Saturday, May 29, 2010

Good Things and Bad Things

I've been doing a lot of research about my "Subchorionic Hemorrhage/Hematoma" and have decided that the wealth of knowledge on the internet can be a good thing, but bad at the same time. I've found a support group and it really IS quite common, but it can be scary. I've found out that I really don't know much about my condition - the ER doctor didn't give me a lot of details on it, so I really don't know how bad it is. Thus far, I haven't bled yet, but in reading, a lot of doctors give the advice that the "blood has to come out sometime" which really freaks me out! I'm not sure how accurate that info is, but I guess this equipped me with some questions that I should ask at my follow-up appt on Tuesday. I had just been thinking mine wasn't bad because I hadn't been bleeding - apparently that's a wrong assumption (according to internet research). It can be bad with or without the blood and some women don't get diagnosed until half way through their pregnancy because the blood just hasn't come out it's sort of a "fluke" of the medical society that mine was diagnosed when it was - it's kind of weird to explain I'll just move on.

This past week, I kept feeling...I don't really know how to explain how I was feeling. Like everyone was over-reacting maybe. Yes, I'd just been through a major ordeal, but I didn't feel like it was cause for such great alarm. I didn't consider myself all! Now, I think that there is some justification on everyone else's part after what I've read. Even though this is common, and most of the time, there is a happy ending involved, there are still quite a few women that lose their baby because of this. They might not have even had a very bad SCH to begin with, and the saddest thing is that it happens suddenly and instantly. A lot of times they will have seen and heard the heart beat within the last couple days (one lady they used as an example heard and SAW her baby and he was just fine...only hours later to have an excruciating pain and deliver the baby at home...she was 12 weeks pregnant). These stories bring me to tears. I don't want to lose my baby and was promised in a blessing that I wouldn't. Maybe that's the thing that's keeping me the most calm during this, but that promise is also contingent on the fact that I HAVE to obey doctor's orders. Have I been doing that fully?

After reading about just WHAT modified bedrest is, and what pelvic bedrest is (which are both what I'm on right now), sometimes yes, and sometimes no. Modified bedrest means I have bathroom privileges, shower privileges, and "foodage" privileges. I can also sit...I don't have to just lay down all the time. I can get up for a few minutes to stretch and move from room to room, but I can't do anything but rest. Pelvic bedrest means no intercourse, orgasms, exercise, straining of any of the muscles around the uterus, etc. Well, this one I've followed as closely as possible, but when you're resting all the time, your digestive systems slows down...causing none other than constipation. So the straining part....well, it needs work (too much info...I'm sorry). Stairs are another thing I am not supposed to do - they're considered exercise. Guess what?! I've got stairs in my home, and yes, I've navigated them a couple times a day, but have tried to stay away from them as much as possible, trust me. Stairs and I have a long history and I'd really like to just not go there. Did I mention that I found a support group of ladies online that are going through this? I don't remember and I'm too lazy to look back and figure it out. In this group, they've compiled a little bit of info that they've gleaned from each other and their personal doctors. It's not supposed to take the place of doctor's advice, just inform women of what they've all learned. It was very informative and I'm going to copy and paste it in sorry, this is going to be a long post!

Welcome new members! We are never happy to welcome new members to this group but are glad you have found a place where you can share your stories of success and loss with women who know exactly what you are going through. Discovering that you have an SCH can be very scary. ER personnel, ultrasound technicians, and doctors give us a variety of prognoses, some very awful-sounding. But the reality is that often women do get through SCH pregnancies. To make things less daunting, we put together this guide. Please note that this hasn't been reviewed by a physician, but rather represents collective wisdom gleaned from women and men on this board.

There is also a lot of great info and some links to studies and more technical papers about SCH in the "message from the group owner" on the board's homepage. You will also find a ton of great information on the archives of this board. Try reading some old posts or doing a search for a specific concern.

What you can do to treat an SCH:
There are several studies that suggest that bed rest (i.e spending all of your time in bed, often laying on your left side, getting up only to use the bathroom or perhaps to shower) and modified bed rest (i.e. a bit of moving around to get a snack, move from room to room, etc. is OK, but you spend the majority of the day resting with your feet up) are helpful for SCHs, and many women on this board will corroborate this. Since there are no scientific studies which prove the effectiveness of bed rest, some doctors don't counsel it, instead telling patients that they only need be on pelvic rest (i.e. no sex, orgasms, breast stimulation; no exercise, lifting, straining, or going up multiple flights of stairs; pelvic rest is generally part of bed rest) or just to "take it easy". At a very minimum you should probably be on pelvic rest, and maybe on bed rest. If you're unsure about what to do, listen to your body. If you bleed from activity, try slowing down.
Here are guidelines from a noted perinatologist: modified bed rest starting the first day of red bleeding until 2 to 2.5 weeks after the last day of red bleeding. Lie on your left side as much as possible. After that, pelvic rest and generally take it easy until the SCH resolves. New red blood puts you back down for another 2 weeks
drink lots of water as it calms the uterus and helps to alleviate some of the cramping.
nutrition - make sure you're getting enough iron, as bleeding heavily can cause you to lose some, also be sure to take your b vitamins and get the right amount of folic acid! Some women feel better with high-protein diets (these can help w/ morning sickness too)
alternative remedies such as homeopathic arnica and acupuncture have helped women on this board.
try to stay calm - it's not easy when things are unpredictable, but reducing your stress will help you to heal

SCH symptoms
(these are just a few of the most common ones - scan the boards for more!)
bleeding - often bright red at the beginning of an SCH, and dark wine, brown, black or grey as the SCH begins to resolve. bleeding patterns vary widely - some women start with a bright red gush and then over a period of weeks, notice that bleeding decreases and becomes more brown. others have shorter periods of bleeding, followed by a break, then more blood. brown/grey/dark blood is generally blood from an older/resolving SCH and not something to worry very much about (get your doctor to confirm this). a new bright red blood bleed is often a reason to call in and check with your doctor. several doctors have stated that you don't need to go to the ER for a bleed unless you're filling more than a pad an hour with bright red blood AND feeling ill/woozy/unstable from the loss of blood.
cramping - blood from an SCH is an irritant to your uterus, so cramps often accompany an SCH. it's always a good idea to discuss cramping with your doctor so that you can distinguish cramps from contractions or other signs of early labor.
passing clots - coagulated blood from the SCH often comes out in clots. they are gross and often to be expected.
feeling tired - SCHs can wear you out physically and emotionally. try to take time to rest to give yourself energy to heal.

What to ask your Doctor/Perinatologist (peri) about your SCH:
-what are the dimensions (usually height, width and depth in cm) of your SCH? Does your doctor have a sense of how long it might take for it to resolve? (usually the answer to this is no… sadly, it’s nearly impossible to predict how long an SCH will last; some resolve in a few weeks, others a few months, and others persist through your entire pregnancy.)
-where is the SCH in relationship to your placenta and the rest of your uterus? If your peri can draw a picture for you it can be helpful to be able to see it.
-Is any of the placenta detached/torn from the uterine wall as a result of the SCH? If the placenta is torn, how much of it is torn away? Does your doctor expect it to reattach? How might the tear affect your pregnancy?
-how often does the peri want to see you? is this enough monitoring for you to feel comfortable between the peri and your ob or midwife?

-What restrictions (bed rest, pelvic rest, "taking it easy") does your doctor recommend? what does your doctor mean by these? are they OK for you? can you fly with an SCH? Should you restrict car travel to a certain time or distance? For those of us at altitude, is it safe to go up or down a few thousand feet (or more) in elevation?
-Can you get prenatal massage or acupuncture to help discomfort and stress until the SCH resolves? Does your Dr. know of reliable massage/acupuncture practices for high risk pregnancies?

getting through it
-Can your peri give you a sense of what to expect in terms of bleeding and cramping? how much bleeding, of what color, and what kind of cramps can you expect? what symptoms would lead you to contact him or her between appointments? what can you do to soothe your cramps if you get them? -What might you be at risk for going forward in your pregnancy? if your doctor is worried about potential early labor, when does the hospital that he/she is affiliated with consider your baby to be viable? where is the best NICU in your area if you go into labor early? (hospitals vary, some consider a baby viable at 22 weeks, but 24 weeks is much more common.)
-What are your next milestones?

Other SHC-related issues:
unpredictability: The causes of SCH are little understood, and what helps them resolve even less so. This means that few doctors can even give you statistics on how the SCH will change your chances for reaching viability, preterm labor, or membrane rupture - it's all unpredictable, and seems to change from woman to woman and pregnancy to pregnancy. This might help explain why each doctor and practice seems to have a different approach - some prescribe bedrest while others do not, some will monitor closely and others just have you check in whenever you have a red bleed. All most will say is that an SCH gives you more of a risk for later complications, and that the longer it sticks around the more risk you've got. Exactly how much though? Few will say.
where is an SCH in your uterus? An SCH is below the chorionic tissue that the placenta attaches to. Many people think that an SCH is a separation in the placenta from the wall of the uterus, but that is only one possible type of SCH. An SCH actually does not have to be anywhere near the placenta, just below the chorion (i.e. the "C" in SCH, the tissure that covers your uterus, and what is shed during a period.) That is why it is important to figure out where the location is of the bleed is. If it is near the placenta or behind the placenta then it could (could... not will) cause the placenta to separate, or perhaps to detach if the SCH really grows, but if it is nowhere near the placenta then it's a bit less threating
severity of the tear - a doppler on the u/s can help determine if the tear is all genuinely a tear, or if part is just dark bc of regular blood (arterial?) flow between uterus and placenta.
placental tear that does not reattach: Sometimes a piece of the placenta will tear and never reattach due to an SCH. If this happens, doctors will look for signs that the rest of the placenta is compensating. If your baby is still growing on target, isn't showing other signs of distress, or u/s shows that the placenta is growing in other areas, this is probably what is happening, and the detachment is less of a cause for concern.
medicaid and WIC - if you are getting stung by the high cost of your high risk pregnancy, you may want to look into getting help from these programs; call or visit your local health office to find out more. when you are pregnant the income limit for medicaid goes up, so you may qualify even if you did not before you were pregnant. also, if you already have health insurance, medicaid can cover the additional costs of your co-payments and work as supplement to your current insurance.
vaginal delivery vs. c-section - you should discuss this with your doctor, but it is definitely possible to have a vaginal delivery with an SCH. many women here have, and there is no particular reason why a SCH (even an active one) would cause you to have to have a c-section.
placental lakes - no apparent impact on pregnancies, they appear to act like varicose veins in the placenta. Look scary, but harmless. Not necessarily tied to SCH - kind of random phenomena.
bright spots in your LO's bowel - while it can definitely be an indicator of a problem, they also pop up in SCH babies because the hemorrhage pigment can cross the membrane and be ingested with the amniotic fluid. Also scary, but if it appears/disappears between scans it's more likely pigment and not harmful.

Useful threads:
SCH stories
Ten things I learned from bed rest

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