We had our second meeting this week with the Maternal-Fetal Medicine specialist (MFM/high risk OB) last week. From New Year’s Day forward, it was a long, hard slog through one moment after the next for about a week. First the trips to the ER on New Year’s day, then the OB’s office the next day which was a Friday, but I was hoping to make it through that weekend without needing further medical intervention.
The Saturday after New Year’s, I’d continued to bleed. I watched closely, mostly just waiting throughout the day. I went to bed. Woke up at 2 am Sunday morning feeling medium-strength contractions moving through my abdomen. More clots. More blood. More fear. I told Arthur we needed to go to the hospital because while I didn’t think I was in labor, that the contractions were more likely my uterus getting irritated from passing all the clots, they were getting stronger. Hopefully I could be given something to slow the contractions to prevent the onset of actual labor.
I checked in at the ER, and after a quick consultation with the ER triage nurse, who placed a hand on my abdomen and could easily feel the contractions, I was sent to the OB unit. My cervix turned out not to be dilated which was a very positive sign, but the contractions were definitely a problem. I was given a shot of pain medicine mixed with an anti-nausea drug, since sometimes the pain medicine can slow contractions, and then a dose of a calcium-channel blocker that’s normally used for high blood pressure and relaxes smooth muscle – including the uterus. The contractions, thank heaven, stopped.
We went home. I slept on and off for hours, mostly waking up with a terrific headache that the nurses had warned me would likely happen when I’d gotten the calcium-channel blocker and mild nausea which I almost always get with pain medication. I was grateful they’d given me the anti-nausea drug. The contractions had stopped, but the bleeding had continued. I soaked pads in bright red literally down to my socks. I called the on-call OB. Back to the OB unit at the hospital, where an ultrasound showed that the baby was fine, my hemoglobin decent, and that the clots were essentially gone from my uterus. The reason I was bleeding had was that when the clots had come out, the blood vessel that had caused the SCH had probably started oozing again or there had simply been a pocket of blood behind all the clots that was now coming out.
I went on bed rest for a bit. Tuesday, Jan. 6 at my normal OB appointment, the baby’s heartbeat was strong on the doppler, which was reassuring. My OB encouraged me to go ahead and get a doppler for home use if I wanted since at 19 weeks, the heartbeat would be generally something I could find even without a professional-grade doppler. I have an anterior placenta, so even though the baby is always moving on ultrasound, I don’t feel much as far as kicks or movement yet. There’s an occasional flutter, but it’s faint and sporadic when I do feel them.
Wednesday Jan. 7, we went to see the MFM. The ultrasound tech took us back and measured the subchorionic hematoma, as well as lots of measurements on the baby. The verdict was that the baby looked anatomically normal and growing appropriately for gestational age. The placenta looked good. The clots were largely gone, other than a very thin strip and a small pocket of liquid blood. My cervix was long and closed.
When we met with the MFM after the ultrasound, he told us that he was glad to see the large clots gone. If he hadn’t actually seen the clots for himself, he said, he wouldn’t be worried about the pregnancy based on the current ultrasound. The only reason he was still mildly concerned was that he had seen the enormous clots from before. He then told us that when he’d seen me at 15 weeks, he had not been very optimistic about my chances of having the pregnancy continue. I remember that he’d told us at that time that the next 7-10 days would be crucial and that I needed to avoid infection, but hadn’t elaborated on my actual chances. I’m very glad he didn’t, because there was absolutely nothing we could have done about the whole situation except what was already being done, and it just would have made me even more anxious (if that was even possible) than I already felt.
The MFM said that my cervix seems to be pretty elastic, since it let all the clots through and somehow stayed long and closed. He said that while he had wondered originally if I hung on to the pregnancy if I’d need a cerclage, he didn’t think that was necessary right then based on what he’d seen during the examination and ultrasound. Doing a cerclage also meant the attendant increased risk of infection and inflammation, so we were glad I didn’t need it so far.
The other big question was how likely I am to go into preterm labor. The MFM pointed out that a high risk factor for preterm labor is bleeding in the second trimester, which of course I’ve had all along. The current plan is that he’ll reevaluate me at around 24 weeks, give me a shot of the steroids to mature the baby’s lungs just in case, and then if everything is still okay at 28 weeks, I’ll get a second dose of steroids.
According to the MFM, we are not out of the woods yet but closer to the edge of the forest.
I continued to bleed, but it started to taper off over the weekend. Today, I went in for my usual check-up (I’m seen weekly for progesterone injections to help keep my uterus quiet), and was happy to note that there wasn’t a large, new pocket of blood sitting in there. Instead, it looked more or less the way it had at the MFM almost a week earlier. Right now, it’s mostly a watch-and-wait situation to see if the bleed has really stopped. Infection is still a risk. However, everyone is far more optimistic at this point now that the clots are out and the pregnancy is still progressing. It’s hard to believe I’m almost to 20 weeks!