RH- with bleeding in 1st trimester

[jeninejessica]

Hi ladies, I'm wondering if anyone can help me. A freidn recently found out she was pregnant, and based on her last period, thinks she's around 11-12weeks along. She went in for a dating ultrasound last monday, and was told by the nurse there was absolutely no way she was 11 weeks... it was more like 6 weeks. Rest of the ultrasound went horrible, and she got a call frm her Dr on Friday telling her she had to come in that day to see him.

Since then she's been told that there may be problems with the growth (although baby seems to be doing ok still), and at first they were concerned the baby had died and body was not miscarrying it... this doesn't seem to be the case now. They checked her HcG and the first test was normal (it was increasing), and then the second it went down, and she did another one this morning, she's waiting for results. She's confused though because she was under the understanding that it's supposed to go up until about your 10th-11th week and then plateau and then slowly decrease again? So based on where she *thought* she was-- this may be normal, but based on her ultrasound- this is not a good sign.

She has been bleeding since Saturday night, but has no cramping whatsoever, and still *feels pregnant*, nauseaus, sore breasts, hunger, tiredness, etc. As of last night and this morning it was darkening and tapering off. It got worse the two times she was active (worked one shift).

She was also diagnosed as RH- and was given a shot on Saturday. Is confused as to why? Perhaps there was concern about the placenta having torn?

She can't seem to distinguish her symptoms and figure out what's going on, and Dr seems to be giving only half the story. Any ideas on what she can expect? We can't find any similiar cases.

[nashvillemidwife]

I'm in a rush and can't address the "what to expect" part of your post right now, but the Rhogam was entirely appropriate any time an Rh- woman has bleeding past the first few weeks of pregnancy. Bleeding suggests there is a problem with the placental integrity and the mom is at risk of fetal blood crossing over into her blood stream at the site where the damage occurs.

[jeninejessica]

ok thanks. She thought that was why she had received it, but wasn't exactly sure. Her Dr has been slightly less than helpful, offering her 'best option' at this point as a d&c since they don't know what's happening with the baby yet.

[Jane]

It's possible she had a miscarriage and got pregnant again - or had twins and lost one - that's one reason why hcg goes up, down, then back up.

If she's comfortable with waiting - that's probably the best choice for someone who wants to be pregnant. It risks a long drawn out waiting period with possible sad news - those women often wish they got it over with early. Of course, those with viable pregnancies feel no such thing!

Rhogam is the recommended treatment for any pregnancy bleeding. If she's onle 6 weeks - the baby doesn't have blood to mix yet. But they can't take that chance.

[jeninejessica]

Thanks Apricot. Every little bit of information I can give her helps. It was an unexpected pregnancy (hence how she got to possibly 12 weeks without knowing), but since she HAS known, she has gotten really attached. I feel so sad for her that she only had a few uninturrupted days with her news.

She hasn't had any period bleeding or spotting until this week since early November. Does that rule out there being two separate pregnancies?

I apologize for what may be a silly question, but would an ultrasound at 6 weeks be able to detect twins? They didn't mention anything to her, and the bleeding did not start until 6 days after the ultrasound.

She definately wants to wait. She was pretty horrified when the Dr offered the D&C knowing that as of right now- the baby is still ok. She knows things might not end up going well, but there's no way she could chance it.

I totally forgot the one other very weird symptoms she's been noticing just these past few days since all of this started. She noted that she's been having a fiar amount of pain while trying to have a bowel movement. I'm assuming she means in her stomach, or cramping, not as in hemmroids etc. Any clue what this could mean?

Thanks ladies. This means a lot to her to figure out what's going on.

[Jane]

They can miss twins with a 6 week ultrasound. Sometimes they even "miss" a singleton. There is a big difference between the older and newer ultrasound machines and some babies hide nicely.
I've also heard the figure that they miss 2-3% of twins on the 20 week ultrasound - seems fishy to me, but that's the official statistic.
I don't think that no bleeding totally rules out another pregnancy. There are some strange things that happen. I think there is a good chance she is miscarrying, but it's not clear yet. If she is okay with it - watchful waiting seems appropriate.
If I had to guess - that's all I'm doing - it sounds like she might have some hormonally related constipation. The progesterone that maintains the pregnancy softens all the smooth muscles in the body - the uterus to prevent cramping that might expel the baby - and the colon, too. It really slows things down, the poo gets dehydrated, and consequently, many women get pretty constipated. The typical advice is to do lots of fruits and veggies and water. All the "make you go" constipation remedies are contraindicated in pregnancy.