Here's a link to a site showing ultrasound images of retained POC (products of conception)

Spontaneous abortion - Retained products of conception

Here's a link which explains how to read ultrasound images of the uterus.

My scan today showed something in the upper part of the uterus but my RE said it wasn't there last time so it is likely just some clots. I sure hope so. I'm ready to be done now.

I passed a hunk of something this morning. I took a three mile slow walk (I'm am fairly blood deficient right due to the bleeding of the past week now so a fast walk was out of the questions) around the neighborhood last night and that must have done it. It wasn't anything exciting, it mostly looked like a large blood clot but it was denser and more formed than a blood clot. Maybe it was the placental tissue.

I'm going to go for another long walk today with the dog and hopefully whatever else is in there will clear out so my scan will show that I'm done. That would be great as my uterus can then heal and I can get my blood levels back to normal and soon enough we can get a little intimate (it's been a few weeks since we BD).

Waiting. Waiting. Waiting.

The RE wants me to wait out the weekend then go in for an ultrasound on Monday morning before deciding to do drugs or a d&c. Okay, I'm all right with waiting a little longer. I don't want a freaking d&c.

I thought I might be lucky enough to move it out last night but nope. That feeling of nausea and pressure must have been something else, or else the upper part of my cervix was trying to grab at the tissue and wasn't having any luck. I have the occasional cramp now and again but mostly my uterus is quiet.

We had a work party last night out and were out on the town. The streets of Capitol Hill were teaming with people, probably due to it being the end of the school year/start of summer and gay pride weekend. Whatever the reason I liked it as I got to just be another person having a good time.

While at this one bar one of my coworker's wives asked me if my partner and I planned on having kids. I told her that we'd see how things went, my typical vague answer which leaves people thinking that yes we are interested in having kids and might actually be trying now or in the near future. Then she told me that they had started trying and that she had a miscarriage a couple of months ago. So I decided to tell her about mine, the last one some people at the office knew about (due to one blabbermouth who no longer works with us) but this time no one knew. I figured that it was okay to tell her though and even if she tells her husband as I suspect she wll it's okay, sometimes it is good for people to know this stuff about you. Especially since I didn't much miss a beat at work (as far as anyone knew).

This morning I have a little hangover and maybe that wasn't the best idea considering my weakened condition right now but I kind of needed the time out and it was fun.

About My Retained Tissue Experience

(to a woman dx with retained POC)

I had retained tissue for certain after my d&c, it was due to my uterus being wrapped around my fibroid so the RE had a hard time reaching all of the tissue on the far side of the fibroid. My doc left the clinic a week after my procedure and I had to have a different RE pick up my care. She said that we could do a repeat d&c but the risk was that they might overdo the scraping; methotrexate which would require taking a break for a few months (and it isn't like that's not a pretty hardcore drug on its own -- it affects all the tissues in your body), or wait it out.

Since my beta was dropping she and we decided to wait it out. It took forever and I was having cycle weirdness and finally my body got fed up and did some really crazy things like not letting me sleep for more than 3 hours for over two weeks and then when AF arrived I was hemorrhaging, losing at least 2 pints of blood in 2 days. And then the bleeding continued on and off for another month up until my repeat d&c. I even asked the RE about all the bleeding I was having and she didn't have anything to offer me. I did see my acupunturist during this time and he was a huge help with symptoms like feeling like I was full of cold water, and feeling like I was drinking 3 triple espressos a day.

The only thing that caused any changes though during that time though was that I went to a health spa with a friend at the end of October. The first day of classes I took Feldenkrais, trancendental meditation, qi gong and walked a labrinth. That evening, 3 months after my first d&c, I passed a large chunk of tissue. There had to be something to all that meditational-like movement practices that caused things to shift. Still there was more left, and it was due to the fibroid preventing my uterus from contracting it out properly on it own, so I still had to have the surgery.

Oh, and to just make things feel freakier, I think the retained tissue continues to grow inside of you, though slowly dying off at the same time. Hence you get a larger mass of tissue with slowly lowering beta levels.

Your doc might consider using a hysteroscope while doing the repeat d&c to better see what they are doing though this requires a visit to the OR under general anesthesia for certain. I used cytotec to dialate my cervix for the repeat d&c.

If you do in fact have retained tissue take care of it sooner rather than later to save your body a lot of struggle and your heart a lot of pain. You want to end this physical connection to the miscarriage as soon as possible.

Hope this helps.

What should I do?

So I still have retained POC (products of conception) from my miscarriage in July. It is likely that my fibroid has contributed to this situation by not allowing my uterus to contract as well as it might (8x10cm intramural fibroid, uterus wrapped around fibroid). My RE wants to go in with a hysteroscope to aid in the removal of the 2x3cm piece of tissue in my endometrium -- the fibroid doesn't allow for a very clear image of what is there.

She mentioned that while I'm under she could remove my fibroid as well. It isn't the largest fibroid that she's operated on, but it isn't small either. She thinks that if I have the surgery done now I should be all right to travel to Ecuador for Christmas -- about 6 weeks post-op -- to go on a birding tour.

My fibroid hasn't shrunk at all since August, though it is smaller than the largest measurement right before my d&c of 9x11x11cm or so. On the day I got my BFP it measured 6.5x7 -- so it is now twice as large and I'm feeling it everyday.

Tthis RE does surgery twice a week only and I like her, she's been practicing since 1983 and does on average one myo a month -- but she's regularly doing reproductive surgeries. I'm feeling pretty good about her and she said that she would consider my desire for a vaginal birth as she did the surgery.

If you were going to be put under right now for another procedure would you opt to have your large fibroid removed as well?

My bad bleeding

Starting approximately two weeks ago I started feeling wired like I had too much drip coffee, and kind of anxious feeling as well. I don't drink caffeine regularly and rarely have coffee at all so this was weird. I also didn't have a lot of stress at work or at home so it was even weirder. Then last week I started having insomnia, I was getting up in the middle of the night for hours an ultimately only having 5-6 hours of sleep. It kept getting worse and that anxious feeling kept building. I also had a loss of appetite. It was like something was seriously off in my system.

Then I started feeling vague pregnancy symptoms last week as well, like a vague recap of my first week pregnant including some itchiness, breast fullness, light nausea and my thyroid felt funny again as well. I had two faint positive pregnancy tests on Friday and Saturday but they didn't get darker. On top of everything I was experiencing I felt utterly confused. On Monday I had a beta HCG draw and it was 13, down from 46 a month ago (or perhaps I had a chemical pregnancy?) The nurse called and said that it was probably residual beta from my miscarriage in July.

I continue to feel awful and anxious and tired and then Monday night my period arrives, the second one since my miscarriage. It is very red and very viscous, there is no slimy mucus to it, and not really clotting either. It just is very runny bright red blood. I easily bled 2 cups worth at least, it is hard to estimate since I would have gushes when I went to the toilet. I had a headache, my body felt full of cold water, my thyroid felt strained. I also had odd cramping. I stayed home from work yesterday and took ibuprofen and vitamin C which did seem to help control it somewhat. I also went for an acupuncture treatment and that helped with some of the symptoms, I didn't feel so watery inside any longer. I woke up this morning and had hardly bled at all overnight, practically just spotting. I feel dry and clotting in my abdomen.

I called my RE this morning because I want to get to the bottom of this. It isn't just my fibroid, it isn't just the miscarriage and I'm not taking meds or herbs so something is just out of whack with me.

Since someone posted about von Willebrand's Disease (VWD) in the past year I've thought that I had a predisposition towards it. I brought up my long periods and nosebleed problems as a child, plus my anemia but no doctor has responded to the symptoms (tell me the patient doesn't need to suggest the disorder and I won't believe you). My father is very prone to bruising and I am a bit as well. We'll see. I did see this page on the All About Bleeding/VWD site that talks about how some hormones can influence bleeding problems. As I recover hormonally still it is very possible and also women in my family have noted thyroid problems post pregnancy. I did ask for a check of my thyroid hormones weeks ago as well as on Monday but they didn't write the script for that. I'm going to ask the doctor about getting it checked.

http://www.allaboutbleeding.com/vwd_and_you/view.asp?id=4634

Oh, and you know how I love my links, I found this one that I thought was a good reference about NSAIDs and menstrual bleeding:

Nonsteroidal anti-inflammatory drugs for heavy menstrual bleeding (Cochrane Review)
Lethaby A, Augood C, Duckitt K
http://www.update-software.com/abstracts/AB000400.htm

I finally got my period, the first one since my miscarriage in July, this past Saturday (Yeah! Time for a party!). My beta was still up last Friday, I hope to have another draw today to see if it has gone down more.

In the meantime I've noticed that my fibroid has gotten dramatically smaller over the past couple weeks (even more cause for celebration!) I've got a call into the doc to see if I can get another u/s to check on it as I'm starting up on my chinese herbs again and I want to know what we're working with. We'll start trying on the baby-making in October to give some time to treat my fibroid with herbs and acupuncture.

Now if this extra fat around my middle would just go away then I would be back to normal....

Beta Numbers

Here are the blood test results after my retained POC was diagnosed in mid-August.

543 on 8/12

259 on 8/17

145 on 8/23

78 on 9/1

46 on 9/10

These were some of the more useful links that I've found in understanding what was going on with my blighted ovum/early miscarriage. I thought I would share.

GENERAL MISCARRIAGE

Understanding Miscarriage

Early Pregnancy Loss

Miscarriage Explained

Early Miscarriage

Miscarriage and PCOS

Missed Abortion

Post-partum Bleeding (lochia)

Miscarriage Information


BLIGHTED OVUM

Blighted Ovum

Blighted Ovum

Anembryonic gestation


DILATION AND CURETTAGE - D&C

Dilation and curettage

Dilation and curettage 2


MEDICAL MANAGEMENT (DRUGS)

Methotrexate For Noncancerous Conditions (Systemic)

Pharmaceutical Induction - Pitocin and Cytotec (Misoprostol)

Medical Abortions

Completing A Miscarriage


I found this study that was published earlier this year and it was interesting because it was both effective, used a lesser dosage than is commonly used in the US currently for abortion purposes and had fewer side effects.

Medical management of first trimester miscarriage (blighted ovum and missed abortion): is it effective?


NATURAL INDUCTION – NOT RECOMMENDED

I did find this link with information from midwives on ways to medically complete a "missed abortion".

Completing A Miscarriage

Here's someone's reading list from Amazon.com on herbal abortions -- no I don't recommend going that route, I found some other links that talks about how toxic it is for the mother.


RETAINED TISSUE

Detection of retained products of conception following spontaneous abortion in the first trimester

GESTATIONAL TROPHOBLASTIC DISEASE/ MOLAR PREGNANCY

Gestational Trophoblastic Disease


Gestational Trophoblastic Disease (Sloan Kettering)


"Of utmost importance is careful follow-up with serum beta HCG (BHCG) weekly until less than 100 mIU/mL and then every two weeks. The patient should have a careful pelvic examination every other week and a chest x-ray every 4-6 weeks. Once the titer of serum BHCG has fallen to normal levels, these two examinations need no longer be done; however, BHCG titers need to be repeated every 2 weeks for 3 months, then monthly for 3 months, then every 2 months for 6 months, then every 6 months for 3 years. Each patient should be counseled in the use of a reliable birth control method." (from the NIH site)


"Women should be advised to avoid pregnancy until hCG levels have been normal for six months following evacuation of a molar pregnancy and for one year following chemotherapy for gestational trophoblastic tumour. The combined oral contraceptive pill is safe for use by women with GTT (III-C)."
(from: http://sogc.medical.org/sogcnet/sogc_docs/common/guide/pdfs/ps114.pdf)

Embolization of Bleeding Residual Uterine Vascular Malformations in Patients with Treated Gestational Trophoblastic Tumors


Molar Pregnancy



GRIEVING, SUPPORT & RECOVERY

http://www.pregnancyloss.info/

SHARE – Pregnancy and Infant Loss Support

Pregnancy After Miscarriage (PAM)

Hygeia Foundtation & Institute for Perinatal Loss and Bereavement

Coping with the 5 stages of grief and bereavement

October 15th - Pregnancy and Infant Loss Remembrance Day

What is Grief?