My story is long, but I wanted to
include as many details as possible to
hopefully help others in my position.
Please feel free to e-mail if you have
questions.
--
After a completely uneventful first
pregnancy (induced at 41 weeks, no
complications during or after
pregnancy), we were shocked when our
next pregnancy ended in miscarriage at
12 weeks. Our doctor said it was OK
to try again right away, and this
pregnancy also ended in miscarriage
(the baby stopped developing at about
8 weeks). With both of these losses,
I had subchorionic hemorrhages
(bleeding that may have been due to
implantation).
We went through a panel of tests that
revealed I had a gene mutation (MTHFR
c677t) that some suggest may be
responsible for miscarriages, but no
clotting disorders or other obvious
reasons. (My OB suggested
miscarriages increase with age, and I
was now 37.) A high risk
perinatologist suggested I take extra
folic acid (800mg / day) and a baby
aspirin daily and gave us the go ahead
to try again.
We became pregnant quickly, but at 5.5
weeks gestation, I began bleeding
heavily (on a Saturday). The bleeding
lasted several hours and included a
few large clots, one the size of a
silver dollar. I was convinced we had
again miscarried and was shocked to
see a beating heart and a baby
measuring right on track when I went
in for an ultrasound the following
Monday. They determined that the
bleeding had come from another large
subchorionic hematoma. I was advised
to stop the baby aspirin, maintain the
extra folic, and when I asked about
them, my OB prescribed progesterone
suppositories through the first
trimester.
I had weekly ultrasounds which showed
the baby growing on track, but
hematoma remained. (It continued to
grow for the next 3 weeks or so,
reaching 60 cm cubed. (My
ultrasonographer calculated volume by
multiplying the 3 dimensions together
and dividing the result by
approximately 2. I'm not sure why
they use this measurement of volume,
but it did allow us to compare size
across u/s's, since the measurements
would vary depending on the shape of
the clot.) After week 9, the clot
started to decrease in size, and by
Week 16 they were unable to find it.
I had my Level 2 U/S at 19 weeks and
things looked like they were going
well. (During this time I avoided
lifting anything over 10 lbs, and
generally took things easy.)
At 21.5 weeks, I felt a gush, and was
certain I had another hemorrhage,
however the fluid was clear. I called
the OB on-call that evening and was
told it was probably just normal
discharge and to call my regular OB
the following morning. I did so, and
was advised to go to OB triage to make
sure it was not amniotic fluid. A
fern test, and a second test
(Amnisure) were negative, and I was
sent home. A few days later, at 22
weeks, I had another small gush.
Another call to the (same) on-call OB
had him assuring me that pPROM was
very rare (1 / 1000 he told me) and
that my earlier hemmorhage "barely"
increased my risk. I was not
confident in his advice, and ended up
going in that evening to OB triage.
This time, the fern test was negative,
but the Amnisure test was "faint
positive." A confirmatory U/S showed
an amniotic fluid index of 5cm, which
is very low. I was admitted
immediately for pPROM and my care was
transferred to a high-risk maternity
group.
I spent 4 days in the hospital
receiving IV antibiotics to ward off
infection. No cervical examinations
were done, as infection is a serious
risk after pPROM. I was sent home on
oral antibiotics for 6 days, ordered
to maintain strict bedrest, and told
to return at 24 weeks for admission
for the duration of my pregnancy.
Although concerned, I am grateful that
the doctors remained optimistic and
hopeful for a successful outcome,
especially after reading many stories
of discouraging doctors.
At 24 weeks, I was admitted and was
given steroid shots to help the baby's
lungs develop. I was told that they
would be monitoring for infection,
which was the biggest risk to the baby
at this point. My temperature was
taken every 4 hours around the clock
and I was to report any abdominal
pain. The baby's heartrate was also
monitored daily. The doctors said if
I went into labor, they wouldn't try
to stop it because it usually means a
subclinical infection and the baby
would be safer out than in. They also
said no more antibiotics would be
given as it doesn't reduce the risk of
infection any more than what I had
already taken, and there are side
effects of continued use. I received
growth u/s's every 3 weeks. I asked
about more frequent u/s's but they
said that the results wouldn't change
the treatment plan so it wasn't
warranted. At each of these u/s's my
AFI measured between 1 and 5 cm. I
leaked fluid almost daily. Things
remained uneventful until I began
bleeding at about 26 weeks. I was
tested for placental abruption and the
test was negative. U/S also showed no
obvious abruption. The doctors stated
that sometimes small abruptions aren't
detectable and as long as the baby was
growing well, it was still safer to
keep him in rather than delivering.
For the next 6 weeks, I bled every few
days, but everything progressed
satisfactorily. The source of the
bleeding was never found. I asked
for, and was granted, continuous
monitoring of the baby. The monitors
were inconvenient, but I was very
worried about cord prolapse, or
something else happening and not
knowing about it in time to do
anything. The continuous monitoring
really helped ease my mind, even if it
made my stay physically less
comfortable. I was vigilant about
hygiene and limited visitors to reduce
the chance of any infection. I also
drank at least 1.5 l of water and an
Emergen-C drink daily.
At 28 weeks I was given a "rescue
dose" of steroid shots and told this
would be the last dose, as research
showed additional doses could be
harmful to the baby. Doctors also
said if I made it to 34 weeks they
would induce, as the risk of infection
at this point becomes greater than the
risks of prematurity.
At 32 weeks I began having
contractions that became more frequent
and painful and began bleeding
slightly more than usual. To this
point, my monitor occasionally picked
up a contraction or two that I had not
felt. Ironically, even though I
reported the painful contractions to
the nurses, they stated that it wasn't
showing on the monitors. I was told
to empty my bladder, drink water, and
was given a shot of terbutaline to
stop contractions. (I initially
objected to this, as I had been told
no attempt would be made to stop
labor. The nurses explained that at
this point, they weren't sure if the
bleeding was causing the contractions
or the contractions were causing the
bleeding and the terb would let us
know. I consented, and the
contractions lessened, but only
slightly.) Within 6 hours, the
contractions were very painful and I
finally convinced the nurses to call
the doctor. I was transferred from
antepartum to labor and delivery at
615am and by the time they had me
connected to monitors, the
contractions were strong and only 3
minutes apart. A cervical check
showed I was dilated to 3 cm. By the
time of the next cervical check, the
nurse could feel the baby's head.
They called for the doctor, but I
delivered my 3lb 15oz son to the hands
of the L&D nurse at 657am before the
doctor could arrive. Isaac was
breathing and crying at birth with
APGAR scores of 8 and 9. I held him
for a moment and he was immediately
brought to the NICU while I underwent
a D&C for retained placenta.
Our son had a rough first 48 hours.
He quickly developed pulmonary
hypertension and was having difficulty
breathing. He was put on a
ventilator, given steroid shots and
surfactant to help develop his lungs,
and eventually placed on nitric
oxide. I believe the NO saved him.
By his 3rd day he was breathing room
air only and continued to do very
well. We had a few NICU scares of
infection, but he did very well in
general and came home on day 27 at 36
gestational weeks. He was sent home
on an apnea monitor which went off a
few times a day until he reached his
due date, then he occasionally
suffered from what doctors identified
as reflux-related apnea spells (where
he would reflux, hold his breath, and
his heartrate would drop. These were
always self-correcting and never
seemed to pose a serious risk.
Isaac is now 5 months actual and doing
well. We expect his doctor will
cancel the apnea monitor at his next
check-up in a few weeks. We will be
both sad and happy to see it go. His
last reflux-apnea was over a month ago
and was only 3 or 4 seconds in
duration. Presumably even term babies
do this sometimes but it's not
identified because most aren't on
monitors.
It was a scary, intense roller-coaster
ride, but I was happy with the
research-based care I was receiving
and as difficult as the 9w hospital
stay was on me and my 2yo son, it was
worth it in the end.
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