughter going on 7 years ago and I had no pain and by the time I left the bleeding had stoped. I was told to make an appointment with my doctor and not to go to work until he say I can. A couple of days later he had to do a emergency D/C because I was in so much pain I couldn't bear it. I still long for questions it has only been 3 weeks ago since my D/C I am having signs of pregancy again I feel nausea, sleepy, and sometime I feel like something is moving in my stomach. I know I not crazy and I know I miscarried. Could I be pregant? Is it a higer chance of me getting pregant and having another miscarriage if I get pregant before I have had two periods? I have yet to have a period. I am thinking that the cause of my miscarriage is because of my home being destroyed in the tornado March 1,2007 I felt angry, sad, lonely, and depressed at the same time my daughter and I was in the house when it was destroyed neither of us was physically hurt. I am still having a stressful time trying to piece our lives back together. I am 28 years old and I have no health problems and I did take Ultra Natalcare Tablets ETH the doctor prescribed for me and I am taking them now because my husband and I are trying again. Is this a bad idea, should we wait longer?
At Tue Jun 12, 10:22:00 AM 2007,
beverley74 said…
my sister whos 29 and healthy had a miscarraige after baby stopped growing at 8 weeks she found out at her 12 week scan,,had d+c.still shoed pregnant after 7 weeks,,then a greyish red thing came out left over from d+c.now a month after that shes pregnant again 5weeks but has had spotting all week and now has period like bleeding last 2 days and also a thing(she descibed as a pink/red grain of long rice with a crotchet like hook on end) came out on her pad..is she having a miscarraige again ?
At Tue Jun 12, 12:24:00 PM 2007,
beverley74 said…
update: an hour after i posted my last message my sis rang and after a pain in her belly she passed a jelly blob wich i pressume that she did have a miscarraige again..i wish i could tell her why?? as me and my other sisster has had 3kids each with no problems at all,,why her?? and im stuck for words to say to her after last miscarraige we both was so upset
At Wed Jun 13, 07:37:00 AM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
Beverley, I am not sure what is going on with your sister. She should not have had a positive pregnancy test 7 weeks after the D&C if the pregnancy was in her uterus and was removed completely by the D&C. Several possibilities come to mind:1) They might not have removed everything from her uterus at the time of D&C; 2) She might have had both a nonviable intrauterine pregnancy AND an ectopic (tubal) pregnancy; 3) She could have gotten pregnant again; 4) She has a more serious problem called choriocarcinoma (a cancer associated with abnormal placental tissues). Regardless, she needs to go back to the doctor who did her D&C, have them review the pathology report from that procedure, get a quantitative hCG (pregnancy test) to find out how much pregnancy hormone is in her blood, and then figure out what to do once they have gotten all that information. Thanks for writing! Wish your sister luck!
At Thu Jun 14, 02:38:00 PM 2007,
beverley74 said…
hello thanks for replying kenneth,,my sister did miscarriage later that day..the excact same weeks that her last miscarriage was..is their an explanation why it happened at same time and why the pregnancy didnt go longer
At Fri Jun 15, 01:12:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
Hello again Beverley. I am sorry for your sister and the family. Tell her to try to wait at least 3 months before trying again. She should stay on her prenatal vitamins and talk with her doctors about other evaluation they might deem important. If she miscarries again, she should think about getting a 'second opinion' from a physician who has a special interest in recurrent early miscarriages. Some doctors will do a more complete workup even now if she requests it. Wish her luck for me.
At Sat Jun 16, 02:20:00 AM 2007,
Christina said…
I recently went to the doctor to find that my baby stopped growing at 10 weeks and 2 days. I was supposed to be 12 weeks and 6 days on the day of the scan. I am a bit of a difficult case. I had a tumor near my pituitary gland rhat was removed when I was 15. The pituitary gland does not function. I am 30 years old now. I under went ART and we conceived after three tries. The doctor said that it could be a chromosome issue. But he also mentions that it could have been an implantation problem. I had a D&C yesterday and we sent to tissue off to be examined. This was very shocking because I was having sono scans about every two weeks before moving to the new ob doctor. The doctor said that on the next round, if I took a baby aspirin every day that this should help. What will the baby aspirin do? The other question that I have is what does implantation mean. I thought that it had already implanted at the beginning? We could see on the sono scans blood flowing into the umbilical cord and the heart rate was 179 bpm prior to this visit. I don’t go back to the doctor until two weeks from now and he stated that tissue sample could take up to four weeks. These are questions that I would like answered sooner or get an idea of what other questions I can ask the doctor. Thanks
At Tue Jun 19, 04:28:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
Christina, I am presuming this was your first pregnancy? If you are seeing a specialist in Infertility, they probably made sure that your hormonal status is in good shape because of your previous tumor, correct? Even with ART (what kind did you have?), you can have a chromsomally abnormal baby and as we have discussed on numerous occasions, most of those will not survive first trimester. Another possibility is that your immune system did respond adequately enough to allow PLACENTATION (not implantation) to progress normally through the end of first trimester. I will be publishing a post within the next few days related to abnormalities of placentation that are associated with preeclampsia later in pregnancy. I think these two issues (losing babies and developing preeclampsia) are related under these circumstances, but the women who develop preeclampsia figured things out at least partly right! Of cousre there are other possibilities like insufficient progesterone production, thyroid disease, uterine abnormalities, autoimmune diseases, thrombophilias, etc, but have that chat with your infertility doctor when you go back to see her/him!
At Sat Jun 23, 08:37:00 PM 2007,
Anonymous said…
hi, I just miscariaged at about 7 wks and the baby stoped growing after 2-3 wks, I didn't have to have a D&C and I feel fine but I was woundering when can I expect my next period? Do we have to use birth control for 3 months? My husband has low sperm motlity anyways.
Annoymous J
At Tue Jun 26, 02:35:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous June 23: You will probably become fertile again within the next 4-6 weeks. Remember, you will ovulate (and therefore be fertile) before having another period. So, you could possibly get pregnant again without ever having a period, even if some degree of 'male factor' problem is present. It is probably a good idea to wait a couple of cycles before conceiving just to give any left over inflammatory reaction from the lost pregnancy a chance to die down. Good luck and thanks for reading!
At Tue Jun 26, 06:29:00 PM 2007,
Anonymous said…
If one were to have recurrent miscarriages, do they typically occur around the same time in a pregnancy? I lost my first pregnancy at 12 weeks (baby @ 8 weeks), in March. I am now approximately 5 1/2 weeks pregnant and, as to be expected, am anxious. I'm not feeling any symptoms yet (I had very sore breasts last time), except for some light cramping in my lower abdomen (off and on, no spotting). Should this be cause for concern?
At Wed Jun 27, 04:22:00 PM 2007,
Anonymous said…
Am I right that the risk of miscarriage (statistically)decreases at 12 weeks? Is this 12 weeks from the last period, or 12 weeks from conception (14 weeks from last period)?
At Wed Jun 27, 04:39:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous June 26: When you lose pregnancies depends on the reason you are losing them I know you are anxious right now, but there probably isn't much you can do except try to relax a little! You have no control over what is happening in there right now. With regard to your absence of symptoms, I do not have a good answer. Although we would prefer to see them (soon), I have also found no two pregnancies are the same. Maybe this is a good sign since the other pregnancy ended after 8 weeks despite your symptoms! If you are worried, your doctor should be able to tell you if the baby is alive by ultrasound within the next week. Good luck!
At Thu Jun 28, 06:18:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous June 27: When we refer to '12 weeks', we mean 12 weeks from the first day of your last period (presuming regular 28 day cycles). And, yes the risk of miscarriage drops dramatically from once a baby reaches 12 weeks. Thanks for reading. Hope this means things are going well!
At Tue Jul 10, 06:02:00 AM 2007,
Amy said…
I came upon this blog in searching for answers for 4 miscarriages. I gave birth to 2 healthy boys in 2001 and 2003. We tried for baby #3 starting in July of 2005 and went on to have 4 early miscarriages between Jan 2006 and August 2006. I went thru the gammut of tests and nothing was found to be wrong with me, my husband or my uterus. We took a break from trying for 9 months and I got pregnant on the first try in February 2007. I am currently 22 weeks pregnant with another boy. The last miscarriage ended with a D&C and the testing that was done on the cells came back "Normal Female Karyotype". Could it be that these 4 miscarriages were girl fetuses and my body cannot carry a girl?
At Wed Jul 11, 11:47:00 AM 2007,
Anonymous said…
hi, i'm 17 and this is my second pregnancy. the first one was a blighted ovum. does that put this pregnancy at a higher risk for a miscarriage? and at 6 weeks, 4 days we saw a heartbeat. today i am 8 weeks, 4 days and i don't feel nauseous like i have been feeling daily. should i be worried? my next doctor's appt. isn't until 10 weeks, 4 days. thank you.
At Fri Jul 13, 06:37:00 AM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Amy July 10: It is possible that for some genetic reason you are having trouble carrying a female baby, but that is also not very likely. Most "sex-linked" genetic problems occur in males. The female X-chromosome and the male Y-chromosome do not share much in common. If there is a bad 'recessive' gene on one of your X-chromosomes, and you pass that along to a son, they may have problems, but a daughter would not, presuming they inherited a normal X-chromosome from their Dad. There are circumstances where a parent carries a "Fragile X" chromosome and they are not themselves affected, but the children (male and female) could be. I think it is more likely that your problems arose as the result of so many pregnancies in that short period of time (one or more of which could have been chromosomally abnormal) and your body never completely recovered to allow a good implantation. Probably the best thing you did was take the break before trying to get pregnant again. Hope things go well and maybe some day you'll get your girl. If you don't, I will give you one of mine (just kidding!).
At Fri Jul 13, 06:41:00 AM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous July 11: Because you lost the first baby early, you are at slightly higher risk for losing the second. If you really are feeling like things aren't going well at this point, tell your doctor about that. They can tell, unequivocally, by ultrasound at this point if the baby is still alive. Good luck and thanks for reading.
At Tue Jul 17, 01:46:00 PM 2007,
Anonymous said…
Dr. Trofatter, this is Christina, June 16. I wanted to follow up with you and let you know about the results after my miscarraige. This was my first pregnancy and I did under go ART (with FSH and LH drugs, some shots and vaginal suppository, I think it was the progesterom sp?) and we also did insemination. After all is said and done the final results were that there was a slight chromosome indication but was ruled and implantation problem. So our next step is to go back to the fertility doctor and see where we go from here. Thanks
At Wed Jul 18, 04:43:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
Hello again Christina. Thanks for the feedback and best of luck the next time around. Let me know how things turn out, okay!?!
At Thu Jul 19, 01:00:00 PM 2007,
Anonymous said…
I wonder if you might be able to advise me - I had a 6 week scan, all was good, heart beat and everything fine. From then I felt sick, exhausted and felt pregnant but for the last couple of days the sickness has gone completely, I have had no bleeding, a bit of pain high up but nothing else but just wondering what it might mean. I realise you can't help but can symptons totally disappear and everything still be ok or is it likely that things aren't so good. Is the only way to find out another scan? I should now be 7 weeks. thanks so much.
At Thu Jul 19, 08:50:00 PM 2007,
emily said…
I have had 2 miscarriages in the last 6 months. One in Feb, one in April. My doctors told me that as soon as I have a normal period that I should go ahead & try. Well this time I waited for 3 cycles & I am currently just barely pregnant (postive test this a.m.)period due tomorrow... but have already started some spotting & went for a quant today & it was 280, so it could be hopefull. I had a miscarriage in '99 a son in 2000 & twin boys in 2002...have been scared ever since, but now have been trying & couldn't get pg for an entire year & now have had 2 & possibly on my 3rd miscarriage now. Any suggestions? Or thoughts for the future? My dr. said they will do the work up on me if I lose this one checking for blood clots??...but I would love to save this one if at all possible. I am on 100 mgs of prometrium 3 times a day. Glad I found you & thanks for your help
At Fri Jul 20, 04:01:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
Emily, take a big breath and relax for the time being. Keep taking the prometrium. Ask your doctor if it's okay to take a baby aspirin (81 mg) daily as well as some extra folic acid (1-4 mg). If you lose this pregnancy, read my last 3 posts in this series and see if they don't answer some of your questions. Good luck with things and keep your chin up. Odds are since you were successful before, you will be again! Thanks for reading.
At Fri Jul 20, 04:08:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous July 19 01:00. It's hard to say because different folks experience the hormonal changes in pregnancy in different ways (even with their own different pregnancies!). Tell your doctors about your concerns. Neither they nor you have any control over what is going on on there right now, but they may want to do another sonogram on you if you're "not feeling pregnant" anymore and certainly if you develop any signs or symptoms of miscarriage. Good luck. Hope things turn out okay!
At Fri Jul 20, 07:36:00 PM 2007,
Anonymous said…
hi. right now i am about 10 weeks pregnant. at 6 weeks i saw a heartbeat and i've been feeling very pregnant ( nausea, fatigue ) for the past few weeks. i have had 1 miscarriage in the past. i'm worried because the last time i had a miscarriage i still felt sick and had no bleeding or cramping up until my d&c. is there anything i should be looking for to see if anything is wrong this time around?
At Thu Aug 02, 03:01:00 PM 2007,
Anonymous said…
Dr. Trofatter,
First I want to thank you for blogging and answering people's concerns.
This is my first pregnancy, I am 29 yrs. old. This week I went for my first ultrasound. I was expecting to be into my 10th week based on the date of my last menstrual period, which was 5/18/07. I have a 30 day cycle. My husband and I were planning this pregnancy, and I am 100% certain that the baby was conceived on 6/1/07...I know because lets just say we only got one try in....and didn't get the chance to get intimate again for a while....
On father's day, June 17th, I took two home pregnancy tests, and both showed positve. I went to the doctor the next day and got a positive confirmation.
All has been well, no cramping or spotting, and I have been definitely feeling pregnancy symptoms..nausea, fatigue, etc.
Well, on our ultrasound July 31, no heartbeat could be found, there was no movement, and the baby only showed a gestational age of 8 weeks 0 days.
The doctor would not say that anything was wrong, nor would he say that everything was ok. He kept questioning if I was sure of the date of my last period. I'M SURE. The doctor simply said "if it would make you feel better, I'll do another ultrasound in a couple of weeks."
The HMO couldn't get me another appointment for three weeks, and I'm simply worried sick. I simply can't wait that long...I'm thinking of fibbing to the HMO and telling them I'm cramping or spotting just so they'll get me in for another ultrasound next week.
Please, I just need to know, should I be worried? Is there hope for my baby? I'd rather hear it straight because my HMO won't give me any answers. Not knowing is the hardest part. Thank you greatly.
At Thu Aug 02, 04:16:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous August 2: If the baby is 8 weeks size, and they don't see a heart beat, and they are experienced in interpretation of early OB ultrasounds, then they have not been honest with you. This pregnancy did not make it and there is no sense beating around the bush. I'm sorry, but honesty is always the best policy under these circumstances. The only hope would be if they are NOT experienced in the interpretation of an early ultrasound and if that is true, then they shouldn't be doing them. I am so sorry. Best of wishes to you and your husband.
At Fri Aug 03, 08:07:00 AM 2007,
Anonymous said…
Dr. Trofatter I am 22 years old, healthy, nonsmoker/drinker and I lost 2 babies around 14-16 weeks due to an incompetent cervix. This time around I was suppose to be 11 weeks and the ultrasound showed only a gestational sac and it looked to be 6 weeks and 5 days. My dr. said the baby just stopped growing. Why would my baby stop growing and the others did not? Also they will be doing a d/c will that cause more harm to my cervix?
Please help
At Fri Aug 03, 05:12:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous August 3: Losing babies at 14-16 weeks due to an incomptenet cervix is a little unusual, especially the first loss. I would be curious to hear about the circumstances surrounding those losses. Were the babies normal? Have you ever been evaluated for the possibility of a uterine abnormality such as a bicornuate or septate uterus, or perhaps a submucosal fibroid? Have you had any infertility problems? As for the most recent loss, I bet that baby had a chromosomal abnormality. They occur much more frequently than folks realize and often are lost as a "blighted ovum" or an early embryonic loss in first trimester. If you really have such severe cervical incompetence that you are losing babies early in midtrimester, I doubt a D&C will worsen the situation. You should give very serious thought to having an abdominal cerclage after your uterus has been throughly evaluated. I wish you well and hope things eventually work out. Thanks for reading! Dr T
At Fri Aug 03, 08:10:00 PM 2007,
Anonymous said…
Dr Troffater-thank you for replying to our queries!I had an ultrasound scan yesterday which showed a heart beat which was apparently 'fine & normal' according to the Dr. He has indicated that the foetus is approx 1 week small for its age. I should be 7wks & 4 days, and the Dr has said it looks more like 6 weeks & 3 days. I am pretty sure of my dates of menstruation as I have neen noting these down. I usually have a regular 28day cycle. I am due to go back for another scan in 1 week, but I am understandably very anxious as he said the chances of miscarrying are pretty high. I have miscarried once already in January this year. What are the chances of 'catch up growth' and my baby surviving or should I prepare for the worst. Many Thanks
At Sat Aug 04, 04:28:00 PM 2007,
Anonymous said…
Dr. This is anonymous from Aug. 3rd with the incompetent cervix. The two babies were healthy with no abnormalities. What are these three possibilites:bicornuate or septate uterus, or perhaps a submucosal fibroid? I never had any infertility problems and I just don't know what to do I really want a child and my fiance does too. Will there ever be hope for us? Thanks so much for answering my comment it is greatly appreciated!
At Sun Aug 05, 06:04:00 AM 2007,
Anonymous said…
Dear Dr. Trofatter,
I was Anonymous August 2nd...I just want to let you know that you were right. After reading your reply, I couldn't wait any longer. I called the HMO and lied and said I was cramping, and I managed to get an appointment the next day with another doctor. He confirmed that the baby had passed away somewhere in my 8th week of pregnancy, as there was no growth, movement, or cardiac activity whatsoever. I have a "missed miscarriage". I chose to medically induce the miscarriage at home with suppositories that will cause labor...
My husband and I are devastated, but we're just glad that we know now. We keep telling ourselves that it just wasn't meant to be.
I appreciate you answering my question honestly. You helped me to have the courage to not wait any longer to find out. Thank you for your help.
At Sun Aug 05, 10:07:00 AM 2007,
Jessalyn said…
I am on my third pregnancy. I had a daughter healthy daughter in October 2002. I lost triplet daughters at 12 weeks in March 2007 with no chromosomal defects (babies measured approximately 8 weeks). My LMP was May 28, 2007. I ovulated on June 21, 2007 with the assistance of the Clear Blue Fertility Monitor. I had my first ultrasound on July 18, 2007 with a FHR of 120 BPM. I called my doctor on July 23, 2007 with c/o cramping, back pain and difficulty emptying my bladder. I went in that day and gave a urine sample to check for a bladder infection. I also had a trans vag ultrasound. Baby measured 6 weeks 5 days (exactly what I should have been that day); however, no heart beat detected. I elected to have a D&C done the next day (7-24-2007) with the exception that I have an ultrasound done prior to getting prepped. My husband and I arrived at the hospital, filled out paperwork and got admitted. We went in to have the transvag ultrasound done prior to surgery prep and found a heartbeat of 144 BPM. My OB came in with a sick look on his face (I will NEVER forget the look) and the first thing he said is "This makes me nauseous." He ordered an additional ultrasound to be done in two weeks from July 24, 2007. Obviously, we went home without the D&C! Since then, my anxiety and stress levels have been "through the roof." I could not wait for my August 7, 2007 ultrasound. I called on Friday, August 3 and asked if I could come in to get my ultrasound done earlier. I was able to get in at 11:20 am that day. Baby measured accurate at 8 weeks 1 day, but no heartbeat.....AGAIN! I had a second ultrasound done right after with an OB present to confirm no fetal heart tone. I, again opted for the D&C the next day (Saturday, August 4, 2007) with the exception again of having an additional ultrasound done prior to surgery prep. Again, we did paperwork, got admitted and went in for the ultrasound prior to surgery prep. No heart beat. A doctor came in for confirmation...no heartbeat. My husband and I elected to NOT do the D&C yesterday because of what happened to us nearly two weeks ago...when they DID find a heartbeat after not. Since the baby measures right on....is it POSSIBLE at 8 +/- weeks that there still may be a live fetus and the heartbeat simply is not being detected or is it possible that my baby's heartbeat stopped and started again??? Or has the inevitable happened again? I am not having bleeding, cramping, etc.
I still have occasional breast soreness and fatigue. I requested an additional ultrasound for next week to check the baby's status (additional growth and/or possible heartbeat). What may be happening? My self and my husband are healthy, 25 years old and have no family or self history of any chromosomal abnormalities. I do not smoke, but my husband does.
At Sun Aug 05, 10:08:00 AM 2007,
Jessalyn said…
I am on my third pregnancy. I had a daughter healthy daughter in October 2002. I lost triplet daughters at 12 weeks in March 2007 with no chromosomal defects (babies measured approximately 8 weeks). My LMP was May 28, 2007. I ovulated on June 21, 2007 with the assistance of the Clear Blue Fertility Monitor. I had my first ultrasound on July 18, 2007 with a FHR of 120 BPM. I called my doctor on July 23, 2007 with c/o cramping, back pain and difficulty emptying my bladder. I went in that day and gave a urine sample to check for a bladder infection. I also had a trans vag ultrasound. Baby measured 6 weeks 5 days (exactly what I should have been that day); however, no heart beat detected. I elected to have a D&C done the next day (7-24-2007) with the exception that I have an ultrasound done prior to getting prepped. My husband and I arrived at the hospital, filled out paperwork and got admitted. We went in to have the transvag ultrasound done prior to surgery prep and found a heartbeat of 144 BPM. My OB came in with a sick look on his face (I will NEVER forget the look) and the first thing he said is "This makes me nauseous." He ordered an additional ultrasound to be done in two weeks from July 24, 2007. Obviously, we went home without the D&C! Since then, my anxiety and stress levels have been "through the roof." I could not wait for my August 7, 2007 ultrasound. I called on Friday, August 3 and asked if I could come in to get my ultrasound done earlier. I was able to get in at 11:20 am that day. Baby measured accurate at 8 weeks 1 day, but no heartbeat.....AGAIN! I had a second ultrasound done right after with an OB present to confirm no fetal heart tone. I, again opted for the D&C the next day (Saturday, August 4, 2007) with the exception again of having an additional ultrasound done prior to surgery prep. Again, we did paperwork, got admitted and went in for the ultrasound prior to surgery prep. No heart beat. A doctor came in for confirmation...no heartbeat. My husband and I elected to NOT do the D&C yesterday because of what happened to us nearly two weeks ago...when they DID find a heartbeat after not. Since the baby measures right on....is it POSSIBLE at 8 +/- weeks that there still may be a live fetus and the heartbeat simply is not being detected or is it possible that my baby's heartbeat stopped and started again??? Or has the inevitable happened again? I am not having bleeding, cramping, etc.
I still have occasional breast soreness and fatigue. I requested an additional ultrasound for next week to check the baby's status (additional growth and/or possible heartbeat). What may be happening? My self and my husband are healthy, 25 years old and have no family or self history of any chromosomal abnormalities. I do not smoke, but my husband does.
At Mon Aug 06, 09:30:00 AM 2007,
Anonymous said…
Dr. T this is anonymous from Aug.3 with the IC. I have never had any fertility issues but ultrasound found that I have a cyst on my left ovary. The Dr. did not tell me this when she told me that my baby had stopped growing I saw it on the ultrasound report. Why do you think she would withhold info. from me? I am going to request a copy of my medical records after the DNC can they deny me access to my records? Thanks
At Mon Aug 06, 08:12:00 PM 2007,
Anonymous said…
((Dr Troffater-thank you for replying to our queries!I had an ultrasound scan yesterday which showed a heart beat which was apparently 'fine & normal' according to the Dr. He has indicated that the foetus is approx 1 week small for its age. I should be 7wks & 4 days, and the Dr has said it looks more like 6 weeks & 3 days. I am pretty sure of my dates of menstruation as I have neen noting these down. I usually have a regular 28day cycle. I am due to go back for another scan in 1 week, but I am understandably very anxious as he said the chances of miscarrying are pretty high. I have miscarried once already in January this year. What are the chances of 'catch up growth' and my baby surviving or should I prepare for the worst. Many Thanks))
Subsequent to this-I had my HCG levels checked yesterday and the nurse put them at the level equivalent to 6 weeks. She was using the ranges of 850-20800 for a pregnancy of 5-6 weeks. My level was 15830. I was meant to be 8 weeks pregnant yesterday, on my calculation. Based on all this I am of course very worried, your thoughts would be greatly appreciated. Thank you.
At Sun Aug 12, 03:57:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous August 3: If the baby has a heart beat, then you were problably just 6 3/7 weeks on the day they did the ultrasound. You may have regular menstrual cycles, but you also may have simply ovulated later in the cycle than day 13/14. Hopefully, the next ultrasound will hsow appropriate interval growth of the baby and a healthy heart beat. Hope things turn out well. RELAX a little! Dr T
At Sun Aug 12, 04:07:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous August 4: there is ALWAYS hope, especially if you have had no trouble getting pregnant. I would strongly suggest that you ask your doctor to perform a procedure (before you get pregnant again) to evaluate the shape and contour of your uterine cavity: options include a hysterosalpingogram, a sonohysterogram and/or a hysteroscopy. Your doctor can explain those different procedures to you. Other recommendations would depend on what is found by these procedures. If nothing is found, I strongly suggest that you ask your doctor to send you to a specialist in Maternal-Fetal Medicine who has a special interest in cervical incompetence to discuss different cerclage procedures. Good luck! I would be curious to know what is found and what is done! Dr T
At Sun Aug 12, 04:13:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous August 5: Thanks for letting me know. I really appreciate the feedback. I am sorry for your loss, but I just don't like beating around the bush in these situations. Many doctors think they are doing you a favor, but when there is a certain diagnosis, it's better to let the patient know in a way that is caring and understanding so that they can begin to regroup. Best of luck on the next go-around and let me know how things turn out! Dr T
At Sun Aug 12, 04:23:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous August 5: OMG what you have been through! Your baby OBVIOUSLY was alive at 6 5/7 weeks and for some reason the heart beat was not adequately visualized (it did not stop and then restart). If the baby is now 8 weeks size and no heart beat was seen (by two separate doctors), I am afraid you have finally lost this pregnancy. In your case, however, it probably IS worth looking again one more time. I hope I am wrong, but it is unlikely at this point. You may continue to "feel pregnant" for awhile before your body figures out the baby has been lost because the placental tissues may continue to make the hormones of pregnancy for a little longer. If this was your first pregnancy together, odds are in your favor that the outcome will be better the next time. Best wishes to both of you and I am sorry for your loss and the stress you have gone through. Thank you for reading. Dr T
At Sun Aug 12, 04:30:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
P.S. to Jessalyn August 5: Sorry, I missed that you had previously had a child and lost triplets. Are you an "infertility patient?" If so, what was done to help you conceive? With regard to your husband's smoking, all I can say that there is more and more information on the effects of "second-hand smoke." Maybe he should use these losses as an incentive to QUIT!!!! Best regards. Dr T
At Sun Aug 12, 04:36:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous August 6: No they cannot deny you the records. However, the "cyst" on you ovary was most likely a 'corpus luteum cyst' or simply CL cyst. Cl cysts are the site from which the egg 'hatched' that became this baby. That site makes the hormones that support the pregnancy during the early stages of pregnancy until the placenta takes over. Almost ALL women have a CL cyst early in pregnancy and they are nothing to worry about. That's probably why your doctor didn't think to mention it to you. They usually go away before 14-16 weeks and yours should too shortly if that's all it is. Best wishes and thanks for reading. Dr T
At Sun Aug 12, 04:40:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
Reprise to Anonymous Aug 6: I don't know. With a normal heart beat and a normal quantitative hCG for the size of the baby, that sounds pretty darn reassuring to me! Like I said before, you just need to relax and let nature take its course. There's nothing you have any control over at this point. Start BREATHING!!! Dr T
At Mon Aug 13, 06:50:00 AM 2007,
millie said…
hi about a week ago i took a pregnancy test as for the past couple of months i have been tired, felt nauseous, really hungry straight after eating and for a short period i had sore breats and dizziness when standing (sometimes)the test was positive on the clearblue digital pregnancy test, BUT whilst i had had all those symptoms i have been bleeding constantly for approx 3 months and i have also had abdominal pains and lower back ache for approx the same time. the day after i got the positive pregnancy test i was worried because i thought if i was pregnant, surely i should have stopped bleeding?? about the time the sickness and other symptoms started (couple of months ago)i did a pregnancy test and it was negative so i waited two weeks and went to see the doctor (1 1/2 months ago). The doc said that the bleeding was down to my mini pill and that the nausea,bloating and abdominal and back pain was down to IBS, so i left the docs and stopped taking my pill. All the symptoms continued and the sickness and dizziness, hunger etc seemed to get stronger but then going back to the day after the positive pregnancy test i was told to go to hospital to see gynacologyst, when they did a urine test and a blood test it came back negative, the doctor id seen originally said id had a miscarriage, she said as i had used such a sensitive pregnancy test it must have picked up the last of the pregnancy hormone and i should now stop bleeding, which i did 3 days after. The problem is i still feel nausious, hunger, tired and dizzy at times and i still have the back and abdominal pain and i swear im not going mad (at least i hope not) but im sure i can feel something moving sometimes in my stomach and im worried because what if i havent had a miscarriage and the baby is alive but distressed? i have a little girl who is 11 months old.I just dont understand, ive got an appointment with the doctor again in an hour but im worried hes gonna think im crazy, i havent had any scans, D&C's nothing. please help x
At Mon Aug 13, 08:32:00 PM 2007,
Anonymous said…
Hi Dr. Trofatter,
I came across your site when looking for answers to a previous miscarriage. At that time you answered a question that I thought should have been simple, to that just let me to chatroom after chatroom when searching for an answer on the internet. (On a positive note, I am 13 weeks pregnant now, and all appears well). I don't have a question now. I just wanted to thank you, and this site, for providing an educated place for individuals to ask questions about a sensitive, and strongly opinionated, issues. Although, in my opinion, chatrooms can provide a venue for support, I worry that too many anecdotes create worry when none is due, or a lack of worry when action should be taken.
-The thankful Cannuck.
At Tue Aug 14, 06:04:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Millie Aug 13: You have raised more questions in my mind than I have answers for based on what you have told me! One thing is sure, it sounds like you are NOT pregnant. The symptoms you are having could be due to one or more problems. Do you have irritable bowel syndrome and how has that been evaluated? Have you been screened for diabetes and thyroid disease? If you are having pelvic complaints, this could be the IBS or endometriosis, or fibroids, or a tumor of an ovary or bowel. Talk to your doctor about all your complaints and let me know what they find! Thanks for reading. Dr T
At Tue Aug 14, 06:05:00 PM 2007,