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Kenneth F. Trofatter, Jr., MD, PhDPregnancy and Childbirth
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Early Pregnancy Loss - 2

Friday, March 16, 2007
Kenneth F. Trofatter, Jr., MD, PhD
...When things had gotten quieter in the room, I went back to talk with the couple about our findings (see my last post). I could see the thousand questions she had on her lips and told them, “Let me just talk with you for a few minutes, and then I will answer any other questions you might have.” Asking my own questions first, I found out that this was her first pregnancy (in fact her husband was her first sexual partner); she always had regular menstrual cycles with periods every 28-29 days since age 13; she had no significant medical problems; she was on no medications other than prenatal vitamins; there was no family history of congenital birth defects, syndromic problems, inborn errors of metabolism, unexplained mental retardation, or chromosomal abnormalities; she did not smoke or use street drugs, but did occasionally “have a beer”; there was no family history of recurrent miscarriages, autoimmune diseases, or clotting disorders. I did not go into detail with her about why I needed this information, but told her that it would help me to counsel her with regard to what might have happened to her current pregnancy.

Then, to answer the first question I knew was on her mind, I told her, “Based on what you have just told me, it is very unlikely there was anything that you have done, eaten, smoked, or drank that caused this pregnancy loss.” “Then why did this happen to me,” she asked. “I know this will not make things any easier today,” I responded, “but, even if people don’t like to talk about them, early pregnancy losses are very common.” I then went on to explain. Across the board, at least 20 to 30% of all pregnancies miscarry. The most common reason for this in someone who has previously had one or more successful pregnancies is a fetal chromosomal abnormality (I did explain what that meant before going on). Most babies with chromosomal abnormalities don’t survive the first trimester, and even the ones folks are most familiar with, like Down syndrome, usually are lost in early pregnancy.

In her case, though, there is probably another explanation. This was most likely her very first conception and a much higher percentage of first pregnancies (perhaps 50-90%) miscarry, even if the baby is not chromosomally abnormal. At the risk of oversimplification, I explained to her that since the baby is only half herself, it is then ‘foreign’ to her body. And, using the analogy of organ transplantation, I told her that if I placed a kidney in her body from someone who was only half ‘matched’ with her, without using very potent immunosuppressive drugs, her body would reject the kidney in a very short period of time. From what we know, it appears that the mother’s immune system does have to be able to recognize that the baby is ‘foreign’ but then, rather than rejecting the baby, it must actually ‘learn’ to promote and nurture its growth. To successfully carry a baby, the mother has to become ‘immunized’ to pregnancy.

Then she asked, “What can I do so that this doesn’t happen again?” I told her that what happened this time may actually reduce the risk of a miscarriage with the next pregnancy. She did not have any factors to put her at risk to have repetitive miscarriages. Because this was her first miscarriage, and because of what I had told her about the risk for the same for someone having their first pregnancy, an extensive medical ‘work up’ for this was not warranted at this time. “Once this is all over,” I said, “give your body about 3 months to recover, continue taking your prenatal vitamins, and then, when you are ready, go ahead and try again. Most of the time things work out the next time around.” “And, what if they don’t,” she asked? “We’ll cross that bridge when we come to it,” I said; and, besides, that will be a good topic for another post………….

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157 Comments:

  • At Fri Apr 27, 01:07:00 AM 2007, Anonymous Anonymous said…

    A sensitive and gentle explanation to a patient grieving the loss of a first trimester baby. Recomended reading for medical staff trying to help a patient deal with the grief.

     

  • At Tue May 01, 07:44:00 AM 2007, Anonymous Anonymous said…

    I myself have just recently suffered a miscarriage in the first trimester. I am 38 and this was my fourth pregancy. The first one I was talked into having an abortion at the age of 18. My second was born, she was full term and is now 15. My third child at first they thought that I was pregnant in my tubes but found out that I had a fibroid sist in my uterus, but that it would not cause any problems, he was full term and is now 8, a very active child. Now with this fourth one I wonder what happened to cause me to loose it I was 12 weeks but they are saying that the baby was only 9 and a half weeks. They could not find a heart beat, so I asked for a second opinion since I had carried two healthy full term babies. The blood work came back and the numbers are steadly dropping. My only concern is why I'm getting the run around and them not giving me a D & C. I just spent six hours in the emergency room and all they done was give me pain meds to ease the pain. I have delt with the loss of my baby fairly well, its just that I want the fetus out so my body can start healing and we can try again that I am having a hard time dealing with.

     

  • At Tue May 01, 11:07:00 AM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    Based on what you have told me, this is most certainly a "missed" or "inevitable/incomplete" abortion (miscarriage). At your age, and with your past successful pregnancy history, this is also very likely to be the result of a baby that had a chromosomal abnormality and couldn't make it past first trimester. As you know, the risk for chromosomal abnormalities increases with your age. If you have an OB provider, you should go to them with the results of your ER experience. Some ERs will take the time to make the diagnosis, but be reluctant or unable to offer you a solution. You will eventually 'miscarry' the pregnancy on your own, but either medical therapy or a D&C is certainly reasonable for you to request under these circumstances now that you are ready. I am sorry for your loss and wish you luck in the future if you want to have another baby. Thanks for reading.

     

  • At Sat May 05, 05:57:00 AM 2007, Anonymous Anonymous said…

    may i ask a question? when u are about 3ays late in ur period does that indicate an early miscarriage? the first time i suspected i was pregnant, i saw my period a week later, 3mths later , i again thot i was pregnant , saw all the signs, but unfortunately my period started 3days later with sever bleeding and cramps. is this a miscarriage? pls advise

     

  • At Mon May 07, 11:10:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    Hi anonymous,
    You may or may not have lost early pregnancies. If you "felt pregnant" then it is more liekly you were. Most over-the-counter urine pregnancy tests are sensitive enough to pick up a pregnancy that early, or your doctor can send an even more sensitive blood test off if there is a question. If this late or abnormal bleeding is happening in consecutive cycles, there could be lots of other causes unrelated to pregnancy - endometriosis, fibroids, a polyp or even something worse. You should probably check with your doctor if it happens again.

     

  • At Mon May 07, 11:55:00 PM 2007, Anonymous Anonymous said…

    can i ask a question?. I have just had a miscarriage at 5weeks, but my doctor is making me go back again in a week for another blood test to make sure.my scan showed that i had thickening of the uterus but no sac could be found. the scan findings said i may be in early stages of pregnancy or have had a miscarriage, I thought at 5 weeks that something should have shown up. at the very least i could have been 4weeks again i thougth that a scan would have shown somthing. why are they makeing me wait a week again and to keep my hopes up that i am pregnant. If i have had a miscarriage how long do i ave to wait to try again.

     

  • At Tue May 08, 09:26:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    You could have had a very early miscarriage. At 5-6 weeks, we should clearly see a gestational sac, and if we use our imaginations just a little, an embryo with a heart beat. If you ovulate regularly, my greater concern at this point, since they did not see much in the uterus, is that you could have an ectopic pregnancy. Usually these are in one of the fallopian tubes. If you have more bleeding, or develop any abdominal pain, let your doctor know right away. Hope this helps. Thanks for reading!

     

  • At Thu May 10, 09:14:00 AM 2007, Anonymous Anonymous said…

    hi my daughter is 17 its her first pregancy and when she went for her first scan last week shes was 12 weeks they found no heartbeat they told her to come back a week later for another scan which shes been for still no heartbeat but how come the baby has moved its arms and shes also been given tablets and has to return on saturday for more tablets shes had no stomach cramps or bleeding can they miss a heartbeat thankyou

     

  • At Thu May 10, 01:09:00 PM 2007, Anonymous Anonymous said…

    First of all, thank you for the great information you post. I am hoping you have time to answer my question which you may not find unlike many others'. I have a healthy baby from my first pregnancy. I miscarried earlier this year between weeks 11 and 12 after having seen a good heartbeat at 7 and 9 weeks. Do you have any comments on the most likely cause of miscarriage? Also, I am pregnant again--currently at five weeks. I have felt some light fluttering twinges in my lower abdomin just this afternoon and some light, pinkish-brown/greyish discharge. Would you say the chance that I'm miscarrying or about to is extremely high or is there simply no way to tell? Other websites do not provide much detail about spotting during the first trimester even though I know several people who did and carried to term. Thank you very much for your time and consideration.

     

  • At Fri May 11, 10:33:00 AM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    Response #1: With regard to anonymous whose 17 year old daughter has lost her first pregnancy, in my experience, it is not at all unusual to miscarry true first pregnancies. Often it does not mean there was anything wrong with the baby and your daughter's chances of carrying the next pregnancy are very high. She probably did not need the second ultrasound if no fetal heart beat was seen on the first one. Some physicians and patients "just like to make sure" and usually the woman who is miscarrying is in no immediate danger. I would presume the "tablets" they gave her are a drug called misoprostol (cytotec) in an effort to help her finish the miscarriage without needing a D&C. I suggest after this is all over, she start taking a prenatal vitamin on a daily basis to prepare for future pregnancy. If she is a smoker, she should stop. Otherwise no special evaluation is indicated at this time unless she has other medical problems

    Response #2: With regard to anonymous who lost a baby at 12 weeks after a fetal heart beat was seen at 7-9 weeks, this baby probably DID have a chromosomal abnormality. That is the most common cause of isolated miscarriages in first trimester in women who have previously carried normal pregnancies. You are at slightly greater risk for another chromosomally abnormal conception than that based on your age alone if what I believe is true. The spotting you are having could be the signs of another loss in its early stages, but is more likely to be simple 'implantation bleeding' as the embryo attaches to the inner lining of the uterus. You might consider asking your doctor to have an early screening procedure done for chromosomal abnormalities, "combined first trimester risk assessment" at 11-14 weeks. Good luck to you and thanks for reading!

     

  • At Sun May 13, 12:19:00 PM 2007, Anonymous Anonymous said…

    Hi
    I suffered a miscarraige at 7 wks last july & am currently pregnant again. I have had a scan at our local Early Pregnancy suite, because of the last miscarriage & as I also started bleeding 2wks ago now, which has been almost constant, but always dark brown in colour & so far I have had no pain. Even although I have not had a period for 9 wks now, the size of the sac when I was last scanned on wednesday suggested I am only around 6 wks. What is really worrying me now though is that today I woke up with cramps really low down & then the bleeding turned to bright red. When I went to the toilet earlier tonight & wiped, there was what looked exactly like a feoteus on the toilet paper! It was approx 5mm in size & bright red. I showed this to my husband, who also agreed it looked exactly like it. There has been no other tisse or clots passed since. Could I possibly have just miscarried again & passed the feoteus or are you more likely to pass the sac & not known what it really was? This was quite a disturbing sight & I would really appreciate your expert advise. Many thanks

     

  • At Tue May 15, 09:43:00 PM 2007, Anonymous Anonymous said…

    Thank you for answering my question on (Mon May 07 11.55.00pm)I have been back to my doctor for another blood test and the result showed that my levels have gone up and that I am still pregnant. I am still bleeding and i am going back tomorrow for another blood test. I went to our local hospital ER a couple of days ago because the bleeding had increased. again my levels have gone up a couple of points but the ultrasound still showed nothing. they sent me home. I am now worried about what you said about an ectopic pregnancy. Would i be experiencing pain now? I have what i would call mild period pain with the bleeding but nothing really bad. I dont know what to do.

     

  • At Wed May 16, 06:35:00 AM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    With that history, I am afraid that you either have miscarried, or will do so in the near future. I am so sorry...

     

  • At Wed May 16, 10:20:00 AM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    I am concerned by the slight rise in your pregnancy hormone (hCG) level. That should ordinarily double every 2-3 days at this point. If yours is going up slowly, you have either an inevitable/incomplete miscarriage or an ectopic pregnancy. Usually an ectopic is accompanied by persistent discomfort that can get quite intense. Do they see any evidence of a pregnancy within your uterus by ultrasound or any masses in your pelvis?

     

  • At Wed May 16, 04:09:00 PM 2007, Anonymous Patricia said…

    Hello, thank you again for answering my questions.I have a corpus Luteum in my left ovary but that is all they could see. My uterus had thickened up but no over evidence has been seen in both of my untrasounds.I am going back to my GP today hoping for some answers.I want to thank you again for what you do. To take the time to answer all of our questions and for free makes you a remarkable person in my books.God bless you.

     

  • At Thu May 17, 10:43:00 PM 2007, Anonymous Patricia said…

    I have again been back to my Doctor and my HCG level is upto 550(Thurs), which is up from 398 on Tuesday. I have no pain, although i am bleeding he has suggested I come back next wednsday and repeat my bood test and see what my HCG level is and if it is still going up i will have another untrasound.On my first untrasound two weeks ago a small bump could be seen but it was not conclusive. My Doctor says not to measure everything against my HCG levels as the rate they go up and the actual level can vary alot between people. Do you agree? What does the effect of low HCG levels cause to the growing baby? Doest it cause birth defects?thank you for your time once again.

     

  • At Fri May 18, 07:42:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    Patricia, based on your first comment on May 7, you should be at least 7-8 weeks pregnant at this time. I am not going to try to second guess your doctor on this, but the hCG level is about 5-10 times lower than it should be for a normal pregnancy at this point. There is variation among pregnancies, but not this much. It should be easy to see a pregnancy with a heart beat by ultrasound if it is in the uterus and growing normally by this time. hCG is the "pregnancy hormone" that we measure in all pregnancy tests and it is made by cells called trophoblasts that form the placenta. If your hCG is low,it is because you are either not as far along as expected or there are too few trophoblasts or they are not able to produce normal levels of hCG. Low hCG does not cause birth defects. There is a small chnace you were not pregnant earlier and therefore not as far along as you thought, but with all the bleeding you have had, I still think it is much more likely this is a pregnancy that didn't get off the ground, or could still be an ectopic pregnancy that is just smoldering along. Again, good luck with things. At that low level of hCG you are probably not in any great danger right now even if you have an ectopic pregnancy.

     

  • At Mon May 21, 01:46:00 AM 2007, Anonymous Patricia said…

    Thank you again for taking the time to answer my questions. I have over this weekend had a miscarriage which my husband and I are now trying to come to terms with. I know that this one was not eant to be. We will try again when I have recovered and I hope to be able to post a good comment to you in the future. How long should i give my body to recover fully before we try again to give us the best chance. Thank you again for your advice. God bless you.

     

  • At Mon May 21, 10:09:00 AM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    Hello again Patricia. I am sorry for your loss but glad it was not an ectopic pregnancy. In anticipation of 'trying again,' continue taking your prenatal vitamins and try to wait about 3 months before getting pregnant (until you have had at least two normal menstrual periods). At least that's what I usually tell my patients under these circumstances.

     

  • At Mon May 28, 04:49:00 PM 2007, Anonymous Anonymous said…

    I have had 2 miscarriages occuring within 5 months of each other I was told that they were both a blighted ovum. Before I miscarried the first time I found out that I had type 2 diabetes could this have been a factor into both miscarriages? Can you please explain this to me and tell me what I need to do to try to concieve again I want another baby so bad.. Thank you for your time.

     

  • At Tue May 29, 07:54:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    Hi there. You didn't tell me if you have had a successful pregnancy (or pregnancies) in the past or if this is a new partner. Anyway, I suggest getting your diabetes in tight control (diet, exercise, and medication as needed). Get your thyroid function checked. Then start a prenatal vitamin with supplemental folic acid (2-4 mg per day) because of your diabetes and the increased risk for birth defects in diabetics that might be reduced by folic acid (neural tube defects and heart abnormalities). Ask your doctor about starting a baby aspirin (81 mg) each day as well. Good luck!

     

  • At Wed May 30, 08:23:00 PM 2007, Anonymous Anonymous said…

    I have a 5 year old child and have been trying to have another for over 3 years. I have had around 10 very early misscarriages. My Dr. has me on 81 mg. aspirin a day and folgard. I recently had a hysteroscopy and they removed polypoid tissue. The Dr. said that would not have caused the misscarriages. What do you think my chances of having a baby are? I am 36 years old! Thank You!

     

  • At Thu May 31, 12:19:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    If you had polyps, these CAN be associated with miscarriages, especially if they have become inflammed. They can act like an IUD inside the uterus. I am still concerend that you may need more help than you are going to get with aspirin and Folgard. At age 36, your 'biological clock' is ticking very fast and your chance of conceiving begins to go down quickly (just as the risk for a baby with a chromosomal abnormality rises dramatically at this time in our lives). If you have not sought out help with a physician who has a special interest in recurrenet early pregnancy losses, I would recommend you do so sooner than later. In many communities, a specialist in Reproductive Endocrinology and Infertility (REI) is where you should start.

     

  • At Sat Jun 02, 10:28:00 AM 2007, Anonymous Anonymous said…

    Thanks for responding Dr. Trofatter! I have been seeing the infertility dept. at Kaiser for two years. What other medication's do you think I need? (besides Folgard and aspirin) I really don't think I am getting the best care with Kaiser. Thank you for your response!

     

  • At Sun Jun 03, 06:31:00 PM 2007, Blogger Andrea said…

    I appreciate the above post from March 15th. My first pregnancy has also ended in a m/c at 6 1/2 wks on May 15th. I was having symptoms of an ectopic (intense & increasing ab pain, more on left side) and had been spotting for a couple days so I was sent for an emerg u/s. After they did an abdominal u/s I was asked to empty my bladder and I gushed blood and clots. They then performed a transvaginal u/s which showed a small retention of tissues, which I passed on my own over the next 4 days. I then had another u/s a week later to confirm everything was complete and it was all ok.

    The findings from the first u/s said I likely have a arcuate or bicornuate uterus and also a 1cm x 1cm cyst on my left ovary was found (the gync. said it was likely a corpus luteal cyst?). Should I have these findings further investigated?

    Also, on the first abdominal u/s there was no evidence of an intrauterine gestation, did I experience a chemical pregnancy?

    I am a very healthy 26yr old who, along with my husband, yearn for children. Do we have a chance?

     

  • At Tue Jun 05, 05:18:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    Response to anonymous from June 2: If you have infertility doctors and they have been seeing you for several years and only have you on Folgard and ASA, you might want to get a second opinion. You have the right to ask! Your doctors surely know that you are running out of time as well. Have they considered stimulating your ovaries, i.e., "superovulation" with or without IUI (intrauterine insemination) or are you a candidate for IVF? As far as your 'empiric treatment' (the folgard and the ASA) is concerned, consider asking them to add heparin or low-molecular weight heparin to the mix! Good luck again and thanks for the feedback!

    Response to Andrea from June 3:
    Andrea, you probably had a "blighted" ovum that never much got off the ground. It was a little more than just a "chemical pregnancy" from what you described. These are often chromosomally abnormal babies, or in your case, the result of the fact that this was your first pregnancy. The cyst should be nothing to worry about. It was probably simply the site from which the egg developed that became your first pregnancy, i.e., a corpus luteum or CL cyst. If you really have a bicornuate or subseptate uterus, you are not only at increased risk for miscarriages early, but increased risk for later miscarriages in midtrimester and premature delivery as the result of cervical incompetence. So don't get complacent on this possibility (i.e., keep your doctor vigilant - have her/him check your cervix by ultrasound in midtrimester) even when you get through first trimester which I am sure you will, probably with your next try! I have some other posts on these subjects over the past year if you care to check them out.

     

  • At Thu Jun 07, 09:58:00 PM 2007, Anonymous Anonymous said…

    Thanks again Dr. Trofatter for answering my question!! With the "superovulation" do you mean something like the "Gonadotropin chorion" that they have me inject the night before the IUI? Three days after that I start the Prometrium. In June 2006 I got pregnant with triplets and made it 13 weeks ( that was the last time I used the Clomid). They never told me what may have been the cause. They did an autopsy on the one "baby" that came out at home. I will leave Kaiser a message about Heparin. I am willing to try anything. Thanks again! Nancy

     

  • At Mon Jun 11, 12:30:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    Hello again Nancy. We are becoming old friends! Thanks for writing back and let me know how things turn out!

     

  • At Fri Jun 15, 12:59:00 AM 2007, Anonymous Anonymous said…

    Hi, My wife has just become pregnant and I estimate it to be 5 weeks since the first day of her last period. We are both very excited but my wife is telling everyone that she is pregnant and going to be a mother. I am concerned that there is a high percentage chance that the preganacy will not succeed. She says I am being daft as both her mother, my mother, her siter and my sister had no problems. Do these facts mean we have a better chance of it all going fine? I am worried that my wife will cope badly if she miscarries and that telling everyone at this early stage is not so sensible. Thank you.

     

  • At Fri Jun 15, 01:22:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    It's sometimes hard to contain the excitement, especially if this is a first pregnancy. Although the family history probably guarantees nothing at this point, I hope for the two of you that everything does go well! If it doesn't, there is no 'shame' or 'blame' in that and at least you both will have the support of the family. That is important for some folks, and your wife may be one of those!

     

  • At Mon Jun 18, 10:45:00 AM 2007, Anonymous Anonymous said…

    I too suffered miscarriage. I am 26 years old, and first became pregnant Nov 2004. i did have awful sickness and was admitted to hospital afew times. However at 17 weeks i had s gush of water. I went into hospital and was examined and everything looked ok and i was sent home. 2 days later i started to develop flu-like syptoms and within 10hours i was crying in agony and called an amubulance to then later discover i was miscarrying. My heart broke then and there. I had developed an infection and gave birth to my baby boy within hours. A post mortem was carried out and everything was normal. I went on to have various tests and they all came back normal as well. It was recommended that the next pregnancy i should be monitored closely and swabs taken every 2 weeks, and a test for cervical incompentence.

    With all that we decided to try agin after 6-7months. I became pregnant again in august 06 and had a fair pregnancy. I was tested (high and low swabs) and everything was normal apart from alittle thrush. I had the internal scan to see whether a stitch was needed in the cervix. This was not needed as once again everything was normal. i was alittle nervous but i couldnt have been happier....until christmas day (20weeks) my waters broke again and i went into hospital. they examined me and said that my membrane had ruptured and they would observe me as baby could survive with little membrane. several days later scans revealed there was not enough water around baby and later on just b4 new years i was induced and gave birth to another baby boy.

    I decided not to have a post mortem as the 1st miscarriage came back normal. test were done once again revealing nothing. i cant explain the torment i go through. no answers.....? the doctors just tell me there is nothing medically wrong with me? so why do i miscarry then i ask? nobody can tell me....has anyone experienced this? Does any1 have any advice?

     

  • At Tue Jun 19, 05:30:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To Anonymous from June 18: I am not completely sure why you have had these problems,but I am quite sure that there was nothing wrong with your babies. Before you get pregnant again, I suggest that you have a specialist in infertility evaluate the uterine cavity to rule out a uterine septum, polyp or fibroid. After you get pregnant, I would have another specialist place a very good cerclage in your cervix at about 13 weeks; then have that person follow you with cervical lengths by ultrasound. This is one situation in which I suggest that you DO NOT have intercourse during the middle part (15-28 weeks) of the pregnancy. Don't ask me to explain that right now! Despite what you have been told, this is still most likely the result of cervical incompetence. By the way, is there any family history of connective tissue disorders such as Ehlers-Danlos??? Anyway, thanks for reading and good luck.

     

  • At Thu Jun 21, 04:02:00 AM 2007, Anonymous JJ said…

    A question- I have a 10 month old baby and got my first post-partum period on May 3rd, 2007. I was also still breastfeeding at the time. The only day in May that my husband and I had intercourse (or did anything at all that could have made me pregnant) was May 26th. I would have expected my next period to arrive either May 31 or June 1, but it did not come (I did usually have regular 28-29 day cycles). Took an HPT June 2- negative. Started having pregnancy symptoms June 5. Took another HPT June 7- positive and another June 13- positive. But how did I conceive 23 days after the start of my period? According to my doctor, based on LMP, I should be 7 weeks now, but that's impossible. Also, 2 days ago, my symptoms disappeared- breast size reduction, no more queasiness, energy level up. No bleeding, but I am concerned that something is wrong- with both the date of conception and with the baby. If it matters, I also stopped breastfeeding on May 28- which I had planned to do anyway since he was losing interest.

     

  • At Thu Jun 21, 06:38:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    You conceived 23 days after you started your period because that was when you actually ovulated. It is not unusual while breast-feeding that ovulate at times very uncharacteristic of your usual cycle. That's why we tell women they cannot use the "rhythm method" while they are nursing (probably never should depend on that anyway!). The fact that you "don't feel pregnant anymore" may indicate you have had a very early miscarriage (but don't count on that entirely either). Women who do not ovulate in midcycle regularly have higher rates of miscarriage for lots of reasons, often the result of the endometrium being out of synch and not as receptive to the embryo as it is under ideal circumstances. You might want to see your doctor, have them run a quantitative hCG (pregnancy test) and then if you are not pregnant, get something for birth control if you don't want to be! Thanks for reading!

     

  • At Tue Jun 26, 05:45:00 PM 2007, Anonymous Anonymous said…

    39yo IVF'er (G2P1001) with now missed abortion. Bled weekly (1d to 4d), although heaviest about week 3 for few days. Couple tiny (mm sized) clots one day last week. Early US showed small GS (esp compared to YS) usually lagging one week. At what should have been 6w4d, tiny fetal pole and no beartbeat (size 5w5d est) seen on TVUS. Recent US (travel intervened) at what should have been 8w EGA with no HB. Presumably chromosomally abnl but why the increase/persistence in nausea over the past week if hcg levels presumably decreasing (and now off progesterone too after recent US - awaiting d+c in few days)?

     

  • At Wed Jun 27, 04:44:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To Anonymous June 26: Sometimes the placental tissues will continue to grow and make hCG even after the baby is lost. That's why some women will go for weeks sometimes before they realize the pregnancy didn't make it/ I imagine your symptoms will begin to go away soon. There is another possibility as well. Sometimes you can have an ectopic (tubal) pregnancy coincident with an intrauterine pregnancy that continues to grow and also makes hCG. How many emvryos did they transfer? Sorry for your loss and thanks for reading.

     

  • At Wed Jun 27, 08:06:00 PM 2007, Anonymous Anonymous said…

    Thank you. It was three although quality not as good as with prior success. Doubtful ectopic in this case given evidence of only small fetal pole intrauterine and nothing abnl outside.

    Appreciate your opinions.

     

  • At Sun Jul 08, 02:02:00 AM 2007, Anonymous Anonymous said…

    Hello Dr.
    I've had a miscarriage just a week back. It was my first pregnancy. Its ust been 4 months to my marriage. I am 25 years old.
    my last period date was 9th May. Can u tell me that by 28th june how many weeks should have been my pregnancy.
    On 28th i saw some blood in my urine. Went to Dr.She gave me some medication & asked me to get sonography done coz acc. to her i was 7 weeks pregnant(1 month 20 days). next day i got my sonography done which said that i was 5-6 weeks pregnant & there was no fetal echo. the Dr gave me some medicines and asked me to wait 4 10 days. But the same afternoon i had a lot of bleeding and with that i passed a big peice of tissue. i knew that i've lost my baby and i cried a lot. next day i had my D&C done in a nearby nursing home.
    After my D&C i m experiencing some pain in stomach ne time of the day and the bleeding is still there. Can u tell me how long will this state continue?
    Does trevelling by air and train, wearing heels, eating food outside, sexual contact with my husband, & a very bad cold & cough be the reasons for my miscarriage. or its something else. coz it all heappened in 2 days 26th & 27th. but on 28th according to my Dr. my fetus should be 7 weeks & my sonography says 5-6 weeks.
    Now my Dr. will take up some tests 2morrow to find out the reasons 4 my miscarriage. Are they Important 4 me?????
    Do reply as soon as possible coz it might happen that my tests would take place before i get the chance to read ur suggestions.

    But Still i am eager to know what u have to say about this. Do reply i will wait for ur expertise on my issue.
    Take Care

     

  • At Tue Jul 10, 09:22:00 AM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To Anonymous July 8: I am so sorry you lost your pregnancy. It is always hard, but especially if it was the first one. Yes, you were supposed to be about 7-8 weeks pregnant (we count weeks from the first day of the last menstrual period if you have regular cycles every 4 weeks). Your baby was lost at 5-6 weeks. There is probably NOTHING wrong with you and none of the things you are concerned about were likely to have caused the miscarriage. The loss was probably the result of this simply being your first pregnancy (see my comments in the blogs about high rates of pregnancy losses with first pregnancies). Your bleeding and cramping should stop within a few days unless there were some other complications of your D&C or you have an infection. I usually do NOT recommend an expensive medical work up for first pregnancy losses because the likelihood of finding a problem is small and the odds are in your favor that the next time will be better. Good luck and thanks for reading!

     

  • At Mon Jul 23, 03:38:00 PM 2007, Anonymous Nancy said…

    Dr. Trofatter,
    You asked me to let you know how things turned out from your "June 11th" message! I had another misscarriage from my last insemination (my level was only 31) two weeks prior. The infertility dept. gave up on me and said not to try again. I am crushed (we tried for over 3 years). What do you think?
    Thanks again! Nancy

     

  • At Mon Jul 23, 06:12:00 PM 2007, Anonymous Anonymous said…

    I have had 2 miscarriages in the past year. The first was at 9.5 weeks and the second at 10 weeks (both with my husband). We have no history of live births. Both times, a heartbeat was seen at a 9 week ultrasound, where the beats per minute was average and the size of the embryo was also average. I've read after a heartbeat is seen (by transvaginal ultrasound), the risk of miscarriage greatly decreases. What are possible reasons for my miscarriages? I want testing to be done, but am afraid my health ins will not cover it because I've only had 2 and not 3. I am 31 and am feeling the pressure to have children before my late 30's. Thank you.

     

  • At Tue Jul 24, 07:10:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To Anonymous July 23: The two most likely causes of miscarriages in your case are chromosomal abnormalities and what I like to term as an 'inappropriate immune response to pregnancy.' Chance usually takes care of the first and time (and unfortunately, miscarriages) the latter. Wait until the next pregnancy before you go through an expensive evaluation. Read my last posts in this series to get some idea of what diagnostic and therapeutic options are possible in your case. Consider asking your doctor about trying some of the approaches I discuss in "Empiric Therapy." Good luck and thanks for your question. Dr T

     

  • At Fri Jul 27, 05:20:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To Nancy July 23: There are still more options. Consider getting a consultation for a 'second opinion' with another provider who has a special interest in this problem. One option you might consider, other than 'no holds barred' empiric therapy, would be to undergo IVF but hire a 'surrogate' to carry the pregnancy for you. Just a thought!
    Sorry for all the trouble you have had. Dr T

     

  • At Sat Jul 28, 07:36:00 AM 2007, Anonymous Anonymous said…

    I am 10 days past my period due date. At 5 days late, a +/- blood test came up negative. Two days later, it came up as level 6 HCG. Two days after this (yesterday) it came up as HCG level 44. When the fertility nurse called and told me this I was happy, but she unenthusiastic and said its probably a Chemical Pregnancy. I am going for more blood work on Monday. I do not know when I ovulated (so unsure if my levels are lower then where they should be). My question is, based on the symptoms above, should I have any hopes that this is a normal prenancy? Thanks...Amy

     

  • At Mon Jul 30, 05:12:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    Amy, although the levels are low, that would be a good rise in 2 days! I cannot tell you if this is a good pregnancy or not. But you simply could have ovulated later than you thought. Good luck!

     

  • At Tue Jul 31, 01:27:00 AM 2007, Anonymous Anonymous said…

    Hi Dr. Trofatter, I appreciate your being available to field questions from all of us very worried pregnant ladies. I just started 8 weeks (LMP 6 June) and am concerned about my HCG levels rising but not doubling; 24 July - 3600, 26 July - 4470, 30 July - 5337. I have had very mild pregnancy symptoms too and had had some mild brown spotting 3 weeks ago which was what made me realise that I might be having a m/c even though I didn't know I was pregnant. I have not had an u/s yet, but based on your experience could this slow rise indicate a pending m/c? I had a very early m/c back in January. Thanks, Blissenz

     

  • At Tue Jul 31, 10:38:00 AM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To Anonymous July 31: Yes, I am afraid the slow rise in hCG could indicate that you will miscarry. Your doctors should be able to tell you now by ultrasound if the baby is alive. Rather than getting serial hCG, why don't you just ask if they wll do the ultrasound. Good luck and thanks for reading!

     

  • At Tue Jul 31, 08:42:00 PM 2007, Anonymous Anonymous said…

    I have had three early m/c's. I just got done with testing and was told that it was "bad luck". I'm not sure if I'm ok with that diagnosis, but am ready to start trying again. My doctor did put me on progesterone starting at 3 DPO, and 81 mg of baby aspirin to be on the safe side. I have also been reading about Folgard being of help in some circumstances. I was wondering if it is ok to take it along with prenatal as a "reasurrance measure", or is that too many vitamins while pregnant?

     

  • At Thu Aug 02, 11:26:00 AM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To Anonymous July 31: What testing did your doctor do? "Bad luck" is never a good answer. There ARE reasons for everything, even if we cannot identify the problem easily. The Folgard is fine. I usually just put my patients on high dose folic acid (4 mg) in addition to a prenatal vitamin and the aspirin. But, if this pregnancy does not work out, you might want to find someone who can give you a "second opinion" as to why. Good luck this time and thanks for reading! Dr T

     

  • At Sat Aug 04, 05:32:00 AM 2007, Anonymous Anonymous said…

    I am 39 years old. I have had hypothyroidism since my twenties.
    At 33 and 36, I had two healthy babies.At 39 my third pregnancy ended in miscarrige after 8wks, I miscarried at home with no tissue samples taken. I got pregnant the very next cycle again and miscarried at 6wks again at home.I was taking prenatal vitamins and my generic synthroid. I waited 3months to try a third time. We got pregnant again. I went to a new dr who checked my progesterone and found it low in my 7th or 8th week and had me take natural progesterone up to the 14th week.We had seen a heart beat and all seemed well.It was shocking at a routine 15th week visit when no heartbeat was found.I had a D&I and they will do testing on the placenta. I would like to know what could have caused all this. What my chances for a heathy pregnancy will be and did I do something wrong to cause this. I worked out on a treadmill careful to keep my haert rate below 140 and swam almost every day, I have a five year old and two year old that I pick up and do lift heavy things just as an every day mom. Could I have caused this? I drank occasionally on weekends prior to the pregnancys and no alcohol when pregnant.

    Judy

     

  • At Tue Aug 14, 05:24:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To Judy Aug 4: Our fertility decreases with age for reasons that are not completely understood. In some cases it is simply the increased risk for having a chromosomally abnormal baby; in some, it is decreased production of hormones; in others, thet might have developed an intrauterine fibroid or polyp; or, you may have another medical problem that has not been identified. Is the father of the miscarriages the same as the father of your children? There are so many things that need to be checked out ASAP at your age that I strongly suggest that you find a specialist in Reproductive Endocrinology and Infertility if you want to do everything possible to have another baby. I sincerely doubt the alcohol or exercise had anything to do with your losses. Best of luck and thanks for reading! Dr T

     

  • At Fri Aug 24, 06:16:00 PM 2007, Anonymous Anonymous said…

    just wondering about my case. I am 1 week past my period due date and am pregnant with 8/22 hcg being 390 and 8/24 being 610, I began bleeding red three days ago. Not enough to be concerned but it hasn't stopped yet.There are no clots but some cramping like period cramps. The doctor doesn't seem concerned but I am worried. Is this a sign of miscarriage? What should I look for if it is and could this be implantation bleeding?

     

  • At Mon Aug 27, 06:18:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To Anonymous Aug 24: Your doctor may not be "concerned" because there is nothing he/she can do at this point tha might improve your chances for carrying this pregnancy and, unfortunately, it is a situation with which they must deal on almost a daily basis. The simple answer to your question is that the bleeding you are describing seems a little heavy for 'implantation' bleeding, so you are at increased risk for miscarrying. Is this your first pregnancy? Anyway, I hope I'm wrong. Thanks for reading and best of luck. Dr T

     

  • At Sun Sep 02, 09:31:00 AM 2007, Anonymous Anonymous said…

    I found out from my OB today that I miscarried (I found out I was pregnant on 8/22, and began bleeding on 8/29, he ordrered a hCG level test which went from 12 to 2 in a 48 hour period, therefor confirming a miscarriage). I have had only two other pregnancies, which resulked in two healthy chidlren (now 4 years and 21 months). Anyway he said I had to wait for my next menstral cyle to start trying to conceive again - why do we have to wait?

     

  • At Tue Sep 04, 05:55:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To Anonymous Sept 2: I am sorry for your loss. Since you have had other normal pregnancies, the overwhelming odds are that this baby you lost was chromosomally abnormal. You lost this pregnancy so early (very low hCGs) that it probably wouldn't make any difference if you "tried again" during the next cycle. But, I too usually suggest that a woman wait for one normal period before trying again, just to give any 'inflammation' that was associated with the recent loss a chance to resolve to improve the probability of successful implantation the next time around. Waiting also gives your hormones and the endometrium a chance to get back in 'synch' and this too might improve the chances for a successful pregnancy. Thanks for reading and for a good question that, I am sure, is on the mind of many women who are in a similar situation! Best of luck on the next go-around! Dr T

     

  • At Tue Sep 04, 08:35:00 PM 2007, Blogger Seema said…

    I am 31 years old. I have a healthy baby boy, 4 years old. My first pregnancy resulted in a missed abortion where we had waited up to 8-9 weeks for a heartbeat and then did a D&C. My second pregnancy was healthy and I delivered a baby boy. My third pregnancy, at 7 weeks i started having cramps and spotting, which they called a threatened abortion, and i eventually had a complete abortion. again, in my fourth pregnancy, there was very good heart beat at 6 weeks 4 days, but when i went for a scan at 10 weeks, they said the fetus stopped growing at 7 weeks 4 days and they put some tablets vaginally and did evacuation. I had so many tests done including toxoplasmosis, CMV virus, herpes, anticardiolipin antibody, antiphopholipid antibody, lupus anticoagulant, antithyroglobulin antibody, thyroid function test etc. and everything came back negative. Now I am 10 weeks pregnant. My doctor has started me on subcutaneous low molecular weight enoxaparin from 4th weeks itself. He says I may be having some immune problems which causes these abortions and enoxaparin helps prevent this. But I am having a doubt, if i have some immune problem, how could I have a normal pregnancy and a normal kid? If the immune problem started after my son was born, then what about my first pregnancy which i lost before my son wasborn. Is it possible that such a immune problem caused my first pregnancy to miscarry and then the immune problem remained inactive during my normal pregnancy and then started acting up again wiht my 3rd and 4th pregnancies? The last doctor i was going to had asked to do a genetic testing for both me and my husband, but we did not do it since it was very much expensive. currently i am taking low dose aspirin 81 mg, low molecular weight enoxaparin 20 mg subcutaneous per day, and folic acid. My doctor says enoxaparin helps increase the blood flow to the baby, if it is so, then how will it increase the blood flow from 4-8 weeks when the placenta is not matured? Is there blood flow between the yolk sac and the baby? If i lose my pregncies due to chromosomal abnormalitiies, what will be the chance with my current pregnancy as now it is 10 weeks. Up to which week can i miscarry if i have a chromosomal abnormality? Kindly answer my concerns. I will be extremely grateful to you. Thanks a lot in advance.

     

  • At Thu Sep 06, 05:34:00 PM 2007, Anonymous Anonymous said…

    Dr. T,
    Thank you so much for the response (I asked about a miscarriage and waiting a month to try to concieve again - Septmeber 2nd) - I would've asked my OB, but when I received the news I had miscarried, I wasn't really paying attention after that. Now I understand and we'll wait!

     

  • At Thu Sep 06, 05:52:00 PM 2007, Anonymous Anonymous said…

    Hi. Thank you for answering all these questions. I also had a question regarding Methotrexate. I was injected with a dose of Methotrexate on the 25 of July, 07.
    I was told my 6 week pregnancy was eptopic and needed to be termenated. One week later I was still pregnant with rising HCG levels. I went to the Hospital, had an ultra sound done, and was told I did not have an eptopic pregnancy. I was about 8 weeks along with a living fetus in my uterus. They showed me the fetus with a strong heart beat. Two days later, on Aug 3, I was given a DNC to end the pregnancy. My husband and I would like to try again. We have three boys, I had one miscarriage my second pregnancy, but the others have been normal. I started my period on September 5. It's pretty heavy. I was wondering if the Methotrexate is out of my system now. Can we try again, or should we wait until after my next period in October? I'm having such a hard time thinking about waiting, but I do know it's important to be careful. I also read taking one baby asprin a day until concieving can help the uterus is this true. Thank you.

     

  • At Sun Sep 09, 06:21:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To Anonymous Sept 6: Ever since methotrexate became popular for treating ectopic pregnancies, I have seen this unfortunate scenario played out time and time again. You are probably 'safe' now, but I would suggest waiting until after your next period, starting supplemental folic acid 4 mg/day (methotrexate is a folate antagonist) to reduce your risk even more, and go ahead, throw a baby aspirin 81 mg into the mix as well as a prenatal vitamin. Start all of this BEFORE you try to get pregnant and continue through the first trimester. Good luck next time and let me know how things turn out. Thanks again for reading. Dr T

     

  • At Thu Sep 13, 09:27:00 AM 2007, Blogger Mark said…

    I would like to know what the consequences of laser hair removal, aspirin, ibuprofen, and oral contraceptives are to a new pregnancy. My last period started August 1 2007. I had my first round of laser hair removal from my upper lip on Aug 28 (I took a pregnancy test that day and it indicated negative). A week or so later I took a couple aspirin for a headache and a couple ibuprofen that evening for cramps that I thought were premenstrual. I just tested positive for a pregnancy with a urine test, but it was undetectable on an ultrasound. (I think I should be about four weeks pregnant based on my LMP. I am having some pains like I normally do when I ovulate. Should I schedule an appointment to be sure I am not experiencing an ectoptic pregnancy or just wait? If I am patient and it turns out that I have a uterine pregnancy, have the above drugs and treatments endangered my fetus and to what degree? I am 30 years old and have never conceived before. Thank you for your time and advice.

     

  • At Thu Sep 13, 04:45:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To Mark Sept 13: This is a little early to have symptoms related to an ectopic pregnancy. But, if you are having any pain or bleeding, you should contact your doctor. If this is your first pregnancy, you are at high risk for miscarriage, but I doubt any of the treatments or medications you had would be a cause for that if it happens. Good luck with your pregnancy and thanks for reading! Dr T

     

  • At Mon Sep 17, 06:34:00 AM 2007, Anonymous Anonymous said…

    Hi Dr T,
    This is Anonymous Sept 6. Thank you for answering my question so quickly. I had one more question. I had an ultra sound done on the 1st of August. The radiologist saw a 1cm left parovarian cyst, in my right fellopian tube. Do these typically go away on there own? Can I get pregnant if it's still there? Can it block the fertilized egg from entering the Uterus? The cyst is right inside the opening to the uterus snug against the tubal wall. I have had no pain. Thank you.

     

  • At Mon Sep 17, 07:22:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To Seema Sept 4: I apologize for the delay in addressing your concerns, so I devoted all of my post on September 17, 2007 to your many excellent questions. I hope I have given you some answers and some reassurance. Let me know how things turn out, okay? Dr T

     

  • At Mon Sep 17, 07:24:00 PM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To Anonymous Sept 17: A paraovarian cyst is OUTSIDE the fallopian tube and the uterus. They rarely grow large enough to cause pain and it should not interfere with your getting pregnant. Good luck! Dr T

     

  • At Thu Sep 27, 01:33:00 AM 2007, Anonymous Anonymous said…

    With a blighted ovum diagnosed at 7.5 weeks... have had brown discharge since week 6... am now in week 10.5, wondering when should one expect to miscarry?

     

  • At Fri Sep 28, 11:34:00 AM 2007, Blogger Kenneth F. Trofatter, Jr., MD, PhD said…

    To Anonymous Sept 27: I would hope soon. Have you considered either a D&C or medical therapy with misoprostol? The longer you wait, the greater your risk of complications related to infection that could impair future fertility. I am sorry for your loss. Thanks for reading. Dr T

     

  • At Fri Oct 26, 12:44:00 PM 2007, Blogger sgchick said…

    Hello,
    I'm Vietnamese, very healthy, don't smoke or drink. I'm 37 yrs old and had a son with my 1st husband at 16, he's healthy. I've been on b/c for a long time and got of it for 2 months, used protection and took 1mg folic acid daily. My cycle is normal 28-29 days with light flow. My husband is a healthy Caucasian 33 yrs old. I got pregnant right after went off protection but had a miscarriage at about 10 wks but I think the fetus died a few weeks earlier. 1 cycle later, I'm pregnant again, at 4wks beta was 437, 6 days later it was a low 565 and 2 days later was 906. What are my chances with this pregnancy? If this were to end in a m/c, how long will it take sa my leve is still going up and should I request for an u/s to rule out ectopic? What are my chances of normal pregnancies in the future since it seems I don't have a problem getting