My name is Annette. I am 34 years old, live in Chicago, married, and expecting our first child November 2, 2002. My husband and I have been married for almost four years and put off having children for career development purposes, to enjoy traveling and all sorts of outdoor activities. We considered ourselves fortunate to get pregnant very quickly and easily after deciding that it was time and of course were very excited. I began a journal shortly after the pregnancy was confirmed. The following is my experience dealing with a subchorionic hemorrhage/hematoma to include journal entries, and dr. info. It is a lengthy but complete account of my experience. In a nutshell my sch returned third trimester in the form of an abruption warranting c -section delivery at 28 weeks 6 days!
About week 8 of the pregnancy, I noticed a change in my discharge. It was tinged brown or pink; I mentioned it at my routine ob appt. My doctor did an u/s at this visit to confirm that I was pregnant and she noticed a very small area below the sac that she said may be causing the color in my discharge. At this point she dismissed it as possibly the site of implantation and that it would reabsorb on its own and it was probably the source of spotting. Again, it was very tiny. I had no reason to worry and was glad that I had some explanation to the scanty spotting because I knew that during pregnancy there should be no color to your discharge. The scanty spotting of brown and pink continued through week 9 and 10. I was working full time, working out, power walking, and just enjoying taking the best care of my body for my baby.
Week 11. I had a huge scare at 4:00 am. I felt like I was losing my urine through my pj's. When I got out of bed, I felt a huge gush of fluid come out. I went into the bathroom to find I had completely soaked through my panties, pj's, and it was very bright red blood. There were no clots or tissue. The bleeding was very quick and stopped after I went to the bathroom. My husband looked through my dr's recommendations as to what required an immediate phone call and this occurrence was one of those times. So I called at 4:15 am and my OB's partner asked me to describe what happened - told me to lay on my left side and said that if I started to bleed heavily w/ cramping to call back and she would meet me at the ER. Otherwise, she would meet us at the office at 7:30 am before regular office hours. She called us back at 6:00 am to see how I was feeling. I am very blessed with wonderful drís. We met her at the office and they checked to see if my cervix was closed, which it was, and did an u/s to check on our little sweet pea. There was no evidence of anything peculiar in my womb other than our healthy fetus with a strong heartbeat. I should mention that I have had abnormal paps in the past and was treated for dysplasia several years ago and at this point the dr. saw an abnormal spot on my cervix that bled to the touch. She said that during pregnancy the cervix becomes very vascularized (develops blood vessels) and often it can cause sensitivity and bleeding especially after sex. So since there was no evidence of anything in my uterus, and my cervix was closed, we attributed the bleeding to the cervix. I did not spot or bleed the rest of this week.
Week 12. Mid-week another scare-this time after a power walk and stretching at home. A gush of blood again came out in the afternoon. I decided to not call immediately but wait until the next morning; I was thinking to myself no big deal. I called Friday at 7:00 am, and my OB saw me 2 hours later. Again, cervix remained closed and bleeding had stopped. However u/s showed sch a small area near the cervix which was described to me as positioned to drain out of my body. So I was instructed that I should expect two things: either reabsorption-not likely, or draining of the clot from my body-likely. They really didn't at this point explain to me what a sch was, only that I had an accumulation of blood between the placenta and the uterus. I didn't ask many questions and there was no mention of stats or final outcome. I was instructed to take it easy, which meant no more exercising and to take off 5 days from work, because I stand a lot. Since my husband travels a lot for his job, my mother flew out to keep me company and help for the weekend. Thank GOD she was here that weekend! (My mother is a breast cancer patient receiving radiation followed by chemo at this time so it was difficult for her to come out to Chicago, but she did). The next paragraph is fairly gross and graphic but describes to a tee my experience.
Week 12. Well, the only way I can describe that evening after my diagnosis of a sch is that ALL HELL BROKE LOOSE! I knew that they said I would possibly pass the clot out of my body but nothing could have prepared me for how my body might accomplish this. At around 4:00 pm, I started having strong menstrual-like cramps. They continued to be strong until about 8:00 pm. At this time I started passing small clots (quarter size) every half hour or so. The weird thing was I passed three clots with little to no red blood between it, just old clotted blood. I wasn't freaked out yet. Went to bed by 10:00 pm. Cramping was getting stronger and clots were getting larger and more frequent and now were accompanied by bright red bleeding in between. I could feel the clot passing-run to the bathroom and sit on the toilet. The clots were now 2-3" in diameter. I thought I was miscarrying, as did my mother. My Mom said we needed to call my dr. and probably go to the ER. I called my dr. at 11:30 pm and she instructed me to go to the ER and the possibility was very real that this was an impending miscarriage. We examined the clots, as the dr. had instructed, for signs of fetal tissue-NOTHING! Upon arrival at the hospital, I had a pelvic which again showed cervix closed, but I had a huge residual clot, about 4" across, in the birth canal which was removed. I was wheeled down to the u/s for a level 2, had a catheter inserted, and much to our amazement, our little baby was sucking it's thumb and basically wondering why Mommy was still up at 1:30 am. We could not believe that a fetus could have survived what had been happening all evening and on top of it all, they could not see the sch that I told them I had been diagnosed with earlier that day! I thanked GOD. The dr. said I was threatening to miscarry. It did not mean that I would miscarry, but if I continued to bleed I could. The odds were 50/50. He said that he had personally seen women pass clots the size of a hand and still carry to term; the nurse concurred. The ER dr. put me on bedrest, (NO stairs, lifting, standing-just get up to go to the bathroom). I was told to really push fluids, and follow up with my reg. OB on Mon. The pregnancy is now labeled as high risk. I had another big bleeding episode on Sun evening. I was scared, but not freaked out. I left things in God's hands, prayed a lot, and thanked God each day that passed that my little sweetheart stayed in my womb. St. Ann is the patron saint of expectant mothers for you Catholics out there.
My follow-up with my regular OB was 3 days later first thing Mon AM it was also the first thorough explanation of a sch. My OB sat down with my husband and myself for a good deal of time to explain. First of all she had first hand experience with this since she told us that she had a sch with 2 of her 3 pregnancies, and bled from month 3/4 until she delivered. Both were healthy babies-one was full term, the other came 4 weeks early. So that was encouraging. This is how a sch was explained to me by my OB: 1. It is basically when a portion of the placenta detaches from the uterine wall (an abruption) and a pocket of blood forms in between the wall and the placenta. Outcome is dependent on where the separation occurs and how much blood volume is in the clot in relation to the volume of the amniotic sac. Mine was fairly large, but on the margins of the placenta near the cervix. 2. This is what can happen: a) The placenta will reseal to the uterine wall-likely to happen with bedrest and when diagnosed early. b) Miscarriage-possible but not likely. c) Placenta will not reseal, bleeding will continue throughout the entire pregnancy, but a full term baby is still likely. So you see, the odds are in your favor. 3. How the condition progresses: By 16 weeks, there is usually improvement evidenced by weekly u/s. At 20 weeks most cases show almost complete resolution. My OB said if they did not see significant improvement by week 16, then I would be referred to a high risk OB or perinatologist who specializes in maternal and fetal medicine. 4. Bedrest is prescribed because it maximizes oxygen and nutrient flow through the placenta to the baby and allows healing. The function of the placenta can be compromised with a sch so you need to make the best of what is flowing through the placenta. Bedrest by my OB is: no lifting, sex, exercise, cleaning or driving. 5. Some ladies will bleed from the sch if it is at a position to escape the body; otherwise the blood may reabsorb. Cramping can occur as well since the blood in your uterus is an irritant-and if not resolved it can cause preterm labor later in the pregnancy. They can possibly treat this successfully if it happens.
I was told that I would have weekly visits and u/s until the sch resolved. My husband was really great through all of this and took over when he was home. I also had mother and mother-in-law help out when they could.
Week 14: Hematoma showed increase in size from previous week. At this point I'm having a big bleeding episode every 6 to 7 days like clockwork with cramping about an hour before I start bleeding with clots. It lasts about 4-6 hours, and is almost always at night. It is never as bad as what prompted the ER visit mentioned above, but very scary still, and uncomfortable. In between those big bleeding days, I had dark brown spotting. I also felt some pelvic pain when urinating. Despite the aches and pains of pregnancy, I was looking forward to not having a period, and here I was wearing a pad daily. This wasn't what I signed up for. UGH!
Week 15/16: Felt first flutters from the baby. I think when you are on bedrest you are more in tune with what is going on with your body. Still bleeding every 6-7 days. I actually started a big bleeding episode in the dr.'s office while waiting for the u/s. Well, this is the week that she spoke of earlier, no improvement means seeing the high-risk dr. I saw him the same day. My dr. called his office while I still was in u/s. At this point there are 3 areas of bleeds visible on my u/s. The main sch, and 2 other small pockets. I went to the peri about an hour later for a level 2 u/s. Sch is clearly visible but, as always, the baby is unaffected and on track for development. The peri actually lets me do a little more than what I had been. I can actually get up to cook a meal if I'd like. He said if I started to bleed after getting up off the couch or bed not to blame myself and that it is blood that has pooled in the vagina and would have to come out sooner or later. Other instructions were to cover or protect my abdomen if in public to prevent someone bumping into me. He explains again about the way it can go and it was reassuring to again hear of cases where women had almost complete separations and things resealed-so I had hope. I chose to remain on the safe side and still do as much bedrest as possible. I was to see him again in 2 weeks for a second u/s. The BIG news is we are having a daughter!!!!!! They could see the identifying anatomy at 16 weeks....amazing!
Weeks 16, 17, 18, 19: More of the same. Again like clockwork every 6-7 days I would have a huge bleed with major cramping. I'm getting closer to the 20 week mark so I'm feeling more confident that I can sustain the pregnancy. I start having feelings that this baby girl is going to make it. I start doing heavy correspondence on the internet with other women who have been diagnosed w/ the same condition and it is an immense support system. The 18 week u/s is showing slight healing and baby is growing normally for gestational age. The peri tells me we are getting closer to the 20 week mark when things should improve dramatically. We'll see in 2 weeks!
Week 20: Peri says u/s shows the hematoma has almost healed. I don't have to see him until Aug 2 at 26 weeks unless I start having a major bleeding episode. They instruct me that I can start doing more. I am warned by the peri though that I am at risk for abruption in 3rd trimester so be aware of the signs of preterm labor...they give me an instructional sheet. I'm measuring 2 weeks ahead of EDD.
Weeks 21-24: No bleeds since 20 week point, just like they said. It seems like I grow overnight and baby is really moving.
Week 26: Peri appointment showed to our surprise residual blood pooled at same location where sch was noted earlier in pregnancy. They tell me to take it easy, but no bedrest. The dr. explains that the next 6 weeks are critical as placenta has further demand on it as baby increases in weight and size. Peri wants to see me again at 32 weeks. I can still get out, but donít overdo it, were the instructions.
Week 27: Thought my water broke one evening at 2:00 am; clear fluid felt like a gush. Called my Ob and they want to see me at hospital in L and D. I'm scared-I know that 28 weekers have an excellent chance of survival but we are a week short. Okay, I find out I'm leaking urine instead. Just have to live with this feeling every so often. It doesn't feel like you are peeing because you have no sensation of having to go it just all of a sudden feels like a gush. Can you say Depends?!? HOWEVER, they discovered that I was contracting every 4 minutes! I could feel tightening, but I thought that was normal Braxton-Hicks. So, I'm put on an IV as first line of treatment-the contractions stop after an hour and I'm released again with a whole list of instructions and warning signs to pay attention to. I might add that I did have an u/s and a small residual pocket was still visible. We named our baby girl Katherine Marie.
Week 27 plus 6 days: I see my OB for the same reason as above-it scared me so to have another HUGE gush of clear fluid. Again u/s revealed amniotic fluid level was normal. I try not to worry. My dr. is reassuring; she is wonderful and supportive.
WEEK 28 to the DAY: ALL hell breaks loose at 9:00 pm. I'm home alone, my husband is on a business trip. I'm sitting at my computer talking with a friend on the phone. All of a sudden, A HUGE GUSH that literally feels like a running faucet is coming out of me. I stand up. Blood and blood clots are coming out... one the size of a fist. The bleeding does not stop. It is literally a faucet like flow. I call my neighbor, they call 911. They also call my OB. She tells them to get me on my right side immediately until ambulance arrives. Remember it is a 911 call if you hemorrhage your last trimester. The ambulance arrives 2-3 minutes after call placed. The EMT's talk to my dr. as we go. They pick up fetal heart tones and start the IV. I can feel baby Katherine moving. The EMTís tell me this can still have a good outcome as bad as it seems. I'm at the hospital 7 minutes after call is placed. It is crucial to get there ASAP when this sort of thing happens. Your baby and you are in a life-threatening state due to blood loss. When you have an abruption, I can't tell you the amount of blood you lose-it is an immense amount. Itís very frightening because I felt like I was bleeding to death. It is more than your bleeds from a sch.
I am stabilized and immediately put on Betamethasone (steroid) to mature Katherine's lung and brain. Also given Ampacillin, and Magnesium sulfate (to stop the contractions.) They are going to keep me in until I deliver and we are hoping for 4 more weeks of gestation to minimize complications.
Week 28 6 days: I deliver Katherine via section and she weighs in at 2.5 lbs. and 13 inches. Very scary! 9 weeks in the NICU. We were fortunate and blessed with very minor complications. The whole NICU ordeal is a long one not suited for telling here...as they say-a whole other show!
3/8/02: Katherine is 6 months now! All I can say is that Robin did a wonderful thing compiling everyone's stories to provide an information clearing house to benefit others. Thank you Robin!!!! I hope my success story helps you all. Even though I delivered 11 weeks early, I always thought I would make it to full-term. Usually you will.
Good luck and prayers!