Miscarriage questions - please advise.

May 7, 2009 8:00 AM

Need help diagnosing miscarriage/blighted ovum, specifics inside.

Hi all, I'd love some feedback regarding the recent events in our pregnancy. This past Monday (3 days ago) my wife was 8 weeks pregnant. "Officially" pregnant - positive tests, all the symptoms (missed periods, sore breasts, enlarged belly, and confirmation from her OB/GYN). On Tuesday she experience heavy bleeding. Within hours she felt "different", and she seemed to know that she was miscarrying. Her breast soreness also decreased.

Wednesday she visited her doctor who performed an ultrasound and said there was an empty sac. They told her to come back for a followup ultrasound next week. She's experienced additional bleeding (not just spotting) and significant cramping as well.

Today (Thursday), she got a call from the Ob saying her bloodwork came back and her progesterone levels were very low, around 6.2 (they said they should be in the teens at this point). They want her to come back tomorrow for another round of bloodwork "before they can D&C".

So. To me, all signs point to a miscarriage of some sort - specifically an early pregnancy failure or "blighted ovum", as all the books/websites describe it. However, her doctor has never specifically said it IS a miscarriage, just told us the test results and basically said "tune in next time". Which is leaving us in an emotional wreck, without any idea what to do.

I guess my I'm basically looking for some form of confirmation. Some specific questions:

- Is there any chance that this is not a miscarriage? I've read about misdiagnosed blighted ovum scenarios, etc. One thing is for sure: We do NOT want to perform a D&C if there is ANY possibility of a continued pregnancy.
- Even if we get a followup ultrasound next week that shows an empty sac (at week 9), how can we be sure that there's still not a chance?
- What questions should we be asking the doctors about this situation?
- I know D&C is generally optional, and my wife is NOT AT ALL excited about having this procedure performed. But she's also terrified of the idea of letting it just "sit" inside her for an unknown length of time... How long should we really expect to wait for her body to eject it on its own? Is there some point where we should bite the bullet and have the D&C done?
- Any other relevant information would be great.

We're not looking for false hopes. We're basically resigned to the fact that this is a failed pregnancy one way or another, but our consciences will certainly not allow us to do anything to abort the pregnancy if there is any chance of viability. So what should we do, what should we know, and what should we ask?

(For those who care: We're doing "okay" emotionally. My wife is pretty fragile emotionally anyway, and she's been alternating between "trainwreck" and "sedate". I'm doing all I can for her - I took off work yesterday to take her out to lunch and walk the mall to get her mind off things, and I think it really helped. I'm taking care of the house, cooking, shopping, etc - she's off work and just taking it easy. We've drawn especially close these past couple days, and communicated openly about this situation, and I don't think there's much more we can do. The hardest thing for her is the not knowing - and when the doctor calls with an update that doesn't give us answers, only more questions, it destroys all the emotional progress she's made to cope with this and we have to start at square one. She just wants it to be over, I think, as sad as that fact is to handle. Also know that this was a planned pregnancy and that we're going to be trying again, but we're not about to throw this one out the window!!)

posted by anonymous to health & fitness (15 answers total)

First of all, let me say that I'm terribly sorry that you and your wife have to go through this, especially with a planned pregnancy. Second, I know it's hard to deal with doctors a lot of the time; as the non-pregnant partner it's really your job to be the advocate for your wife. It sounds like you're really not getting the answers you need from your physician, which is something that you need to strongly convey to her: "My wife is upset and confused. We needs a clear explanation of what is going on and what our options are at this point before we move on with any procedures." To me, it seems that the reason they're having her do more bloodwork is exactly because they want to confirm that the embryo isn't viable.
posted by muddgirl at 9:02 AM on May 7, 2009 [2 favorites]

I think you should call your wife's doctor back and try to get some better answers. I'm sorry you're going through this. In my totally unscientific, completely non-medical opinion, it does sound like a miscarriage. The bloodwork she gets tomorrow will speak to this. These things quite frequently take care of themselves (without a D&C) but the ultrasound next week probably isn't so much for determining viability but to ensure that all of the tissue has been released. They'll continue to do bloodwork to monitor the HcG levels and if they fail to come down all the way, might recommend a D&C but probably only if it's really necessary. Take care of yourselves.
posted by otherwordlyglow at 9:11 AM on May 7, 2009

First, my condolences to you on the loss of your baby. I've been there, and I know the pain you're both going through right now.

Second, what muddgirl said: Call up your OB's office with this list of questions in-hand and don't hang up until you get them answered. Is there a nurse in the office whose job it is to answer these sorts of questions? Often, there is -- in particular because the MD perhaps isn't really good at the whole "bedside manner" thing.

Now, some personal experience -

-- I suspect this is your first pregnancy. Miscarriages -- especially miscarriages in the first pregnancy -- are incredibly common and not any sort of medical emergency. Don't get too hung up on the "blighted ovum" thing. No one understands the cause of the vast majority of miscarriages. They just ... happen.

-- If she's bleeding heavily and cramping, that is her body's way of trying to expel the placenta/embryo/membranes on its own. I'd be wary of any OB who wanted to do a D&C on a woman who was already going through this process. To your list of questions I would add: "Why, specifically, do you want to do the D&C?"

I don't know anything about "misdiagnosed blighted ovum" but what your wife is experiencing sounds, to me, like a classic miscarriage. No idea why your OB is being so cagey about it.

Feel free to email me or Mefi mail me if you or your wife want to talk about this. As I said, I've been there.

Peace to you and your family.
posted by anastasiav at 9:17 AM on May 7, 2009 [1 favorite]

Sorry for your loss. We went through this. The thing to think about that is worse than a D&C is an emergency D&C. You're better off scheduling it. The thing with "delivery" is that she might not stop bleeding then you're in an emergency situation.
posted by notned at 9:42 AM on May 7, 2009

My heart goes out to you and your wife. Miscarriages are one of the worst experiences anyone - man or woman - can go through. I've had two and neither was a walk in the park.

With my first miscarriage, I had no bleeding, but I did have the diminished symptoms just like your wife. The fetus had stopped developing at 9 weeks. I was wary about having a D&C because I wasn't convinced that the fetus was gone, so I went back to my doctor and asked for confirmation. He stated that he performed all of the different scans - heat, etc - to determine if there was any viability and found none. I think I needed to ask the questions to know before I could really let go and have the procedure. We had chromosomal analysis performed on the "products of conception" and it turned out to be a monosomy (aka Turner's Syndrome) which is 95% fatal. I had no regrets at that point about the D&C because I knew that the doctor was right that the fetus was gone.

I understand how frustrating it must be to be getting non-answers from your doctor, but I think they actually are trying to be 100% certain that the pregnancy is not viable before scheduling a D&C. Throwing around the 'm' word carelessly might be as cruel to you and your wife and stringing you along waiting for a definitive answer. Hence the request that she come back for a follow up visit.

I will tell you that with my second miscarriage, it was initially predicted very early - at about 5w6d. But, my HCG kept going up and I hadn't miscarried. They brought me back about a week later for a follow up and lo and behold, there was an embryo with a heartbeat where a previously empty sac had been. Needless to say, I was floored. Unfortunately, the heartbeat was gone two weeks later, and the miscarriage was confirmed. I tell you this not so much to give you hope - since, ultimately I did miscarry again, but to impress that the need to wait things out and see what it looks like in a few days is actually really important.

But, the limbo land that you are in is just awful.

With respect to whether to have a D&C performed, assuming that it is a miscarriage, I would recommend it, if only because it gets it over with quickly and with little pain. The people I know who have miscarried naturally have experienced a lot of pain and prolonged bleeding. Not saying this to scare you, but it is a very real possibility. Generally, the farther along you are, the worse it gets. Some women have actually had to go back and get a D&C in the end anyway because they didn't pass everything naturally.

Also, having the D&C makes it alot easier for the doctor to get everything out the first time and to be able to send it along for chromosomal analysis, if that is something you want to have done.

Above all, just be good to yourselves. This is a terribly difficult time for you both. It gets better, though. It really does.
posted by Leezie at 9:44 AM on May 7, 2009

anonymous: Even if we get a followup ultrasound next week that shows an empty sac (at week 9), how can we be sure that there's still not a chance?

Honey, I am very sorry you're going through this. I understand how painful this is and the desperation to cling on to hope. But as awful as it is, you have to be realistic, both for your wife's health and your mutual emotional well-being.

This is what a 9 week ultra-sound looks like. There is a clearly defined fetus there. If your ultrasound just shows an empty sac, then you can be confident there is no pregnancy.

Is there some point where we should bite the bullet and have the D&C done?

Yes. The point at which she wants it to be over. Which is already now.

Bleeding, cramping, falling progesterone, and empty sac ultrasound is a textbook miscarriage. But I think you should call the OB back, or wait till your next ultrasound, and say "So this is definitely a miscarriage?" if that will put on this the words you need to hear to accept it.
posted by DarlingBri at 10:04 AM on May 7, 2009 [1 favorite]

I agree with everyone here that you should call the doctor and ask your questions. Doctors often think they are being clear when they really aren't. The doctor may not realize that you're questioning is this/is this not a miscarriage. Also, some doctors tend to shy away from the term "miscarriage" because it has an imprecise, layperson connotation in the medical profession. The technical term is "spontaneous abortion" but doctors often don't like to use that term either, for obvious reasons.

I had a miscarriage years ago, at around 8-9 weeks. There was a lot of bleeding, but really no pain. I did not have to have a D&C, but they did an US to ensure that all the products of conception had passed. When I was going through this, the doctor told me I was "probably" having a spontaneous abortion/miscarriage (he actually used both terms), and described what would happen next (blood test, US).

A good doctor won't mind in the least that you are calling and asking for clarification. Even just asking, "is this probably a miscarriage, or is something else going on here?"
posted by jeoc at 10:05 AM on May 7, 2009

I'm sorry for this frustration, I went through this twice with my (ex) wife.

Look, one 'positive' thing to keep in mind; biology is a wonderful thing.

We had a great doctor who had to deal with patients in this situation (loss) all the time. He pointed out there's a reason that my wife miscarried - the child wouldn't have been healthy. It's not that every fetus that makes it through birth is going to be healthy, but biology is designed for the health of the baby and mother.
posted by filmgeek at 10:41 AM on May 7, 2009

My condolences to you and your wife. This is where you get to demand good, reliable information from your ob/gyn's office and as others have said, be an advocate for your wife. I wish I had known as much when I had my miscarriage years and years ago. Good luck to you both.
posted by Lynsey at 10:46 AM on May 7, 2009

I have had a blighted ovum, and it was exactly as you described - symptoms of pregnancy, with bleeding at 8 weeks, low/falling hormone levels and an empty sac. My GYN was pretty cagey about it too, and when I kept referring to it as a pregnancy, actually snapped a bit and said "there isn't a pregnancy here, there never was." Ouch.

I had the D&C, and did not really think there was an option not to. It's uncomfortable and emotionally draining, so please prepare a nice nest for your wife to rest in when it's over. The best to both of you - be kind to yourselves and each other.
posted by The Light Fantastic at 10:48 AM on May 7, 2009

I am sorry that you both have to experience this.

If you feel like you need support, http://stirrup-queens.blogspot.com/ is sort of a hub of an incredibly supportive community, and it's also a good jumping off point for a lot of factual resources as well.

If you wanted to set up an email that you could give out, I would suggest getting in touch with Mel (who runs the site) and ask for your question to be posted on LFCA (http://lostandfoundandconnectionsabound.blogspot.com/), which is a part of the same place, and leave your email as a contact point.

I wish you both the best.
posted by KAS at 11:15 AM on May 7, 2009

One thing not mentioned here yet is the option of trying drugs before a D&C. And speaking of, she should not be afraid to ask for painkillers; it can get quite physically painful before it's over. Sorry to you and yours.
posted by kmennie at 12:46 PM on May 7, 2009

My deepest sympathies to you and your wife -- I too have been through something similar (fetal heartbeat slowing, then stopping, between 7-9 weeks, followed by D&C at 10 weeks) and I know how painful it all is.

Honestly, and I am not a doctor, I think the chance of this being a successful pregnancy are virtually nonexistent. I say this because I've heard several accounts of fetal heartbeats not being detected on ultrasound (say, at 5-6 weeks) but then popping up a bit later. Pregnancies are also sometimes misdated if the mother didn't know the date of her last period, the date she ovulated, etc. However, DarlingBri is right -- an ultrasound at 8 weeks should be quite clear, and to show no signs of a growing embryo wouldn't make me optimistic. If the 9 week ultrasound doesn't show a clear embryo and a beating heart (in the healthy range), I can't fathom things will improve from there. I am so sorry.

That said, everyone is right that you and your wife should ask whatever questions you need to in order to feel comfortable. Your OB/GYN needs to put things in layman's terms -- this is nothing to be vague about. I am not sure if the evasiveness is some attempt to spare your feelings and your wife's, but this is a situation where they need to provide you the answers you need.

FWIW, and I know this isn't the avenue you intend to take, the scheduled D&C honestly isn't that unbearable, physically speaking. Mine took a very short time, and I recovered over the next day or two (but with minimal pain and almost no bleeding). It was a relief to me to know that all the tissue was gone (I had been carrying around a non-living embryo for a couple of weeks by that point) and to begin the emotional healing process.

Again, my condolences to you and your wife, and please feel free to MeMail me if I can offer any further support.
posted by justonegirl at 6:06 PM on May 7, 2009 [1 favorite]

An empty sac is a clear sign of blighted ovum and while it could be something else - as in, some other reason for miscarriage - it *can't* be a viable embryo.

So, so sorry for your loss. I had a blighted ovum a few years ago - I knew I was pregnant, but I also knew that it wasn't going to "take" so to speak. It was just awful. Be good to your wife. Also beware that she could be fine for a while and then suddenly... not be so fine anymore. It took a few months for the grief to really, truly hit me.
posted by grapefruitmoon at 7:17 PM on May 7, 2009 [1 favorite]

It's much too late for the OP - I hope you are both ok now. But I wanted to post for anyone else that a 'natural' miscarriage is not necessarily the worst way to do it.

I miscarried at 12w (missed at 8w) and am kind of glad I didn't have a D&C. However I did miscarry while in hospital for observation. For me this was a good outcome; I felt safe being in hospital but didn't have the distress of aneasthetic and surgery. If you want to/have to do it at home, I think it would be okay; just get some good prescription painkillers (insist you are given some when miscarriage is diagnosed) and go straight to hospital if the bleeding becomes heavy or the pain is frightening. If this does happen, hospital triage can be a bit crappy about miscarriage; make sure you mention 'heavy bleeding' and 'possible hamaeorraging' and this should mean you aren't sitting around in the waiting room for too long. Take care.
posted by 8k at 4:03 PM on May 26, 2009