A very different pregnancy
Well, yesterday was mostly good news, and a little bit of (not unexpected) bad news. The good news is that the baby is growing very well, measuring 3 days ahead of schedule, with a strong heartbeat of 156bpm, which I think is exactly what Maya's was at her NT scan. New baby's NT measurement was a wonderfully low 1.4mm, and the basic gross anatomy check looked perfect. They did more brain hemisphere shots than they did with Maya, which was kind of fun. We got one clear look at her girl bits, and indeed, they do in fact look like girl bits. Overall, she was active and moving - so fun and beautiful to watch - and completely gorgeous.
Now to the bad news...so I definitely have an active bleed (called a subchorionic hemorrhage, or SCH). I knew something has been "different" (read "wrong") about this pregnancy because I've pretty much spotted through most of it, which NEVER happened even once with Maya after implantation. I also had one actual bleed event with red blood, although it was quite small as these things go and triage/midwives wouldn't even see me unless or until it was much worse. The machine yesterday was waaaaay better than the one used for my quickie ultrasound at 8 weeks, so that's probably why the SCH wasn't officially detected/diagnosed until now.
There were a number of possible causes of my bleeding, some of them stemming from potential complications of my c-section (e.g., placenta accreta, which would have been bad), and an SCH is definitely the most common and benign of the possibilities, so that's a huge positive. Also in the positive category, my bleed is (currently) relatively small as these things go, about 2.9cm long and 0.5cm wide, and positioned about as well as we could hope (far away from the placenta). The larger the SCH is - they can easily be triple the size of mine - and the closer it is to the placenta, the (much) greater the chances for placental abruption and a second trimester loss (or at least preterm labor), which is of course super scary. The other bad news is that the bleed hasn't started to "organize" yet, which would mean that it's clotting and healing, and would appear gray on the ultrasound. As you can see in the image below, my bleed is still quite black and therefore fluid.
Presuming my body does deal with the SCH successfully, there are two ways that this could go: 1) in time, the SCH "organizes," my body absorbs it on its own, and it'll be gone by ~20 weeks - this is statistically the most likely outcome, or 2) I bleed the rest of it out, which is not an unlikely outcome, given how close the SCH is to my cervix (which is happily still very long - 4.1cm - and very closed, yay!). In some cases, women with SCH's, especially large ones, are monitored weekly by ultrasound to ensure that the bleed is shrinking in size rather than growing. SCHs are a bit unpredictable, and they can re-bleed and get much bigger very quickly, sometimes with no external signs that anything is wrong (this is of course the scenario about which I am most afraid). The OB that met with us after the NT scan basically said two things: 1) although the SCH is clearly a risk factor, of the many bleeds she has seen, I'm in the low risk category, and 2) even if I was monitored closely, nothing they found would change their recommendations for my activity, nutrition, etc. There's literally nothing they can do for me if the bleed does get bigger. Thus, they're kind of refusing to monitor me - I will only find out more information about the status of my bleed in 6 weeks at the anatomy scan, presuming all goes well until then.
However, the internet disagrees. On SCH forums, bed rest until resolution of the bleed, along with weekly ultrasounds, is clearly the preferred course of action. Primary lit evidence is mixed at best, but most recent studies suggest that at least some reduction of activity, especially during and immediately following a true bleed event with red blood, is generally beneficial. Above all, everyone says to drink absurd amounts of water. Thus, I have been doing these things, even though I wasn't 100% positive that my issue was actually an SCH (although I strongly suspected when the spotting just would. not. stop.). The question is when to feel confident in stopping especially the activity restrictions, as you're not supposed to go back to regular life until the bleed is no long visible by ultrasound. Six more weeks is a long time to go with no more info!
Anyway, so we're in a bit of a holding pattern until 18 weeks. But overall, I'm feeling optimistic because the most probable outcome is a perfectly normal rest of my pregnancy. The very best predictor of the pregnancy's outcome, and the impact of the SCH on the baby, is the baby's growth and development - which could not look more perfect at this point. The best thing I can do is just focus mentally and physically on promoting healing for the next 6 weeks. I will go in and demand to be seen again, though, if I actually see another red bleed before 18 weeks.
However, this pregnancy has thus already been quite different from my first, especially in terms of anxiety. Symptom-wise, the pregnancies have been almost identical (apart from the bleeding and spotting, I mean), but I am much more nervous with this one. I was hoping it would be so mellow, so much so that I'd forget how far along I was and have to look it up, and spend much more of my time devoted to actual work than to scouring books, journals, and websites frantically trying to gather information. But alas, no, I'm counting the days one by one until viability, guzzling water like an untreated diabetic, and monitoring the output of my vag with hawk-like precision and focus. I've also been way more liberal with use of the home doppler, probably too much. Sigh. I'm trying to add in more meditation to my life.
So that's the update from the North Country. As I've been so focused on this for the last month, I haven't done enough work, so I need to catch up on that. Additionally, I begin teaching very soon, starting with a "teaching academy" next week for which they want me to do a bunch of stuff beforehand, so summer is officially OVER. Onwards and upwards!
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| Awww, isn't she CUTE? I think that so far, she looks identical to Maya, actually :) |
Now to the bad news...so I definitely have an active bleed (called a subchorionic hemorrhage, or SCH). I knew something has been "different" (read "wrong") about this pregnancy because I've pretty much spotted through most of it, which NEVER happened even once with Maya after implantation. I also had one actual bleed event with red blood, although it was quite small as these things go and triage/midwives wouldn't even see me unless or until it was much worse. The machine yesterday was waaaaay better than the one used for my quickie ultrasound at 8 weeks, so that's probably why the SCH wasn't officially detected/diagnosed until now.
There were a number of possible causes of my bleeding, some of them stemming from potential complications of my c-section (e.g., placenta accreta, which would have been bad), and an SCH is definitely the most common and benign of the possibilities, so that's a huge positive. Also in the positive category, my bleed is (currently) relatively small as these things go, about 2.9cm long and 0.5cm wide, and positioned about as well as we could hope (far away from the placenta). The larger the SCH is - they can easily be triple the size of mine - and the closer it is to the placenta, the (much) greater the chances for placental abruption and a second trimester loss (or at least preterm labor), which is of course super scary. The other bad news is that the bleed hasn't started to "organize" yet, which would mean that it's clotting and healing, and would appear gray on the ultrasound. As you can see in the image below, my bleed is still quite black and therefore fluid.
 |
| Since ultrasounds mostly only look like unidentifiable blobs, I will try to provide some orientation here. The bleed itself is the black area outlined by the crosses and x's. The top X is on the chorion (one of the membranes that holds the baby), and the bottom X is on the edge of my uterus. Baby's head, looking down through the top of the skull, is the circular blob just above the bleed. The gray rounded blob at the top of the image is the placenta, and the big black area next to the baby's head is the amniotic fluid. Cervix is not really visible, but is down near the bottom right hand side of the photo. |
Presuming my body does deal with the SCH successfully, there are two ways that this could go: 1) in time, the SCH "organizes," my body absorbs it on its own, and it'll be gone by ~20 weeks - this is statistically the most likely outcome, or 2) I bleed the rest of it out, which is not an unlikely outcome, given how close the SCH is to my cervix (which is happily still very long - 4.1cm - and very closed, yay!). In some cases, women with SCH's, especially large ones, are monitored weekly by ultrasound to ensure that the bleed is shrinking in size rather than growing. SCHs are a bit unpredictable, and they can re-bleed and get much bigger very quickly, sometimes with no external signs that anything is wrong (this is of course the scenario about which I am most afraid). The OB that met with us after the NT scan basically said two things: 1) although the SCH is clearly a risk factor, of the many bleeds she has seen, I'm in the low risk category, and 2) even if I was monitored closely, nothing they found would change their recommendations for my activity, nutrition, etc. There's literally nothing they can do for me if the bleed does get bigger. Thus, they're kind of refusing to monitor me - I will only find out more information about the status of my bleed in 6 weeks at the anatomy scan, presuming all goes well until then.
However, the internet disagrees. On SCH forums, bed rest until resolution of the bleed, along with weekly ultrasounds, is clearly the preferred course of action. Primary lit evidence is mixed at best, but most recent studies suggest that at least some reduction of activity, especially during and immediately following a true bleed event with red blood, is generally beneficial. Above all, everyone says to drink absurd amounts of water. Thus, I have been doing these things, even though I wasn't 100% positive that my issue was actually an SCH (although I strongly suspected when the spotting just would. not. stop.). The question is when to feel confident in stopping especially the activity restrictions, as you're not supposed to go back to regular life until the bleed is no long visible by ultrasound. Six more weeks is a long time to go with no more info!
Anyway, so we're in a bit of a holding pattern until 18 weeks. But overall, I'm feeling optimistic because the most probable outcome is a perfectly normal rest of my pregnancy. The very best predictor of the pregnancy's outcome, and the impact of the SCH on the baby, is the baby's growth and development - which could not look more perfect at this point. The best thing I can do is just focus mentally and physically on promoting healing for the next 6 weeks. I will go in and demand to be seen again, though, if I actually see another red bleed before 18 weeks.
However, this pregnancy has thus already been quite different from my first, especially in terms of anxiety. Symptom-wise, the pregnancies have been almost identical (apart from the bleeding and spotting, I mean), but I am much more nervous with this one. I was hoping it would be so mellow, so much so that I'd forget how far along I was and have to look it up, and spend much more of my time devoted to actual work than to scouring books, journals, and websites frantically trying to gather information. But alas, no, I'm counting the days one by one until viability, guzzling water like an untreated diabetic, and monitoring the output of my vag with hawk-like precision and focus. I've also been way more liberal with use of the home doppler, probably too much. Sigh. I'm trying to add in more meditation to my life.
So that's the update from the North Country. As I've been so focused on this for the last month, I haven't done enough work, so I need to catch up on that. Additionally, I begin teaching very soon, starting with a "teaching academy" next week for which they want me to do a bunch of stuff beforehand, so summer is officially OVER. Onwards and upwards!
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