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Sunday, November 10, 2013

Miscarrige, Blighted Ovum, Missed Abortion, Molar Pregnancies and Other Causes of Bleeding In Early Pregnancy

One in four pregnancies are lost to miscarriage, and your gyno is going to need to know what type of miscarriage you had in order to recommend any treatment or follow up. If you have bleeding in early pregnancy, your pregnancy is very likely to be fine. Only about half (or fewer) of the pregnancies with early bleeding will go on to a pregnancy loss by 20 weeks of pregnancy. If you have had pregnancy confirmed, and you are bleeding, please contact your gyno so you can be checked. When you first come in to be checked early in pregnancy thinking you are having a miscarriage the question will be: how far pregnant are you, how many babies (twins?), what is the source of the bleeding, and if the pregnancy is still healthy. Some of our patients have bleeding and what has occurred in prior pregnancies is important, did you have an early miscarriage, or an evolving miscarriage, a blighted ovum, a molar pregnancy or other types of history of miscarriage.

Prior to trying to get pregnant again, we spend time trying to discuss with our patients, what did happen or what is really happening these situations. The timing of the bleeding in your pregnancy or the history of how many times this has happened to you can help clarify those situations. The terms you may have heard at your gyno's office many include abortion, incomplete abortion, or complete abortion.  Lots of terms have been applied to what is essentially a non medical term: the miscarriage. If you have been pregnant, and had an ultrasound that diagnosed a on-going pregnancy and now you have miscarried, we term that a complete  abortion. It is pregnancy loss whether you have seen tissue pass. If all the tissue has not passed, and the cervix is closed, you may have an incomplete abortion. The best way to differentiate this is to have seen a previous pregnancy on ultrasound, and now when the ultrasound is repeated after the initial diagnosis, you see almost no tissue. We use measurements of the lining of the uterus to conclude whether the tissue is completely passed or not. After a complete abortion the ultrasound of the lining gets fairly thin, actually to under 15 mm of thickness. Women may still have some bleeding, they may still have signs of pregnancy, and this may go on until all the hormones of the pregnancy are out of your system, or you have your next period. If you have an incomplete pregnancy loss, you have begun to pass some of the pregnancy, but there is still tissue in the uterus, the cervix is still open, we call this either an incomplete or inevitable abortion, depending on the exact circumstances. The ultrasound may appear to still contain the entire sac of pregnancy and the lining thickness can be very thick or somewhat thinner.

There are situations where the pregnancy has failed to thrive, but no yet begun to pass. You may have heard the terms: missed abortion, blighted ovum, anembryonic pregnancy (a pregnancy sac but no fetal development). Women will still have positive pregnancy tests, an often the hormone levels are high enough that they feel no differently than how they felt when they were told they had a healthy ongoing pregnancy, This is difficult for the patient to accept, and there is no reason to be cautious with this diagnosis to see if in fact the pregnancy will still progress healthily. There are conditions that are not really pregnancies that will produce a baby. They are called molar pregnancies which is a tumor of the placenta and are different than the conditions described. Because these tumors produce the pregnancy hormones that cause the symptoms of pregnancy women may think they have a normal pregnancy.

Pregnancies can be lost without any new bleeding.
Many women have not yet even begun to have bleeding yet, and when they go for a routine exam or sonogram this is only found because there is no growth or development to the pregnancy or now the heart beat of the fetus cannot be found. But if you do not have a molar pregnancy, but just a very early pregnancy that has bleeding your physician has to use ultrasound to determine if the pregnancy is healthy. There are distinct ultrasound features that your physician uses to determine that a miscarriage is occurring including: a fetus that is small for how far pregnant you are supposed to be, a fetus that measures 6 mm, yet has not grown over a week, or one that is a bit larger than this but still has no heart beat. Pregnancy gestational sacs seen on ultrasound should appear healthy to your physician as well, for instance those that are big, over 20 mm, but have no fetus or no extra structure like a yolk sac in them are another sign of this delayed pregnancy loss, and technically is in the missed abortion group. Ultrasounds, pregnancy tests and pelvic examinations are the best tools to help figure out what is really going on. It cannot always be accomplished in one visit to the gyno, but often it can be diagnosed accurately. Once you have a diagnosis the treatment may be waiting, surgery or medicine, and you and your gyno can discuss the plan. So if you have had a miscarriage, which type did you have? Did you get enough information to help you make that diagnosis, so that you can get the care you need to have a healthy future pregnancy.

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