Wednesday, July 13, 2011

Maybe it's a subchorionic hematoma after all

Saw the high risk OB today.  I had my first "tummy" ultrasound today.  The ultrasound tech was super nice.  She was so excited when the ultrasound started and baby was standing on his/her head.  (Baby slid down on its side soon after the ultrasound started.)

After she was done with ultrasound, she went and talked to doc, and then he came and talked to me.  He asked me what my fertility doc thought and I told him that the fertility doc had not seen anything like it before.  He seemed surprised.  He looked at the pictures and films she took and said he thought it was a past bleed.  (He did not use the words subchorionic hematoma in our appointment, but that's what he wrote on my form.)

What?  I thought we ruled that out weeks ago, right?

Well, high risk OB said he thought I just have a wonky vascular system (which is where the strange pumping blood in my uterus is coming from) and, totally unrelated from that, I had a bleed (which is what caused the lake).  He pointed out that it had shrunk from the last time I had an ultrasound.  He said it was good that baby was measuring slightly ahead of schedule--it suggests that blood is getting to the baby.  He gave me the same diagnosis that the fertility doc gave me when he originally thought it was a subchorionic hematoma--no activity, no sex, hope it shrinks.  But he wants to see me next week just to be sure.

I was so excited I was speechless. 

When I was leaving, I overheard him talking to the ultrasound tech about me.  She asked him something and he said, "pray that it gets smaller."  She said, "what if it doesn't?"  He responded, "pray harder."

A little cryptic, but I was still excited for a diagnosis and the first good news I'd gotten in a while.  I actually allowed myself to get excited for the first time that this pregnancy might last.  I'm 11 weeks and 1 day, less than 1 week to 12 weeks!

But later I started thinking about it... and I saw what he wrote on my form... how can it be a subchorionic hematoma?  That's generally a past bleed, not an active bleed.  Over the course of almost two weeks my fertility doc monitored the bleed, and it was pulsing with my heartbeat.  That's not a past bleed.  That's connected to my vascular system.  The high risk OB did not watch the ultrasound, he just looked at the pictures and videos.  Is it possible the high risk OB just missed what the fertility doc saw--namely an active bleed?  That seems impossible, considering my fertility doc sent all of his notes along. 

Also, I'm not bleeding.  I have not had a single spot of blood.  If it was a past open bleed, wouldn't blood come out?  Again, fertility doc thought all blood was still in my vascular system.  But high risk OB thinks that the blood is leaving my vascular system, even though it's not coming out of me.

On the other hand, for the first time in two weeks it's shrinking, which IS good.

I wish I could have articulated why fertility doc ruled out subchorionic hematoma (also known as a blood clot or chorion), but I did not realize that was the actual diagnosis until I left.  (That's what doc wrote on the patient form.)  I was just so excited for good news.  Also, I'm not a f-ing doctor!!!

Let's be clear, a subchorionic hematoma is NOT a good thing to have.  It can cause a miscarriage.  It also means you're at a greater risk for placental abruption.  But I was excited for that diagnosis because the outlook is generally good--most people end up delivering healthy babies.

I'm so confused.  Which diagnosis is correct?  What the hell is wrong with me?!?

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