Gestational sac measuring larger... need input and advice

Bronwyn - posted on 09/03/2015 ( 1 mom has responded )

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Okay, so I apologize for this being incredibly long but I figured any information that could be even remotely relevant should be included.

When I was younger, probably about eleven through seventeen, I had eating disorders. Bulimia and Anorexia. After seventeen, I still battled with these on and off until my early twenties. I didn't get my first period until I was fourteen and they were extremely heavy, painful, and highly irregular. My pediatrician suggested that I get on birth control to attempt to tame them when I was fifteen even when I wasn't having sex.

Since I was getting it through a local health department, whatever I told the nurse and doctor there was kept confidential from my mother. I did finally come clean to my nurse and doctor when even the pill failed to get my periods regular. They did another work up with this information and I was told that because of my hormone levels and under developed uterus, it was very unlikely I would ever be able to get pregnant and that if I did, carrying to full term would be next to impossible.

When I did start having sex, I went to the shot and was on it for years. More studies were done and they showed that long term use of depo-provera could lead to osteoporosis. Eventually, given my history, they would no longer prescribe it to me so I went back to the pill. I was in college when that happened and my schedule was crazy so even though I was taking a pill every day, I failed to take it at a consistent time which led me to finding out I was pregnant.

My first pregnancy was when I was 22 and had a handful of complications, mostly low amniotic fluid and going into early contractions. I had laughable "morning" sickness that lasted pretty much all day, nearly every day well into my second trimester. I did start to have frequent dizzy spells and even passed out due to low blood pressure a few times. My blood pressure has always been on the low side though, Finally, after going into the hospital so much for stuff... we scheduled to be induced but only a week earlier than my expected due date. I had a beautiful, perfectly healthy baby girl in 2008. There were complications during the delivery that were on the OBs end so I ended up in the ICU.

I got on Implanon shortly after her delivery. My ICU stay and pain meds pretty much negated breast feeding until the point I was having a hard time producing anything. But anyways, for those who aren't familiar, Implanon lasts for five years. It took about three months after coming off it for my periods to get back to normal. They were still pretty irregular but I was finally having one every month now but they could be off by a couple of weeks. I was also still bleeding heavy and painful cramping.

My husband and I weren't really trying for another, but weren't doing anything to prevent it either. Now, I live in a small town and the OBs here aren't the greatest. Some are down right horrible. Some have outdated ideals. And the good ones take FOREVER to get an appointment with.

When I found out I was pregnant a second time in 2013. I only figured out I was pregnant by going to my regular doctor for a follow up to a back injury. I had been on pain medicine for at least two weeks and made an emergency appointment with an OB. Going by the last date of my period, I was only four to six weeks along at the very most but I started bleeding before my appointment so I went back to the hospital. Since I had an appointment with the OB two days later, I still went to see what the cause could have been. So she chalked it up to a combination of things but said it probably wouldn't have made it with my hcG levels being what they were anyways.

I wasn't told that we should wait a minimum of three months before trying again and that most OBs actually recommend longer, closer to six months if it was because of hormones. So I was pregnant again within two. This one I miscarried when I was ten to twelve weeks. Only days before I miscarried though, I had an appointment with the same OB and I was told my levels were fine, the heartbeat was strong, and everything was in the right place and developing on schedule. I was told by my OB that it was best to let "nature take its course" and my body would handle it all on its own. Never was I offered the abortion pill or even told that it would help to, even when I had already started bleeding. Never was a D&C brought up. I ended up having to have one when I went back to the ER four days after I had started bleeding because I started losing feeling in my legs and my blood pressure was dangerously low. And again, nothing mentioned about how long we should wait before trying again.

So, I was pregnant again in three months. Growing tired of being given no answers and after talking to some of the hospital staff, realized that my OB had put my life at risk, I sought out an appointment with a fertility and high risk pregnancy specialist out of town. However, because they didn't take my insurance, I had to go through an approval process to be taken on as an out of pocket client. The nurse at his office suggested that in the interim, I might want to schedule an appointment with another OB who could get me in quicker since it would take about two weeks for approval and given my history, she wanted to make sure that everything was alright. This would also cut down on some of the costs as a transferring patient since they wouldn't have to run so many tests on my first appointment. So I went back to my local OB. I was told everything was in the right place again and the blood flow was fine but I was still pretty early along. This worked out since I was able to get approved with the specialist and had an appointment the very next day after my approval.

When I went, he and the midwife were appalled. They said I was obviously ectopic (and very likely would have been when I first saw my local OB). There was also a lot of scar tissue in the tube that had begun to rupture by this point, probably from not being told all my options and that with my under developed uterus, a D&C should have been done. I had to have my right tube removed and I was given proper instructions on how long to wait and some small things my husband and I could do at home to help boost our chances. Both taking vitamins, him cut back on drinking and smoking, go ahead and start taking folic acid, better diets, things like that. My periods were still pretty irregular so that made trying to keep track of when I was ovulating almost impossible.

On June 28th of this year, I had my last "normal for me" period that lasted through till the 7th. I normally have a heavy flow for a few days, a small two or three day break from any bleeding, then medium flow to spotting for the rest. But on July 31st, I started bleeding again but it only lasted three days. It wasn't anywhere near as heavy but was heavier than spotting if that makes sense.

I started noticing my normal period symptoms were lasting longer than usual and my breasts were staying swollen and tender. On the 15th I took an at home test and got a positive result so fast it made my head spin. On the 18th, I had it confirmed at the health department. When the nurse asked me when my last period was, I told her I wasn't sure and what had happened. They don't do blood tests but she said that getting a positive result at two weeks would take longer and be faint. Same thing happened. I was showing positive before the control line in the first circle was even at the end so she put me down for six weeks. Since I was already approved as an out of pocket patient, I was able to make an appointment with the specialist I had seen before even though they had started taking my insurance.

I had that appointment today and the news I got was so confusing and potentially heart breaking.

Basically, my gestational sac was measuring the size of what would put me at about six weeks. She thought she saw the beginnings of a fetal pole but wasn't entirely sure because it was still very small. There was an embryo that, going by measurements, was about four weeks. I had great blood flow, my hormone levels were good (not great but within acceptable levels), and everything was in the right place. But they couldn't pick up on a heartbeat.

The midwife and doctor came in and talked to me and said that, maybe because it was because of all I had been doing before the pregnancy, I managed to boost my hormone levels on my own and that because of my irregular periods, the time of conception was hard to track and I was only four weeks along at which point they wouldn't be able to pick up a heartbeat yet. They explained how going on the last date of period and measurement of gestational sac alone often were unreliable. They explained it this way. "It's like trying to figure measure out a yard with your naked eye alone. Once a fetal pole develops and can have measurements taken, you can use your feet. When a yolk sac starts to develop too, you can use a ruler. When you can watch the embryo develop, you have the yard stick."

The other scenario was that, the baby had stopped developing and my body just hadn't miscarried fully yet. Since my hormone level is higher this go round, it will take a little longer for those hormones to come down. They had all my records from previous OB visits and hospital visits, even with my daughter who I delivered, and said they were the higher than any of them at this stage at both 4 and 6 weeks (where approximate time could be determined). I haven't experienced any kind of cramps or feeling sick like I did with the other three previous ones.

They scheduled me an appointment for the 17th, two weeks from now and told me to be cautiously optimistic and to be on the safe side, the doctor gave me some progesterone supplements.

When I got home, I did the worst thing I could possibly do in my situation. I went online and used Google trying to find out which way to lean. I've found a bunch of things with the gestational sac measuring smaller or even being empty, but very little with it being larger and having an embryo. The only ones I can find are only off by "a few days" to a week going on the date of their last period but I don't know about two weeks off? I read somewhere that someone said the gestational sac size can also be influence on hydration level, something I've been being sure to do in my bid to make sure everything goes right with this one.

Has anyone else had this happen? Or know anyone who has? I can't imagine waiting two weeks to hear a heartbeat or to start bleeding. I'm trying to be optimistic but given my past history, it so hard to do. I'd rather be realistic... but I can't without knowing more.

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Melissa - posted on 09/03/2015

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I don't know the answer to your dilemma, but I hope I can offer some encouragement. I am also pregnant and older, so I had to wait for a few tests, and I was online constantly trying to 'educate myself' on what to expect. I would say, go do your research, trust your intuition, and know that this is out of your control. Being that this is out of your control you cannot do anything really but wait, which is hard, but it's waiting none the less. Remember that each day is really a blimp in the spectrum of your life, and you can do this and no matter what you are going to be ok. That has worked for me, and thanks for your share, it as interesting

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