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Subject: misc.kids FAQ on Miscarriage, Part 2/3

This article was archived around: 21 May 2006 04:22:36 GMT

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Misc.kids Frequently Asked Questions Miscarriage Part 2 of 3 --------------------------------------------------------------------------- Causes and Technical Information (cont.) --------------------------------------------------------------------------- I read your post to misc.kids about having 2 miscarriages in a row, and really feel for you. Unfortunately, I had 3 miscarriages in a row (after having a previous normal pregnancy, which made it all the more puzzling). I will be glad to share my experiences with you, but I want to relate a some things first: You said you realized there is not always a reason. Not true! I said the same thing, and our doctor (a specialist in recurrent miscarriages) said there is always a reason, the problem comes in finding the reason. Also, it may be helpful for you to contact RESOLVE. RESOLVE is a support/education/advocacy group for infertile couples. I'm not saying you are infertile, but someone like me (after 3 in a row, I am considered infertile - unable to carry a pregancy to term) is. They have lots of good information on miscarriages, and there are lots of opportunities to get in contact with people you have or are going through similar experiences. I don't have their phone number with me right now, but will get it to you if you want it. Now to our situation. We have a little boy who will be 4 at the end of May. I got pregnant in April of 1992, and everything seemed to be going fine. The ultrasound we had at the time of the amnio showed a beautiful, normal miniature baby. Then, inexplicability, the baby died in utero. I began to get nervous after a while, because a friend at work was pregnant at the same time (we were due 2 weeks apart), and she was feeling lots of movement. I was actually standing in front of the mirror in the mornings, looking at my breasts, asking myself - "Are they getting smaller?" I didn't say anything to anyone, thinking I was exhibiting hysterical pregnancy fears. Well, the water broke at 19 weeks, and I aborted. Thankfully we got to the hospital in time, and it happened there. The pathology showed nothing abnormal, and all my OB could tell me was a guess - a cord accident. A rare, random event. That reasured us somewhat, so we tried again. We lost that pregnancy at about 8 weeks, and lost the third at 10 weeks (that was May of 1993). Well, by that time we said "Enough is enough!" and we found an excellent doctor in Boston who specializes in recurrent miscarriages. My mother in law sent me a newspaper article after the second miscarriage in which the reporter interviewed this particular doctor. I hauled it out and read it after the 3rd loss, and that gave us a name. I then talked to people at RESOLVE, and he was highly spoken of. He is Dr. Joseph Hill, a reproductive endocrinologist at Brigham and Womens Hospital. Here is a description of the tests he ordered for us: 1. Chromosomal analysis of my husband and myself. He said that a chromosomal abnormality in one or both of us could result in recurrent losses, but that this was not too common. This involved drawing a blood sample from both of us. Everything was normal. 2. Endometrial biopsy. This involved removing a sample of the lining of the uterus just before my period started. The development of the lining was assessed to determine if I had a leutal phase defect (ie levels of hormones not right to support a pregancy). By the way - I am not a medical person, and do not have my reference materials with me as I write this, so my explanations my be off somewhat! This was uncomfortable, but not overly so. Some women feel more discomfort than I did. I believe they told me to take motrin before the procedure to minimize discomfort. This was normal. 3. Hysterosalpinogram (spelling?) also called a 'Tubogram' - during this procedure, a dye is injected into the uterus, and the radiologist takes photos to assess the condition of the fallopian tubes (open, closed) and the uterus. Abnormalitites in the shape of the uterus can cause recurrent miscarriages. This was normal. Some women have quite a bit of discomfort with this, but it was not too bad for me. They had me take antibiotics prior to and after the test. This was done to prevent infection. 4. Blood tests for anticardiolipid antibodies and lupus anticougulant antibodies. This was also normal! Tests 1-4 are the standard tests that are performed during an assessment of recurrent miscarriages. During our initial visit, Dr. Hill said that a large proportion of couples are not diagnosed by these tests. He then proceeded to say that he has developed a theory of recurrent pregnancy loss, in which the women's body views the early placental tissue and/or the early fetal tissue as foreign objects. The white blood cells then attack and cause a miscarriage. He has developed a blood test that detects what he calls 'embryotoxic factors'. It is my understanding that these 'embryotoxic factors' are proteins given off as part of the process of attack by the white blood cells. Please remember my previous disclaimer! He said that of the couples who test negative during the standard tests, 80% test positive for the embryotoxic factors. Well, I tested postive for the embryotoxic factors, followed his treatment, and am now beginning the third trimester of a healthy, normal pregnancy. I will be glad to send you details of the treatment, but it is basically rather high doses of progesterone during the first 20 weeks of pregnancy. There is no danger to the fetus. Doctor Hill said that physcians have been prescribing progesterone for recurrent miscarrianges for years, without really knowing if it would work. The thinking was that it couldn't hurt. Well, they may have been treating this condition without realizing it. We naturally asked him about our normal first pregnancy, and the fetal demise. His theory on this is that when the baby died and stayed in the uterus (for as long as 2 weeks, maybe) that my body became sensitized to pregnancies and attacked the subsequent two. He said a normal pregnancy changes the women's immune system to keep itself from being attacked as a foreign object (which it is, being composed of half your partner's genes). Doctor Hill said his treatment has not had the benefit of a double - blind, placebo controlled study because he has not been able to get the funding for such a study. He does believe there is "something to it", though. The women at RESOLVE said he has a high success rate, and that 4 or 5 years ago, when he was just getting started with this, that his waiting room would be clogged with frantic women looking for help. He has modified his office procedures a lot since then, and the situation is busy, but much more orderly. Another empirical verification came from a doctor at the same hospital who is using a special ultrasound technique to study blood flow around the fetus and placenta of women who suffer recurrent losses. Her subjects come from Dr. Hill, and are under his treatment, and she said a problem (for her, not for me) is that there are very few failures (miscarriages) so she doesn't have much data! That was reassuring. I don't know how much reading you have done on the subject of recurrent miscarriages, but a recent theory says that the woman and man can be too close to each other genetically, and that some sort of injection into the woman can help (I don't know too much about this theory). Anyway, Dr. Hill said that has recently been debunked. This theory was promoted by a doctor in Philadelphia. Another thing - Dr. Hill has said that if a couple is in their 30's and has had 2 miscarriages that they should consider having a workup. I don't know your situation, but it is something to keep in mind. Yet something else - Don't hesitate to go to a specialist! You may like your OB/GYN just fine (like I do), but don't feel you are being disloyal by going to a specialist. After the 3rd loss, by OB/GYN said "I can't help you with this". So off we went, and are we glad! Please pursue this with as much vigor as you can muster, and don't give up hope! I have just dealt with the medical aspects of my experience here, not the emotional. Please let me know if you care to exchange notes on the latter. Best of luck and let me know how you are doing! --------------------------------------------------------------------------- Got your message. I'm glad you are seeing a doctor who wants to start testing soon. The tests on me took 1 cycle to complete, which was much faster than I had thought. I should think that your body has to readjust a bit before the more invasive procedures are done, though. In the newspaper article on Dr. Hill, he said progesterone was described in the '70's as 'nature's immune supressor', and that is why they looked at it as a possible treatment for this condition. We asked him why he chose the dosage he did (50 mg progesterone twice a day via vaginal suppositories (ugh)). He said that in the lab they added progesterone equivalant to that dosage to the blood of women who tested positive for the toxic factors, and they (the factors) disappeared. He said there is no guarantee that the levels of progesterone in the women's blood would be the same, however, because each women's body is different. He said if the woman miscarries under his treatment they increase the dose of progesterone in hopes that will deactivate the toxic factors. The blood test he uses is, to my knowledge, different from the usual tests for antibodies (I *think* the usual tests are for the anticardiolipid and lupus anticougulant antibodies - may want to ask your doctor on this). I think he is the only person doing this test, and do not know if he does it 'long distance'. Dr. Hill and another doctor co-authored a chapter of a book, and it deals with miscarriages (causes, treatments). He gave us a copy to read, and I his theory is described there. I'll try to get the reference for you (and your doctor?) if you want. --------------------------------------------------------------------------- Here is the information on the book: Kistner's Textbook of Gynecology. 1990. It will be updated this year. Hill's secretary got the information for me, and when I asked her if she had the publisher, she just laughed. I guess she considered herself lucky to get that information from him (he's busy!). It has been good to correspond with you. Please keep me updated on how you are doing, and how the results of the tests come out. You are doing the right thing by being an active participant, because you and your partner have the most to gain and the most to lose. --------------------------------------------------------------------------- Dreams and Realities by Nancy P. Hemenway Reflecting back on a hot morning in early August, I distinctly remember the eager anticipation of the long awaited culmination of my hopes and dreams in my marriage to David. I was 38 and I had kissed a lot of frogs before my prince came along. Hearing the loud ticking of the biological clock was enough to throw caution to wind (along with our birth control) a whole 2 months into our marriage! My only concern at this point was that I might get pregnant too fast and our "honeymoon" would be cut short! When nothing happened the first year I became concerned but realizing we were both healthy, active individuals, I pushed that thought as far away as possible attributing it to works schedules and bad timing. Another two birthdays and no pregnancy. Then in July while on vacation in Florida I realized my period was late. David and I rushed to a local drug store for our first of many home pregnancy tests. Postive! ! I couldn't believe it! We were finally going to have a baby. Unfortuanately, we were both a little naive and innocent about pregnancy. At about 7 weeks I started spotting so we rushed to the Dr. and had an ultrasound. The results were alright and everything looked fine. He told us 20% of pregnant woman bleed. The spotting continued and the cramping began. The next sono revealed a problem with the sac and the doctor told us I was "threatening a miscarriage". My heart was in my knees but I managed to pull myself together and push these negative thoughts out of my head. At almost 10 weeks we had another ultrasound. The doctor told us the baby was growing again and the sac looked ok. We lost the baby the next day in the hospital emergency room. Having come from a background in nursing, I asked for genetic testing of the fetus. I was told because it was only my first pregnancy they would not do this. I also believe they attributed the loss to my age (41). The genetic testing I never had could have been a major diagnostic link with the problems we have now been diagnosed as having. Several months after my first miscarriage I referred myself to a reproductive endocrinologist who tested both of us for every disease know to man (and woman). Over the next two years, we went through ovulation induction with all the drugs, had numerous IUI's (intrauterine insemination) and finally three cycles of IVF. We were again, overjoyed, when I got pregnant on the second cycle. This pregnancy ended at about 6 weeks. The Quest For a Diagnosis Through all the testing I never had a diagnosis. The doctors never found anything wrong with either my husband or me. "Unexplained Infertility", that's what they call us. We're healthy, active people, "the perfect couple" except we can't do what 90% of the rest of the couples can do. I am not the kind of person to settle for "unexplained", so I set out on my own personal quest to, at least, explain why I couldn't get pregnant or stay that way once I achieved a pregnancy. I searched the internet for articles and read everything I could on infertility. I commiserated with my "sisterhood of infertility" on the medical support bulletin board of Prodigy. One of the women on the bulletin board had a similar history to us and sent me some research studies. I couldn't believe what I was reading. Dr. Alan Beer of the Chicago Medical School in North Chicago Illinois had been studying the immune system as it relates to reproduction for about 20 years. I read about women (just like me) in many parts of the studies. I gathered up the information and took it to my doctor. He told me this was rare and he didn't think I had these problems. I decided to refer myself to Dr. Beer. After a review of my chart, he told us we were indeed candidates for problems in this area and ordered blood tests to be done. Not only did we have these problems but Dr. Beer told us they were about as "bad as he knows they can get!" My new diagnosis was : Habitual Aborter. Dr. Beer had discovered we have three major problem areas: Blocking Factor Problem, Antiphospholipid Antibodies, and Natural Killer Cells. Blocking Antibodies One out of every 200 - 300 couples who marry and start a family will share similar tissue types to their spouse. Basically this is a white blood cell (WBC) problem. In the WBC system symbols relate to different types of cells. The last 4 symbols are called the DR / DQ numbers . these DR/DQ numbers are inherited . Couples who lose every pregnancy are matched for 3 out of 4 of these number (symbols). David and I found out that we are an "unlucky match". Our DR / DQ numbers are 1.1, 1.2, 1.3 and a 4 . There is little more than one amino acid's difference between us. This means we are 75% alike. As you know the WBC system is our defense against disease. Each of the above numbers within the WBC system have little antennae which when touched by a certain virus or bacteria sends signals to make antibodies. These antibodies take care of any foreign interlopers (bacteria) entering the body. The man has all the genes (in his sperm) to blueprint out the placenta. He starts to build the placenta . This sends a message from outside of the woman's body (from the genes within the sperm) to alert the mother's body to prepare for a baby. The message sent from the man is called "g". All the cells of the placenta that line up around the egg have the genes that will be needed to construct the placenta and the message sent is also "g". The mom and dad are now in a partnership together building the placenta. The dad's "g" should be different from the mom's "g". The mom is responsible for making antibodies to dad's "g". This will provide a camoflage for the baby making it a sort of "wolf in sheep's clothing". The "g" of the husband acts liks a fertilizer, a growth molecule telling the placenta to grow and divide. When a couple is similar (as we are) there are too few antibodies to "cloak" the fetus. The placenta doesn't grow and divide like it should, beta tests don't double, ultrasounds may be "up and down" , the sac may disappear and the pregnancy is pretty much doomed. There is hope for this problem. Dr. Beer extracts the WBC from the husband (or a donor if the couple is too similar). The lab takes the WBCs and feeds them wheatgerm . After a couple of hours of breakfast the cells grow and divide. Dr. Beer theorizes at this point the "g" comes out of hiding. A concentrated serum is made (10,000 times stronger than what would be found in the placenta) and it is injected under the skin of the forearm (of the wife) much like a skin test for allergies. After two lymphocyte immuniztions (two sets of injections) the couple ought to be capable of producing the blocking antibodies necessary to take the pregnancy to term. Antiphospholipid Antibodies There are consequences for every action. Pregnancy is no different. Each time a pregnancy doesn't make it inside your body, there are conseguences. This includes even the act of fertilizing an egg. A 20% chance exists with each pregnancy and/or pregnancy loss that one problem make create another. In all probability, this is why we now have the antiphospholipid antibody problem. The phospholipids are a sort of glue necessary in every pregnancy. They look like little snowfalkes (of fat) which have a sticky end to hold the cells together. They fuse into other cells and act like a membrane . Think of them like a swimming pool filter. The phospholipids filter the nourishment from your blood and than in turn filter the baby's waste back through the placenta which feeds the baby and produces the BHCG throughout pregnancy. Phosphlioids necessary in pregnancy are: cardiolipin, ethanolamine, phosphatidic acid, glycerol and serine . In our particular case I have developed an immunity to ethanolamine (this is the "glue" which also sticks the sperm to the egg). Just like being immune to chicken pox and measles (I no longer get them) I now am immune ethanolamine so I no longer get pregnant. Ethanolamine and serine are also the "glues" which are necessary to build the placenta, so even if I were to get pregnant I still wouldn't be capable of building the placenta. Couples with this problem are good candidates for multiple failures at IVF / GIFT / ZIFT cycles. Once you have developed an immunity to one of the phospholipids there will be an attack on the baby even in a donor cycle! This problem is 97% efficient in the end to a pregnancy. However the key which locks this glue in place is your own body's natural heparin. Most people think of heparin as a blood thinner but in the case of combating the phospholipids, heparin acts in a way to lock the glue in place and keep the organs attached. The heparin must be taken preconception because the cells are already functioning as they are lining up around the egg. If there is a pregnancy 86% of the woman will become mothers. If they wait until after a postive pregnancy test 75% will lose their babies again. After the immunizations, treatment with heparin and baby asprin preconception 30% of Dr. Beer's patients have been successful without the use of ART. Natural Killer Cells and "Unexplained Infertility" It seems like years since we sat in Dr. Beer's office on a very cold, snowy Chicago morning in December. The consultation lasted almost two hours and Dr. Beer saved the "best" until last. The problem with my natural killer cells was the "icing on the cake" and probably the most difficult thing for me (us) to deal with. Everyone has (circulating) in their body something called natural killer cells. They secrete a substance called TNF (tumor necrosis factor) and lately the "powers that be" have been looking at the body's own immune system (these NK cells) as a way to fight cancer. The overactivity of these cells producing their TNF is deadly to a pregnancy. Unfortunately for us, I have an overactive immune system. Remember the DR /DQ numbers? I inherited a "4" from my father which puts me on the "Olympic Team of Immune Responses". Unless we can get this problem under control ther may be no way to complete a pregnancy. Treatment involves infusions of IVIG (intravenous immunoglobulin). The drug is called Gammamune and it is administered through an IV over a period of three days each month (preconception). Dr. Beer arranges to have this given through a home health care agency. the latest studies concerning this treatment are more than encouraging. Woman who have unexplained infertility are able to conceive with this treatment. Preliminary studies in recent clinical trials are showing as high as 80% are able to conceive with the use of IVIG. Light at the End of the Tunnel Our consultation with Dr. Alan Beer although hard, was a breath of fresh air. Dr. Beer with his impecable credentials and extensive knowledge of immunology exudes compassion for his patients . For many of us this is our last stop. Dr. Beer did both his residency and Genetics and a fellowship in Obstetrics and Gynocology at the University of Pennsylvania. He is a board certified OB/GYN who is also a joint Professor in the Department of Obstetrics and Gynocology and Microbiology and Immunology at the Chicago Medical School. Dr. Beer has been researching the issues associated with the question of why a mother does not reject the newly formed child in utero since 1970. I hope David and I will have a "Beer Baby" but whatever happens I will forever be grateful to Dr. Alan Beer and his dedicated staff for turning on that light at the end of the tunnel. For there truely is hope now that didn't exsist before. Addendum: Dr. Beer started treating us in November of 1993. We went back to IUI and then again to IVF. We were again successful on our FET (frozen embryo transfer) but this time the pregnancy is well underway. At this writing I am almost 26 weeks pregnant. We are due August 13, 1995. Our little "Beer Baby" is indeed on the way and that light at the end of the tunnel is very bright indeed now! Nancy P. Hemenway inciid@mnsinc.com --------------------------------------------------------------------------- It has been my experience that the miscarriage process has not been adequately covered by books or by doctors, especially, the emotional distress afterwards. Besides the understandable grieving process, I think that there is also a hormonal aspect that has caused me to experience "PMS times 10" for a month after each miscarriage. I had never had a PMS problem before I had the miscarriages, so I was not prepared for the emotional rollercoaster that followed. While some of it was natural mourning, and therefore a process that is necessary, even spiritually beneficial, to undergo, some of it was simply distressing and non-productive. I am starting to research literature on reducing PMS symptoms to see if it would also reduce the post-miscarrage syndrome. While I have not found much on herbal or vitamin recommendations for post miscarriage there are several for the traditional PMS. The whole B complex - especially B-6 has been shown to be useful for alleviating symptoms. Folic acid is also recommended. Supposedly, one of the reasons for the chocolate cravings that occur with PMS is a need for magnesium, which should be taken with calcium. I don't even like chocolate that much but I found myself wolfing down candy bars after each miscarriage. Herbal treatments include: St. John's Wort for depression, Valerian for anxiety and Dong Quai (there are numerous spellings) for disorientation. From the readings, I gather that Valerian should only be taken before bedtime, but the other two can be taken during the day. In fact, St.John's Wort not only has an immediate soothing effect, but supposedly has some enzyme-like positive effects that can only be felt after a few months of usage. Please research these before taking there are some medications that can't be taken with St. John's Wort, like asthma medicine. I took it during my pregnancy, along with Skullcap, to help sleep. There is a book that mentions these herbs called "Relief from PMS" by Pamela Patrick Novotory, published by Dell. I hope this helps. Deborah Pastor DAnnPastor@aol.com --------------------------------------------------------------------------- Bleeding in Pregnancy --------------------------------------------------------------------------- The question came up about bleeding during pregnancy and whether or not that indicates miscarriage. The summary of what I have to say is that I have been told that more than half of the women who bleed during pregnancy go on to deliver a full-term child, but pay attention and don't take it lightly if you find yourself bleeding. When I miscarried, I spotted for three days, lost the baby, and then continued to bleed for another week. I read like mad before I lost the baby, so I found all sorts of information. The three best books I had were "The Well Pregnancy Book," "A midwifes Guide to Pregnancy and Childbirth," and "Preventing Miscarriage: the Good News." I also talked to about 5 doctors in the course of being given 2 ultrasounds and some phone advice in the face of various changes. Things I learned (this is graphic): All vaginal bleeding *OF*ANY*KIND* should immediately be reported to your doctor. Don't wait until lunch, don't wait until morning, don't wait to make the drive: call and report what you can to whoever is in a position to advise you. Heavy bleeding is more likely to indicate miscarriage than spotting, but even women who bleed heavily do carry to term. One book said some women shed the uterine lining that is not near the embryo's implantation site. Bleeding accompanied by cramping or any kind of abdominal pain is more likely to indicate miscarriage. It is also an indicator for an ectopic pregnancy--especially if the pain is more on one side than the other. (Ectopic pregnancies will lose you a fallopian tube if you don't catch them *very* early.) Don't panic if you do have cramps, because digestive distress and stretching of uterine ligaments can cause abdominal pain too. Bright red blood is much more likely to indicate miscarriage than dark brown blood. Anything gray or pink is a very, very bad sign, since it usually indicates embryonic tissue or placenta. In my case, the fetal sack itself was unmistakable and left me no room for doubt (or hope). Bleeding that continues for three days or more is more likely to indicate miscarriage than some spotting that stops. Bleeding that occurs when you would have had your period is much less worrisome than bleeding that occurs during what would have been mid-cycle. Implantation bleeding is *very*common*, and it occurs around when your first period would have been. Many women will have bleeding at their normal menstrual points for up to three months. If you have a fever, faintness, or nausea markedly worse than it has been until you started bleeding (especially if it is accompanied by worsening abdominal pain), you may have an ectopic pregnancy that needs emergency treatment: don't wait to make that call--you need to receive further instructions based on your case. Two of my books told me that women who bleed and can get an ultrasound should be totally reassured once they see a strong regular fetal heartbeat. One book told me that 90% of the women who are bleeding but have a fetal heartbeat shown with ultrasound will carry to term. You have to be careful though, because those statistics are for abdominal probe ultrasounds, and apparently seeing a heartbeat using the trans-vaginal probe is not so reassuring. (I only found that last out because I lost my baby after seeing a strong heartbeat on the ultrasound monitor.) So I guess the amended rule is that if you are far enough along to see the heartbeat with an abdominal probe (and you see the heartbeat), stop worrying. The last, and most depressing thing I have to say is that if you do start losing anything gray or pink (or anything solid), you need to save it and give it to your doctor. What you lost can tell them if you have miscarried, if you might need a D&C to make sure no tissue is left behind, and (in very rare cases) clues to the cause of the miscarriage. Mostly, you will never know what caused it, but if you are like me, you have a tremendous need to try to find out how this happened. In my case, the fetal sack was a good clue because it was much too small for my stage of pregnancy. Even though I had a baby with a beating heart, something was wrong. Two doctors suggested that even though the cardiovascular system of my little one was showing signs of working well, the baby was not getting enough in the way of nutrients. They suggested that it might be an implantation problem. This is all conjecture, but even having a plausible scenario helped me. I needed an explanation of how I managed to violate the maxim about no longer worrying about the bleeding once you see the heartbeat. Tracy Larrabee larrabee@cse.ucsc.edu --------------------------------------------------------------------------- Tracy, thank you for a very informative article on bleeding in pregnancy, however, I would like to point out one thing about the statistic above. The fact that over 50% of women who bleed during pregnancy go on to deliver a full-term child doesn't mean (and you didn't imply this, either, but I'm sure someone will read this this way) that if you do bleed you have a 50% chance of miscarriage. I am currently 24 weeks pregnant with my second child, and with both pregnancies I bled and had cramps at the beginning. The first one was worse and I spent three months thinking a miscarriage was imminent. I had intermittent, heavy, bright red bleeding accompanied by sometimes severe cramps. Fortunately, everything turned out fine, and I delivered a big healthy baby boy. If I had read this article during those first three months, however, I would have freaked out. Anyway, maybe you could add a note to your FAQ article pointing out that every pregnancy is different and that although bleeding is a signal that you should get checked by the doctor, it doesn't necessarily mean miscarriage is likely, or even indicate a 50% chance of miscarriage for any particular woman. BTW, in my case it turned out that I wasn't bleeding from the uterus after all, but that I have what they call a "friable cervix," which means that it has a lot of blood vessels in it that bleed easily. So despite all my worrying, I probably wasn't in any more danger of miscarriage than in any non-bleeding first-trimester pregnancy. Anyway, this is just my experience. Thanks, Judy Drake judy@pendragon.cna.tek.com --------------------------------------------------------------------------- I first want to preface this by telling you that I had a perfectly healthy baby boy - 8 lbs 11 oz, 23 1/2 " long! At 7 weeks, before my first Dr.'s visit, I had spotting of the dark brown kind. This was over the weekend, so the Dr. told me to schedule an ultrasound on monday morning to see if everything looked normal. The baby's heartbeat and growth all looked perfectly normal, so he said I could continue all regular exercise. Don't take up a new sport, but he specifically said my horseback riding was perfectly fine, just no jumping. At 10 weeks, I tried out a friend's horse for only 10-15 minutes, but when I got off the horse, I had floods of blood running down my legs. I was hysterical, and my friend rushed me to the emergency room. I assumed I had miscarried because I couldn't believe there could be so much blood and the baby could live. They called in an ultrasound tech, and the ultrasound showed a healthy baby with a normal heartbeat. 10 weeks is before the placenta is completely formed, but they guessed that I had a low lying placenta and had torn off a piece of it. I was given strict orders for bedrest for a week, but before the week was out, I had hemorrhaged again. This heavy bleeding continued off and on until 14 weeks even with bedrest. For no apparent reason, I would stand up and the floods would just start. It went away on its own. Later sonograms confirmed that I had a small piece of placenta that had torn off. They explained that the danger passed because as I got bigger, the placenta moved up with my expanding uterus. At the time, all they could tell me as a diagnosis was "threatening to miscarry". Any unexplained vaginal bleeding during a pregnancy gets this label. I carried my pregnancy to term, but the next time I am pregnant, I will not ride a horse regardless of what the Dr. says! Michelle Schott MBS4@psuvm.psu.edu --------------------------------------------------------------------------- I think when you start to bleed in the first trimester, this is not good, but not always bad. My doctor had me check the color (bright red is bad), as well as the amount of bleeding. I was in my 8th week when I started to spot. My doctor told me that if bed rest doesnt slow down my bleeding they would have me take a quanitative pregnancy test. The test showed that my HCG level was down very low and this is why I was bleeding and if it continued to drop that meant that I was miscarrying. I miscarried after 1 1/2 days of bed rest. I got pregnant 4 months later and gave birth to a healthy baby boy in May. I feel that my first pregnancy that ended in miscarraige was not meant to be. It took some time to get over, but I did. I do think about it, I did all through my second pregnancy, and I thank God for giving me Zachary. I think its important that women who are pregnant be aware of what may or may not happen. I went into my first pregnancy thinking that every thing would be perfect, I had no worries, then boom it happened. With my second pregnancy I knew what could happen, so I took it one step at a time. I didnt tell anyone until I was well into my third month. Then when I started to show and I heard the baby's heartbeat I just sat back and enjoyed being pregnant. --------------------------------------------------------------------------- I had spotting with both my pregnancies (one ended with a lovely girl, the other was a miscarriage at around 6 weeks) and the only difference I could see was that the spotting was a little heavier for the one that miscarried. So spotting may not be a definite indicator of an impending miscarriage. I also disagree with the doctor who said to keep on with normal activities even with the spotting. My doctor recommended taking it easy the first trimester (the spotting ended after that) because that's the time when you are most likely to miscarry and a little extra care (no heavy lifting, no athletic exercise beyond walking, etc.) would go a long way to prevent any sad endings. Joanne Petersen joanne@hpcc01.corp.hp.com ---------------------------------------------------------------------------