Early Pregnancy Loss – Miscarriage & Ectopic Pregnancy

We talk a lot about pregnancy in our society, but not so much about failed pregnancy. We don’t talk much about miscarriage, ectopic pregnancies, stillbirths, or how so much of the aftermath can be the same as far as postpartum depression goes. It’s easy to forget that as women, we go through extreme changes to our bodies and hormone levels just by going through a very natural process.

This post has been a real struggle for me. I started writing it a few weeks back when my first sentence was “This month was a roller coaster of emotions.” The sentence has now become “Last month,” as time is charging on and I’ve struggled to finish writing.

I’ve put so much pressure on myself to do this subject justice, that it has become a bit of a roadblock. I want to walk through the steps and explain my experience, but also not downplay the emotional side of the process. I want to provide information for anyone going through a similar situation, and also provide a warning to those who are trying to conceive, without also creating fear. Hopefully my story will meet those ends.

Early Pregnancy

Last month was a roller coaster of emotions. In addition to the regular chaos of Christmas, Hubby and I had some personal issues going on that over-complicated the holiday season. For those who know us well, it is no surprise that we have always wanted three kiddos. I got my first glimpse of that reality at the beginning of December. I was three days late and saw my first positive on a pregnancy test. While I was excited, I was also hesitant to completely experience that excitement. I had started testing about a week before, with no signs of a positive. For me, and my body, this was not normal. Both successful pregnancies had registered days BEFORE my missed period – not after.

Despite my hesitation, I decided to throw caution to the wind and enjoy the excitement of being pregnant. I shared the news with my best friend (who rushed over with an extra pregnancy test for me – just to make sure), downloaded some pregnancy apps, and calculated my baby’s due date – August 8th. That night when Hubby got home, I surprised him with the news. He was equally excited and a bit shocked – we hadn’t been actively trying, so neither of us was expecting it to happen so quickly.

A Blighted Ovum

Before I get too far into my current story, it’s important to share some background information and general statistics on pregnancy loss. In 2016, I had a blighted ovum that resulted in a miscarriage. A blighted ovum is when a fertilized egg attaches itself inside the uterus, but the embryo never develops into a baby. Your body believes you are pregnant (because technically you are), but nothing comes of it. Eventually your body recognizes that there is no baby developing and you miscarry.

In my case, it took my body about a month and a half to realize that I was not carrying a viable pregnancy. A month and a half of daily bloodwork, weekly ultrasounds, emotional highs and lows (far more lows), missed workdays, and medical bills that easily could have done us in without excellent insurance. I kept holding out hope that in one of the many ultrasounds, they would finally see a baby. Of course, that never happened.

At one of my appointments, my doctor recommended I schedule a D&C (dilation and curettage). WebMD defines a D&C as “a brief surgical procedure in which the cervix is dilated and a special instrument is used to scrape the uterine lining.” This removes the pregnancy so your hormones can return to pre-pregnancy levels.

Miscarriage

A few days before my appointment, I miscarried naturally. At this point, it was almost a relief. I was disappointed, but at least there was no baby to mourn, no loss of life. However, I didn’t realize how much would still be involved. After the miscarriage, I thought I was done. Done with all the appointments and done with the ultrasounds. Turns out I was wrong. My doctor requested another ultrasound to make sure I had passed all of the pregnancy tissue. I hadn’t. If my body failed to pass the tissue naturally, I would still need a D&C. Pregnancy tissue cannot be left inside a woman’s body. If it is, it can become infected, creating further complications.

My doctor gave me some medicine to take that would help pass the tissue. This part of the process was done at home. Then I needed another examination to once again make sure all the tissue had been expelled. And, like before, it had not. Fortunately, it was just a small amount. My doctor felt that walking around the hospital would help. After hours of walking around and multiple examinations (I spent an entire day at this appointment), my body had finally passed all the tissue. I then needed weekly blood draws to make sure my hormones had returned to pre-pregnancy levels. It was quite a process and one I was not expecting. I figured our bodies would naturally miscarry correctly. The amount of possible medical intervention never crossed my mind.

Fortunately, within just a few months of my miscarriage, I got pregnant with Love Bug. The miscarriage was finally behind me and I had a new baby on the way.

Risk of Miscarriage

Did you know that miscarriage occurs in 10% to 25% of all confirmed pregnancies? The exact number is unknown and could be quite a bit higher. Because so many women miscarry before they even know they are pregnant, they just assume the miscarriage is their period. It’s a common occurrence, and yet one people don’t really talk about. I had no idea that miscarriage was such a high risk the first time around. Fortunately, we had smooth sailing with my first pregnancy, but many women aren’t as lucky. It’s a traumatic thing to experience and can take its toll on your body. The risk of a repeat miscarriage increases slightly after each one, so Hubby and I knew that miscarriage was a risk when trying for baby #3.

While it’s normal to expect those suffering from a miscarriage to have an emotional recovery, it’s easy to overlook the physical repercussions. Even in healthy pregnancies we rarely talk about postpartum depression or give moms the proper support they need after a baby is born. The focus shifts to the baby – its health and well-being. However, in the case of miscarriage, there is no baby to focus on. This fact alone makes it easy to forget about the physical toll the body goes through. Postpartum depression impacts 10% to 15% of all women who experience a miscarriage.

Postpartum Depression

According to Medical News Today, “PPD is likely to be the result of multiple factors. However, its exact causes are still not known. Depression is usually caused by emotional, stressful events, a biological change triggering an imbalance of brain chemicals, or both.”

Medical News Today lists the following factors that may contribute to PPD. If we look at them and compare miscarriage to a normal pregnancy, it’s easy to see that many of the possible causes overlap.

Contributing Factors:

  • the physical changes of pregnancy (Although these changes are not always visible from the outside before a miscarriage occurs, our bodies start changing the second we become pregnant.)
  • excessive worry about the baby and the responsibilities of being a parent (Relevant the second a woman finds out she is pregnant.)
  • complicated or difficult labor and childbirth (Not relevant to miscarriage, though treatment of the miscarriage can be complicated and difficult.)
  • lack of family support (Relevant to both miscarriage and normal pregnancy.)
  • worries about relationships (Also relevant, especially considering the stressors of miscarriage on both the mother and the father.)
  • financial difficulties (Costs associated with a miscarriage can get quite high, with the pain of no baby in the end result.)
  • loneliness, not having close friends and family around (This can be the case with any complication during pregnancy.)
  • the health consequences of childbirth, including urinary incontinence, anemia, blood pressure changes, and alterations in metabolism (Less relevant with a miscarriage, though there can still be multiple health consequences.)
  • hormonal changes, due to a sudden and severe drop in estrogen and progesterone levels following birth (Hormone levels plummet any time a pregnancy ends – regardless of whether it’s a miscarriage or healthy birth.)
  • changes to the sleep cycle (Not as relevant to miscarriage.)

From the above list, it becomes clear that postpartum depression can occur after any pregnancy – regardless of the length of pregnancy or the result of the pregnancy. The bottom line is that pregnancy is hard on a woman’s body and her emotional state. Often ignored topics.

The Roller Coaster

Jumping back to the more current situation (I promise this will all tie in at some point), on Tuesday, December 4th, I got my first positive on an at-home pregnancy test. As I mentioned earlier, I had started testing about a week prior, so the delayed positive was a red flag for me. I know my body well and I know how it has reacted to pregnancy in the past. This was not normal. With my successful pregnancies I had gotten a positive days before my missed period. With my blighted ovum, I had a delayed positive that only showed up days past my missed period. History seemed to be repeating itself.

Because I was nervous (yet cautiously optimistic), I called my doctor and made an appointment to have my HCG levels checked. I didn’t want to assume the worst, so I allowed myself to get excited and remain hopeful. I assured myself that everything was going to be okay and that I was worrying needlessly.

Suspected Miscarriage

On Thursday, December 6th, just two days after my positive, I went in for bloodwork. That morning I had some light spotting, which was another red flag. This is not unusual for many women in their first trimester (or even throughout their pregnancy), however, I had never had this happen. By the time I had gotten my bloodwork, I was bleeding heavily and it was the bright red you never want to see. At this point, I assumed I was having a miscarriage.

Though it was early, I was crushed. I had wanted to hope for the best, even though it wasn’t a total surprise. Hubby and I were planning to make the announcement at Christmas and had pulled in a family friend to help us with the surprise. I felt the disappointment more this time around than I had with the blighted ovum. That night, I allowed myself to grieve. I was disappointed, devastated by the loss, and angry. Because of the two losses I had now experienced, I knew that any subsequent pregnancy would be a cause of concern and hesitation, rather than joy. I felt robbed. Having to worry about complications seems unfair when pregnancy should be a joyful and exciting time.

The next day, my doctor called with the information I already knew. My HCG levels were much lower than they would have expected at this point in the pregnancy (5 weeks). My doctor agreed that my suspicions of miscarriage were likely correct. However, I needed more bloodwork to make sure my levels were dropping appropriately. They wanted me to come in Monday for another blood draw. I had a busy week ahead and didn’t want the cost of more bloodwork, so I put it off. On the 11th – a full week after the suspected miscarriage – I took another pregnancy test. I figured if the result came back negative, I wouldn’t need the extra bloodwork. Unexpectedly, not only did the test come back pregnant, but it was a very strong pregnant.

Still Pregnant

After another round of bloodwork, I had to wait over the weekend for my results. I was likely still pregnant based on the pregnancy test. The doctor’s office explained that the bleeding could have been the miscarriage of a twin. There was also a chance that the pregnancy was fine and I was just having bleeding (some women have bleeding throughout their entire pregnancies). At this point, I allowed myself to get my hopes up once again. However, I also began worrying that the pregnancy could be ectopic – a feeling that was nagging at me in the back of my mind.

Ectopic Pregnancy

Ectopic pregnancy is when a fertilized egg attaches itself outside the uterus, very often in the fallopian tubes. It occurs in 1% to 2% of pregnancies, or 1 in 50, so the risk of an ectopic is relatively low. According to the American Pregnancy Association, risk factors include:

  • Maternal age of 35-44 years
  • Previous ectopic pregnancy
  • Previous pelvic or abdominal surgery
  • Pelvic Inflammatory Disease (PID)
  • Several induced abortions
  • Conceiving after having a tubal ligation or while an IUD is in place
  • Smoking
  • Endometriosis
  • Undergoing fertility treatments or are using fertility medications

Symptoms of an ectopic pregnancy include:

  • Sharp or stabbing pain that may come and go and vary in intensity. (The pain may be in the pelvis, abdomen, or even the shoulder and neck due to blood from a ruptured ectopic pregnancy gathering up under the diaphragm).
  • Vaginal bleeding, heavier or lighter than your normal period
  • Gastrointestinal symptoms
  • Weakness, dizziness, or fainting

The only risk factor I had for an ectopic was prior abdominal surgery from my two cesareans. Other than vaginal bleeding, I hadn’t had any symptoms either. My doctor felt my risk for ectopic was pretty low since there are so many other explanations for bleeding during pregnancy. However, it was still a possibility, so once again more bloodwork would be needed. My doctor also scheduled me for an ultrasound, to confirm the location of the pregnancy.

Decrease in HCG Levels

On Monday, my results from Friday’s blood test came back quite high – I was definitely still pregnant. I went in for more bloodwork on Tuesday and had my ultrasound scheduled for Wednesday. At this point, Hubby and I were cautiously optimistic that I had a viable pregnancy. Hubby took part of Wednesday off so that we could get some Christmas shopping done, go to my ultrasound (hoping for good news), then go out for a nice dinner, just the two of us. Part of the day went as planned, but while we were shopping, my nurse called. The bloodwork results from the day before had come back and had dropped significantly. Things weren’t looking good.

The Ultrasound

The ultrasound confirmed our fears. There were no signs of a baby anywhere in my uterus. With no answers, we sat in an exam room for almost 2 hours waiting for my doctor to finish her scheduled appointments. At this point I was feeling a myriad of emotions. Disappointment, frustration, anger, and impatience over the wait. Finally, my doctor came in – and she had no answers either! During the ultrasound they had found a mass near my right ovary, but they couldn’t tell if it was in my fallopian tube. Based on my HCG levels and the lack of visible pregnancy in my uterus, they were fairly certain I had an ectopic pregnancy. That said, they weren’t 100% sure that the mass they had found was the ectopic. There was a chance it could be something else entirely – in addition to the ectopic.

The Options

Because of this, I had two choices – I could get a shot of Methotrexate, which allows the body to absorb the pregnancy tissue. If it works, it can save the fallopian tube. If it doesn’t, the fallopian tube can rupture, causing a life-threatening situation for the mother. In my case, if I went with the shot, I would still need to have the mass monitored in case that was something other than the ectopic. We would also need to hold off on conceiving, as it takes months for the body to recover after Methotrexate. Most doctors recommend waiting a minimum of three months – three months longer than we wanted to wait.

My other option was to have laparoscopic surgery. My doctor would go in laparoscopically, get a better look at what was going on, and make decisions from there. The risk with this option (other than the normal risks that come with surgery), is that once they went in, they would need to make a decision on how to proceed without discussing it with me first. They didn’t know what they were going to find during the surgery. Because of this, I had to give consent for them to do whatever needed to be done. If I chose surgery, I had to provide consent on the following:

  • Removal of my fallopian tube, ovary, uterus – or even all three
  • Opening me up for more invasive surgery along my c-section scar if they couldn’t get a good enough assessment of the situation laparoscopically
  • A D&C (dilation and curettage)

Hubby and I only had a short amount of time to decide. The situation was urgent and I needed to be treated that day, whether by surgery or with the Methotrexate. The minute my doctor walked out of the office to give us time to talk, I burst into tears. I had a ticking time bomb inside my body, plus an unknown mass that could be anything.

One of my closest friends has been battling breast cancer this past year, so my first concern was that the mass could be cancer. My second concern was that my doctor would have to remove a part of my body that could make future conception difficult, if not impossible. My third concern was over the finances. Surgery isn’t cheap and we were nowhere near meeting our deductible for the year. We only had one week until the new year turned over to a new deductible – one week! The timing certainly wasn’t in our favor.

On top of all that, we were dealing with the knowledge that had the egg implanted correctly, this would have been a viable pregnancy. We were having to terminate a pregnancy – a baby – that was otherwise healthy.

The Decision

Despite all of the risk factors, I opted for surgery. Hubby was nervous, but I didn’t want to go into the holiday stressing about what could happen. I am not a patient person and I wanted answers. Answers that could only be provided by allowing my doctor to get a better look of what was going on inside my body. I also didn’t want to risk my fallopian tube rupturing and creating a life-threatening emergency. I wanted the bomb removed.

Within two hours of the consult with my doctor and four hours after my initial appointment, I was sitting in the emergency room of the hospital waiting to be admitted. Within an hour of that, I was put under general anesthesia and after that the timeline becomes blurry. I vaguely remember waking up and being disoriented for a moment. I also remember being exhausted and not wanting to wake up, but feeling like I had to and not knowing why. The nurses taking care of me were phenomenal. They were sweet, sympathetic, patient – everything you hope a nurse will be.

After Surgery

After I was awake (but still relatively drugged up), my doctor came in to talk to me. While the worst-case scenario had been avoided, I was still devastated to hear that she had needed to remove my right fallopian tube. Fortunately, the mass had been the ectopic, so there was no cancer and no need to be monitored further. I’m glad I was drugged up at this point, because I’m pretty sure I would have broken down had I been completely coherent. I didn’t want to lose a part of my body, and certainly not one that would make conceiving a third child harder.

My doctor also told me that I had made the right decision by opting for surgery. My fallopian tube was so stretched that it likely would have ruptured within 24 hours, even if I had taken the shot of Methotrexate. It was leaking blood into my abdomen, and could have become life-threatening in a very short amount of time.

Because laparoscopic surgery is an outpatient procedure, I was allowed to leave as soon as I could stand. I don’t remember how long that took, but it was probably around 9 or 10 pm at that point. Most of the evening is a bit fuzzy. I remember snippets here and there, but not individual details or conversations because of the painkillers and anesthesia. I do remember not being very hungry, even though I hadn’t eaten all day. My stomach couldn’t handle much and my doctor recommended keeping any meals fairly light for the first 24 hours. That said, in order to take painkillers, I had to have food in me.

Hubby stopped on our way home and picked me up some chicken noodle soup, which was perfect. He even got me some ice cream, but I wasn’t able to stomach it – that was a clear sign to him that I wasn’t feeling well!

Recovery

The pain from laparoscopic surgery was not nearly as bad as the pain from my c-sections, though it did hurt to sit down and stand back up for the first day or so. Like a c-section, coughing, laughing, and sneezing hurt, but again, it was just for a day or two. I had three small incisions in my stomach – one on the left, one on the right, and one in my belly button. What I wasn’t expecting from recovery was the exhaustion. I was so tired. Every afternoon, between 12 and 2 pm, I would crash. This lasted for about 2 weeks. I was also incredibly hormonal, with no patience and a very bad temper.

Between the exhaustion and the hormones, I felt very out-of-control of my body. I worried about post-partum depression. I wasn’t expecting either of these side effects and they both hit me harder than recovery from my c-sections. Another odd side effect that I’ve heard is actually quite common, was shoulder pain. For the first 3 days, I had stabbing pains in my shoulder. Apparently, it has something to do with the CO2 gas they use during surgery. Hubby would rub my shoulders for me and that helped quite a bit.

Complications

While I was lucky in that I had minimal complications with my surgery and recovery, not all women are as fortunate. I mentioned the possibility of postpartum depression not because I dealt with it personally, but because it is a real possibility for any woman dealing with a pregnancy loss. It is helpful to be aware of that fact because it is not a topic doctors generally talk about with the loss of a child. With miscarriage, ectopic, and stillbirth, the female body goes through huge hormonal changes. And, of course, there is also the emotional damage of dealing with such a loss. My doctor discussed the risks of surgery, but she didn’t discuss with me how I might feel after.

Side note: I love my doctor and none of this is meant to be a reflection on her. I trust her completely. That said, the medical field, in general, tends to focus on the physical side of things, rather than the emotional complications after. I mention all of this not to be critical of my doctor, but so that others going through something similar know what to expect and be aware of.

Food for Thought

Finances

When dealing with something this emotional, one doesn’t like to think about finances. Unfortunately, for many of us, finances aren’t something we can ignore. Medical procedures cost money and the bills come in whether we want them to or not. Dealing with an ectopic pregnancy cost us thousands, even with decent health coverage. We had one week before our deductible rolled over, which means we will have another deductible worth of costs when I get pregnant again. This is a huge stressor.

Don’t feel guilty if your mind goes to the cost of everything while going through this. It doesn’t make you insensitive – it makes you realistic. When I had my miscarriage, a woman in the finance department at the hospital had the audacity to make me feel guilty for showing concern over the cost of all the procedures I needed. She told me that no cost in the world should outweigh the health of my child (a child that didn’t even exist because of the blighted ovum). Not only was this comment completely inappropriate, but it was unrealistic. Very few of us have unlimited financial resources and money is a legitimate concern.

Emotions

Everyone will deal with the loss of pregnancy differently. I joined an ectopic pregnancy support group on Facebook and it became clear immediately that loss affects everyone differently. Some people are devastated and terrified to try conceiving again. Some feel as if they have had an abortion (this is a valid feeling, but please do not blame yourself – any pregnancy outside the uterus is not viable and needs to be terminated). Or, some people mourn the loss of the pregnancy, or the loss of a body part, but not the baby specifically.

I fell into this latter category, and it made me feel like a horrible person. Disappointment over not being pregnant, upset that I lost my fallopian tube, stressed about the financial implications of everything – those were all emotions that I felt significantly. However, I didn’t mourn the loss of the baby. This made me feel inhuman and insensitive. Maybe it’s because I knew deep down that the pregnancy wasn’t viable and I had come to terms with it. Maybe it’s because I had already mourned when I thought I had miscarried. Or, maybe it’s because I just haven’t allowed myself to think about it much. It’s likely a combination of all three.

No matter the reason, everyone deals with this loss differently. Everyone grieves differently. And everyone is allowed the range of their emotions. Please remember that if you are going through something like this, you are allowed to feel whatever you feel. There is no right or wrong in a situation like this.

Conceiving Again

After a fallopian tube removal, there is a 65% chance of having a healthy pregnancy after 18 months. That percentage jumps to around 85% after 2 years. These numbers depend on the health of the remaining tube, but as long as it is healthy, then the chances of a subsequent pregnancy are high.

Generally, ovulation occurs on varying sides of the body, switching from the right ovary to the left and back again. This is not a hard and fast rule, as oftentimes one ovary can be dominant and ovulate more regularly.


When a person has only one fallopian tube they are still able to get pregnant from an egg at the opposite ovary as an egg from one ovary can travel down the tube on the other side. Conservative estimates suggest that an egg produced on the tubeless side manages to descend the remaining tube around 15 to 20% of the time. This means that rather than your fertility being halved it has been affected by around 30% or, looking at it another way, it means we have around a 70% opportunity of conception with each menstrual (period) cycle.

The Ectopic Pregnancy Trust

Isn’t the female body amazing?

Unfortunately, Hubby and I need to wait before trying again on the advice of my doctor. She recommended that I wait for my period to become regular. It will likely be irregular for the first cycle and hopefully back to normal by the second. Depending on when it returns, that could be a month and a half, or as long as three months. Not ideal, and certainly not my preference, but it is what it is.

This advice is in place for a few reasons. First, it is important to make sure that my body has healed and that I am emotionally ready. Second, having a regular cycle is helpful when determining an accurate due date for further pregnancies. My doctor considers any subsequent pregnancies high-risk until an ultrasound can confirm the pregnancy location. Knowing the correct due date and how far along I am helps them track accurate hormone levels so that another ectopic can be found quickly.

Although the cited risks of getting pregnant too soon after surgery are difficult to find, some resources indicate that there is a greater likelihood of a repeat ectopic or early miscarriage. As it is, my risk of having another ectopic have increased by 10% to 12%.

The Ectopic Pregnancy Trust is a great resource for further guidance if needed.

Final Thoughts

If I could leave you with one takeaway from this experience, it is that you need to know your body. Understandably, this is harder for first-time moms who don’t have other pregnancies for comparison. However, always listen to your gut. Emotionally, I chose to ignore what my body was telling me. Physically, I still went in and had the tests done. Had I not known my body, and known its warning signs of a non-viable pregnancy, I could have been faced with a life-threatening situation. Because I didn’t have any signs that pointed specifically to an ectopic pregnancy, I could have very easily ignored everything.

Know your body. For me, a positive test result should have appeared sooner than it did – I knew my body. My friend with breast cancer – she knew her body. If she hadn’t, the cancer could have spread before she ever knew it was there. You need to know what is normal for you and trust your instinct. If you have any hesitations or concerns at all, see a doctor. It is always better to be safe than sorry.

Please like & share!
error

Leave a Reply

Your email address will not be published. Required fields are marked *

error

Enjoy the blog? Please share the love!