I’m only “5 weeks pregnant” (ie the embryo was transferred less than 3 weeks ago) and of course I already have a threatened miscarriage. I was sitting in my office today when all of the sudden I felt a gush between my legs. I went into the bathroom and there was blood everywhere—it was reminiscent of unexpectedly getting my period when I was a teenager. So that was not good. (Fortunately I was wearing really thick tights and had an extra pair of underwear and a thick pad in my desk.) I called my doctor’s office right away and they got me in for an ultrasound. In the three hours between when the bleeding started and when I was at my doc’s office, I bled a lot. Like filling a large pad every hour and larger than quarter sized clots in the toilet a lot.
I went into the doc’s office and they confirmed it—I have a subchorionic hematoma. A big one. Right next to the (presumed*) sac. He said that subchorionic hematomas are not uncommon, and that many women who have them will still go on to have a healthy pregnancy. He said that until recently he would have put me on bed rest, but recent literature indicates it may not matter. That’s not to say I’m going to be running a marathon anytime soon…. He said move slowly, walk softly, etc. And if I want to do bed rest do bed rest. But nothing strenuous. No travel.
Okay, what’s a subchorionic hematoma? Bleeding (hematoma) between the chorion (a membrane surrounding the embryo) and the uterine wall. What causes it? Who knows.
Subchorionic hematomas are vastly more common in IVF patients than the general population:
“[T]he frequency of SCH is significantly higher in the in vitro fertilization group (22.4%)” (The study did not even INCLUDE women who did IVF)
The larger the hematoma the worse: “A very large first-trimester hematoma is associated with a 46% risk of adverse pregnancy outcome”.
Even women whose pregnancies continue have more adverse outcomes: “In the case of prolongation of pregnancy, patients with SCH have a higher risk of maternal and neonatal complications of hypertension in pregnancy, preeclampsia, placental abruption, fetal growth retardation, fetal distress, and others”.
The study concluded that “pregnancy loss during the terms of 6 to 12 weeks in [SCH] patients was 4.64 times higher” than the non SCH patients.
For women with a “live fetus” about 10% with subchorionic hematomas miscarried. The rates of miscarriage were higher (double) if the subchorionic hematoma was large. The rates were higher (double) if the women were over 35. And the rates were higher (double) if the bleeding was at less than 8 weeks gestation.
The overall spontaneous abortion rate was 9.3% (48 of 516 patients). The rate nearly doubled when the separation was large (18.8%) compared with small and moderate hematomas (7.7% and 9.2%, respectively). A large separation was found to be associated with an almost three-fold increase in risk of spontaneous abortion. The spontaneous abortion rate was approximately twice as high for women aged 35 years or older versus younger women (13.8% and 7.3%, respectively) and for women with bleeding at 8 weeks gestation or less compared with those with bleeding at greater than 8 weeks gestation (13.7% vs 5.9%).
Mine is large, I’m over 35, and I am at less than 8 weeks gestation. Shit. Shit. Shit.
This article is even MORE of a bummer. While it basically says nothing is proven, it goes through all of the bad shit that can happen from a SCH (miscarriage, placental abruption, etc):
This article suggests that there may be a benefit to bed rest:
It also reports that length of bleeding did not matter.
UGH. Some of my long-time readers are like, “heeyyy, didn’t you have this before?” I’m surprised you remembered! Yes, sortof but not really. With my son I had some kind of internal bleed (that they never fully diagnosed, even when I was released to the high-risk OB):
But I never had any external bleeding, so it was less scary than this.
I also talked to my doctor about my strange and very severe 12-hour morning sickness. He was like, “yea, probably not. Sounds like a bug.” Son of a bitch! I did NOT want to get sick during my neural tube closure window. Also, he told me to go off of my aspirin and Medrol right away. So that solves the question of how long I’ll be on Medrol.
So what to do? Rest and hope it goes away. The bleeding seems to have stopped (at least externally) for now. No surprise—I have been doing a 12-hour kegel.
*The sac is so tiny at this point that they were not 100% sure it was even there—they identified something they thought was the sac. It was measuring at 5w0d, even though I’m 5w3d. I don’t know how much I can read into that when they were not even sure what they were looking at. I think they should have been able to more easily identify the sac at this point. This is all just really bad.
If things were going the way they should have been going, my HCG should be hovering around 10,000. I know that 5w3d is early for a heartbeat… but it’s not that early. This article seems to suggest that they should have easily seen a sac, yolk, and maybe even heartbeat:
When the level of HCG reached 1000 mIU/ml by using the first International Reference Preparation, a gestational sac was seen sonographically in each patient. When the HCG level reached 7200 mIU/ml, a yolk sac was seen in every patient. Ten of 22 patients with HCG between 1000 and 7200 mIU/ml had a visible yolk sac. Every patient with an HCG level greater than 10,800 mIU/ml had a visible embryo with a heartbeat. A discriminatory level of 32 days was found for the presence of a gestational sac. A yolk sac was first seen in every patient between 36 and 40 days. Every patient with accurate dates greater than 40 days had an embryo with a heartbeat identified. When correlating sac size with structures within the sac, a yolk sac was first seen in a gestational sac between 6 and 9 mm and a heartbeat seen in every patient with a 9-mm or greater gestational sac diameter.
Dammit!
