Bleeding in Pregnancy
Some subjects don't change quickly, or even look as though they are changing very much at all. Especially feelings. Medical treatments change constantly and sometimes very rapidly. Feelings tend to lag behind.
One thing that hasn't changed in the twenty-five years that I have been participating in the infertility/fertility community is early bleeding in pregnancy. It still happens. It still happens often.
And I think it's safe to say that most, if not almost all of us, panic when we see the blood. There are women out there who do not panic and if you are one of them, so happy that you meet this type of situation with calm and equanimity. Would love to know how you have achieved that sense of serenity in your life, please share.
For a lot of us, panic is a very common reaction to seeing any blood, staining or spotting. You may not feel it. You may feel it very strongly. That sense that the pregnancy you have worked so hard for is slipping away. That a miscarriage is imminent. And that there is nothing that you can do.
Dr. Cynthia Murdock, award winning board certified reproductive endocrinologist at RMACT, and Castle Connolly Top Doctor in the field of Reproductive Endocrinology and Infertility, talks to us here about what to expect if you are experiencing bleeding in your pregnancy. ~ Lisa Rosenthal
CT Fertility Specialist Speaks Out
If I had to choose one single problem which causes the most stress and anxiety among our patients, I would say that it is bleeding in early pregnancy. The official medical terminology for this is first trimester bleeding. Nothing is worse than working so hard to achieve a pregnancy only to discover that you are bleeding. The first thought that enters everyone’s mind is “I am losing this pregnancy”.
All bleeding should be evaluated with a blood test to check estrogen and progesterone levels, and an ultrasound to rule out any bleeding in the uterus. Most often when the bleeding is light we may not find a reason for the bleeding, but luckily most light bleeding episodes are limited to 1-2 days. Common recommendations are abstinence from sexual intercourse. In some cases of heavy bleeding we may ask you to decrease your activity level, but there is no evidence that this will prevent a miscarriage.
Luckily we have some positive news on this front. First of all, approximately 25% of all women have bleeding in the first trimester of pregnancy. A recent large study of over 4,000 women revealed that of the 25% of women who have bleeding, only 8% have heavy bleeding (defined as more than a normal menstrual bleed). The majority of women (92%) who have bleeding, have only light bleeding (less than a menstrual period) or spotting. The good news is that women with only light bleeding or spotting are at no increased risk for a pregnancy loss. The not-so-good news is that women who experience heavy bleeding have a 3-fold increase in the risk of miscarriage. The most important messages that we can take home from this study are that first trimester bleeding is common, and that greater than 90% of women with first trimester bleeding are at no increased risk for a miscarriage.
Remember bleeding is common, but luckily most of the time it poses no risk to the pregnancy. Call your nurse so you can be evaluated but don’t panic!
About Dr. Cynthia Murdock
Dr. Murdock earned a BA in biology at Cornell University and an MD at Creighton University School of Medicine where she graduated magna cum laude. She completed her residency at Creighton University Medical Center where she was named Berlex Best Teaching Resident. In 2003 she completed a fellowship in Reproductive Endocrinology and Infertility at the National Institutes of Health.
An experienced researcher, Dr. Murdock has contributed to numerous peer-reviewed studies and presented at several of the most prestigious conferences in the field of reproductive medicine. The focus of much of her research has been on estrogen receptors, hypothalamic neuron function, and precocious puberty.
Dr. Murdock is a member of the American Society for Reproductive Medicine and the Society for Reproductive Endocrinology and Infertility, as well as a Fellow of the American College of Obstetrics and Gynecology.
Dr. Murdock was previously an assistant clinical professor at Creighton University School of Medicine and a staff physician with Reproductive Health Specialists at Nebraska Methodist Hospital. She has also served as an Assistant Professor of OB-GYN at the National Naval Medical Center and Walter Reed Army Medical Center.
Dr. Murdock is now a staff physician and a fertility specialist in Reproductive Medicine at RMACT. She is board-certified in Obstetrics and Gynecology and in Reproductive Endocrinology and Infertility.
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A Little Bit Pregnant
You can be a little bit pregnant. I was, twice.
Each time was a pregnancy that was not viable or sustainable. Each time, the numbers in my blood that proved I was pregnant would not double or reflect a growing pregnancy.
For me, both positive pregnancy tests were quickly followed by bleeding that made it clear that the pregnancy was not progressing or surviving. There was no question, not in my mind and not in my doctor's voices when I spoke with them.
At least there was no question, that was a silver lining, only in retrospect. I went immediately into grieving. Deep grieving. Crying, feeling deep down, bone marrow disappointment, frustration and fear. I isolated and found solace in being alone and slowly, incrementally slowly, rejoined the world, through the lifeline of a few dear friends.
Sometimes the pregnancy will progress farther and you will sit on the possibility of the pregnancy progressing properly, safely, with the baby in your arms at the end of nine months. You will balance between hope and fear. Straddling them both as you breathe through your days, hoping that the bleeding doesn't commence or continue. Fearing that it will all just go away, as quickly as a breath.
Do you feel crazy through this?
Most of us do. Many of us have moments of calm and serenity, quickly followed by intense fear and even terror. Some of us start praying, (I did), when that was never a possibility before. Offering and bargaining. I know I did that. I shudder when I think what I offered to give up, just to have the pregnancy progress and the infertility to be behind me.
Working with Symbols of Infertility
There's a reason that a roller coaster is so often the symbol of infertility. The ups and downs are significant, the unexpected dips can make your belly sink so quickly that you have to hold onto something or gasp out loud.
I love roller coasters. There's a roller coaster that I have been on many times. Probably about twenty times over the last fifteen or so years.
I know where the dips are, where the curves are, what's coming next. I remember quite clearly the spots when my stomach will feel like it's been left thirty feet behind me.
And yet, each time, it feels unexpected and unmanageable.
Why don't we get used to it? Why don't we get used to the ups and downs of fertility treatment? Why don't we learn to modulate our reactions and expectations?
Hope you weren't expecting an answer.
For me, it was directly related to the amount that I cared and wanted my baby. I am a passionate person, about many things. This was different, life changing different. When the stakes are so high and the desire so much higher and then you throw in the expenses and the medications and the appointments and the possibility that it won't work, doesn't it make sense?
If you're feeling crazy, you are not alone.
Let us know how we can help. We are here.
Lisa Rosenthal's Google+
Wednesday is the day of the week that we have our medical pieces on PathtoFertility. The line up for the next several weeks is exciting in that several challenging topics are being tackled. Some of these subjects are not talked about very much and are difficult for patients to bring up with their fertility doctors or other medical care individuals. Although they are not talked about easily or openly, they are certainly on many of our mind’s and can often weigh heavily on our hearts as well. Please read these educational and informative blogs for a clear and comprehensive explanation and understanding of some tough subjects.
The first this Wednesday, is from Dr. Cynthia Murdock, of Reproductive Medicine Associates of CT. Dr. Murdock has been with the practice for over two years and has office hours in all three of RMACT’s offices (Norwalk, Danbury and Greenwich). Dr. Murdock writes about one of the most alarming things that can happen after a positive pregnancy test. Bleeding or staining in the first trimester of pregnancy is scary; Dr. Murdock explains what it can mean, what it generally doesn’t mean and what to do. Anyone, whether after an IVF (in vitro fertilization) or IUI (intrauterine) cycle or having become pregnant on one’s own, knows just how heart stopping it is to see any blood at all after a positive pregnancy test. It’s very reassuring to have a Board Certified Reproductive Endocrinologist tackle this upsetting subject and separate out the truly worrisome from the ordinary. Read this Wednesday to hear exactly what she has to say.
Next Wednesday is a thought provoking blog written by Jane Elisofon, MSW. Jane is one of the two mental health professionals who work with Reproductive Medicine Associates of CT. (Dr. Lisa Tuttle works in our Norwalk office.) Jane sees and counsels couples and individuals; evaluates donor situations; facilitates support groups, and on occasion writes wonderful blogs. This particular blog is on how a woman’s feelings about a previous abortion in one’s life may continue to affect her through her life, and particularly as she enters infertility treatment. If you are one of the many women who experienced an abortion, then you know just how conflicting the feelings can be around this subject. Jane’s blog is non-judgmental and compassionate while giving solid support and useful advice on how to manage such a difficult subject.
Dr. Spencer Richlin (Surgical Director of Reproductive Medicine Associates of CT) will be up the Wednesday after that, writing about fertility preservation. He writes about patients who have been helped by pre-counseling after getting a diagnosis of cancer. While the diagnosis of cancer and subsequent treatment is devastating enough, to a woman of reproductive years that has either not started or not completed their family, it can feel even more hopeless. How reassuring to read Dr. Richlin’s blog and find out about the procedures that can be done prior to cancer treatment to enable a woman to become pregnant and have a child after treatment.
Thank you to all three of these Reproductive Medicine Associates of CT professionals for taking on uncomfortable, challenging subjects so that infertility patients can breathe a sign of relief, understand what their options are and know that you are not alone on this path to fertility.