# What can I expect for a 5 week miscarriage, with our without misoprostil?



## tenzinsmama (Apr 30, 2011)

I found out that my hcg levels were low and not rising, and therefore my pregnancy is not viable. At 18dpo my level was 92 and then 2 days later it was 112. Told to go off the progesterone, which was yesterday. I'm waiting for bleeding to start, and I'm starting to freak out that it's going to happen when I am in Cuba the week of Dec 13 to 20. Apparently, one option would be to take misoprostil to get things started, instead of waiting for it to happen naturally. Does anybody care to share what I might expect, either with the med or without, when I am about 5 weeks along? And at this stage, I can't wear a tampon when I start bleeding, or can I? I'm just thinking how some women may not even know it's a miscarriage, if they didn't know they were pregnant, and be using tampons. I am so scared and confused about what to do.


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## LTurtle (Aug 7, 2012)

My miscarriage was closer to 8 weeks, but I didn't pass anything larger than a big clot. I don't use tampons anyway but I don't see why you couldn't use them for something so early. I would be surprised if your MC presents much differently than your menses would, but I am no expert. Sorry I don't have any experience with misoprostil. I didn't know I had miscarried until I started bleeding, it was similar to a heavy period (for me) but crampier and clottier.

Can you talk to your doctor about what to do next? I am so sorry for your loss.


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## tenzinsmama (Apr 30, 2011)

@LTurtle, thanks for responding. Turns out it isn't straightforward loss... they aren't sure what is going on because my beta levels, while very low, are continuing to rise slowly. Now they are thinking it is ectopic. I'll find out tomorrow, hopefully, when they do another u/s.


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## Sleepymama (Oct 9, 2003)

Replying here to say that this sounds ectopic. Low not rising betas are a sign. You're low enough that they probably won't intervene but if it is ectopic the miso won't help. I would wait it out but keep doing betas. If they keep going up you might need a methotrexate shot instead. 

They won't see anything on ultrasound until you get to a beta of about 1500. Sometimes they can see it at 1000. I had an ectopic last month but they didn't even see mine at 3000. They thought it was in my right tube but weren't sure. I got methotrexate but it ruptured anyway and I had surgery to remove my tube. 

I've had regular miscarriages and this was the worst. The uncertainty is terrible


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## tenzinsmama (Apr 30, 2011)

@Sleepymama, yes, I hear what you are saying...If I were to have a regular miscarriage, that would be straightforward and better for me than having this probable ectopic. I had already decided I wouldn't have taken the miso, but just let things happen naturally with miscarriage... and now, I don't what is going to happen. I don't want the methotrexate, either, because I'm worried about side effects. I have no idea what they think they are going to find on an u/s, because as you say the betas have to be a certain number before things start showing up. I'm sorry you had to go through what you went through. To have to take the med and then have to have surgery anyway. In hindsight would you have just done the surgery at the start?


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## Sleepymama (Oct 9, 2003)

Well I didn't have a choice. They didn't know where it was when I had betas over 3000. I had three doctors present at the ultrasound and one of them thought maybe right tube but wasn't sure. So it was dx as a "pregnancy of unknown location" and they gave me the option of having a D&C to check for products of conception (and if betas would go down) or just the methotrexate. It was clearly not in my uterus so I didn't see what good that would do (I also just had a D&C in August and didn't want to mess with my uterus any more) so I just did the shot. It truly wasn't that bad. I felt pretty rotten for 2 days afterwards - flu like symptoms but it wasn't too bad. And then felt just tired for a week. And my betas went down - until it ruptured when it was down to 500. Everyone was shocked. We thought it was on the way out. But they think it tore the tube when it detached. When I was in the ER yet another doctor looked at my previous u/s and said there was definitely a sac and yolk sac in my right tube in that u/s. 

I think with levels as low as yours they probably would not offer surgery even if they know where it is - you're less likely to get damage to your tube with methotrexate. Surgery of any kind is going to leave scar tissue or loss of a tube. You can't try again for a couple of months but that's true of both the methotrexate and surgery. 

Expectant management (waiting) is still a possibility if you start to plateau at low levels (500?) and don't get higher. But this rupture was seriously awful. Scary, painful, month long recovery. Don't let it go too long without treating. In hindsight I wish I had taken the methotrexate when they first suggested it - betas at 1000. But I still had hope because the betas were rising close to normal sometimes. I really wanted to be sure before I ended it.


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## tenzinsmama (Apr 30, 2011)

@Sleepymama, that is just awful what you had to endure! Thanks for sharing more, I hope it isn't too triggering for you to go over things here. So much loss around these ectopics... it feels like a nightmare. I just want to get to the other side. I'm thinking they are going to say it's PUL for me, too, since my beta levels are in the mid-500s... I hope whatever decision I have to make tomorrow will be clear for me to make.


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## Sleepymama (Oct 9, 2003)

@tenzinsmama update?


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## tenzinsmama (Apr 30, 2011)

@Sleepymama,I still don't know anything. I am stuck in this nightmare. I had a scan done by one of the fertility docs at my clinic, and he couldn't see anything in my uterus or tubes. He said he didn't think he would see anything intrauterine, because of my beta being at 554, but it was worth a shot to try, since we were supposed to be going to Cuba in a couple of days. He said if the trip had been booked for a week from now, that it may be a different story, because then we would know something by then. Timing is bad, he says. This sucks so much, because not only is our family vacation cancelled, it is also my birthday on the 20th and then of course, Christmas. I am feeling worse and worse as the days go on, emotionally and spiritually. And mentally-- every twinge, every gas pain, I am thinking, is this it? Is this the day I rupture and I have an emergency surgery?

I was so upset at the fertility clinic yesterday, they are very clinical there. They assumed I would give informed consent for bloodwork to do liver function tests-- when I saw the req, and it was more than just the beta hcg checked off, I was like wtf? They are assuming I would go for MTX, if it turns out to be ectopic. When I questioned the nurse, she said it was to be 'efficient'-- so that I wouldn't have to go back for a poke for those tests. Okay... well, MTX means that I have to go to hospital for the shot, and while they are going over the risks and benefits of this treatment, they can do a poke and we can wait for the results in that time. She said if they find something on Friday with another u/s, I would need the MTX right away to 'avoid rupture'. I was like, why did the doc say that if the trip was booked a week later it would give us time to diagnose something'? First we have time, then we don't have time... And the doc wanted me to go for another beta hcg this morning... well, here, all of our non-hospital blood labs have an appointment system, and you usually can't book one with less than 48 hours notice-- so then you are a 'walk-in', which means you are given less priority. So you can wait 2 or more hours to get bloodwork drawn-- the other day, my husband had to take time off work so I could go and get it done this way, to look after our 3 kids who are all under the age of 4.5. So I phoned the clinic back up and said, No way, I'll do this Friday when my husband has a day off.

So, bottom line is I'm grieving over the loss of this pregnancy which right now is a 'pregnancy in unknown location', I'm scared of something happening to me and I leave my kids behind without a mother, and then there is also my future hopes and dreams of completing my family. I am going to be 45 years old, I conceived this pregnancy through injectibles with IUI and by the grace of the powers that be I had help with the others as well... and I probably wouldn't be in the situation I am in if I had not married the wrong person the first time around and then the second time around, if I hadn't put my education and career first... I basically changed my mind after meeting my partner and being with him for a couple of years. I realized that I really did want to be a mother... so I started at age 40. I'm scared that this PUL and whatever comes of it will mean that I have lost my chance. Lost this baby, and a chance at another.

I'm scared of taking the MTX, although from what I've been reading it seems to be the preferred way to go in certain cases. In a lot of ways, I would rather have the surgery. Seems like whichever way you go, the treatment can fail and then you need to resort to the other.

So, I go back tomorrow for the bloodwork, and the scan. If Bhcg is at 1000 or more, they hope to see something. Since this pregnancy is considered a loss, my hope now is that I have an intrauterine sac and I have a natural m/c.

How did you manage to get through when it was really uncertain? When you were faced with the most acute time? With the aftermath? Is there an area on mothering where there are other people posting at a time when they are facing early pregnancy loss? I don't want to be posting in the wrong spot, and triggering people.


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## Sleepymama (Oct 9, 2003)

That is awful that you have to wait so long for blood draws. I had over a dozen during my ectopic saga and I am lucky that I only have to wait 10-15 min or so on a walk in basis. 
I also had a trip planned - had to cancel it when I ruptured. The worst part for me was the 10 days or so between when we knew it was not viable and the beta got high enough to see in u/s. My betas were higher the yours though so I knew they would eventually get to 1500. I got my mtx shot on Halloween - a Friday - so I had the weekend to rest after. You are right that they won't let you go anywhere for 7 days. They do a 4 day blood draw and a 7 day one to check beta. They want to see 15% decrease from the day 4 number or they will give you a 2nd shot. Can you postpone your trip at all? 

I am 40 so I feel your sense of urgency. Mtx is the most likely to preserve your fertility though- especially if your hcg doesn't get much higher. 

This forum is so slow - I posted an ectopic stories thread a couple of weeks ago and got no responses. I say post wherever you want. I'm so sorry you don't have answers yet


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## tenzinsmama (Apr 30, 2011)

@Sleepymama, that's unfortunate that you never got any responses.  I am in that part that you described as being your worst time-- currently on day 12 of knowing it's not viable and it being PUL. We cancelled the trip yesterday afternoon. I'm reluctant to take medication, normally... so the idea of MTX is seriously freaking me out. And I just want to do whatever is going to get me back on track the quickest-- that doesn't sound like it would MTX anyway. Thanks for being my lifeline right now. I hope you are well on your way to healing-- have you gotten a cycle back yet? How long were you told to stay away from ttc'ing for?


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## Sleepymama (Oct 9, 2003)

Well I think if your hcg plateaus and doesn't increase much you're ok with waiting. I hope that's what happens became then it won't matter as much if it's ectopic or uterine. It will just dissolve on its own. Are you having any bleeding? It's possible they could see it at hcg of 1000-1500 and then you could have a surgery option. Maybe. You have to wait after surgery too though. And it's anasthesia and tons of drugs there too. I imagine surgery without rupture is a lot less traumatic though. My recovery has been really hard but I think that was the blood loss. 

I was told to wait two full cycles to try again because of the methotrexate and because my surgery was traumatic for my body. Methotrexate is a category x teratogenic and it uses up all your folic acid - you have to stop taking prenatals and avoid greens for the first week or so or it doesn't work as well. That is a pain. It goes out of your body in a few weeks but probably safer to wait. I was also really freaked out about it - its chemotherapy - but it turned out to be not as bad as I expected. I think women who get it at lower hcg have better success with it. Once you're over 3000-4000 rupture is more likely with or without it. Walking around feeling like a ticking time bomb is a horrible feeling. I hope you get some closure soon.

I did just get my first AF this week. 35 day cycle if I count from the onset of bleeding after the methotrexate. About 45 days after the shot itself. A month after surgery. Pretty painful - especially where my tube used to be (I assume) - shooting pains on the lower right. Pretty weird feeling. I've never been aware of my Fallopian tubes before and now that it's gone I feel it? Ugh.


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## tenzinsmama (Apr 30, 2011)

@Sleepymama, at my appointment yesterday, the doctor said exactly what you said in your first paragraph-- that if the levels plateau and start going down, then we could do expectant management even with it being PUL. My beta yesterday was 896, so rising still but not as big of a jump as the one 3 days before. So maybe I am at the point where things are going to start resolving on it's own. The u/s I had yesterday didn't show any signs of ectopic or intrauterine-- but not surprising since it should be 1000 or over to see even a sac in the uterus. I go for another beta tomorrow. Was supposed to have gone to Cuba today, oh well. At this point, they don't want me to be more than 30 mins from a major hospital ER in case something were to happen. That's good you got your AF back relatively soon after, that must have felt so strange how it gave you the phantom pain on that side. I'm not sure what thread you are normally part of-- are you actively ttc'ing?


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## Sleepymama (Oct 9, 2003)

tenzinsmama said:


> @Sleepymama, at my appointment yesterday, the doctor said exactly what you said in your first paragraph-- that if the levels plateau and start going down, then we could do expectant management even with it being PUL. My beta yesterday was 896, so rising still but not as big of a jump as the one 3 days before. So maybe I am at the point where things are going to start resolving on it's own. The u/s I had yesterday didn't show any signs of ectopic or intrauterine-- but not surprising since it should be 1000 or over to see even a sac in the uterus. I go for another beta tomorrow. Was supposed to have gone to Cuba today, oh well. At this point, they don't want me to be more than 30 mins from a major hospital ER in case something were to happen. That's good you got your AF back relatively soon after, that must have felt so strange how it gave you the phantom pain on that side. I'm not sure what thread you are normally part of-- are you actively ttc'ing?


I sometimes post on the TTC after a loss thread (it's in the TTC after loss forum) but we are not actively TTC right now. I am in a forced 3 month wait because of methotrexate and also I want to lose some weight and feel a lot better first. I'm not sure DH is fully on board either. I'm trying to get some more repeat loss testing done - this was our 3rd loss in 18 mo and 5th overall.

My betas sometimes rose only a little and sometimes a lot - they started high and climbed steadily. Just not normal. 
10 dpo - 274
12 dpo- 363
14 dpo - 435
17 dpo- 750 (u/s that day showed nada)
21 dpo - 5 weeks- 1070
5w2d - 2100
5w6d - 3000- u/s still showed nothing. Possible spot right tube.

They advised D&C and then check for products of conception at the 1000 mark. It was rising enough that I still had hope and wanted ultrasound confirmation. Yours is rising enough too that maybe they'll see something soon and you will have a clearer decision to make.


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## tenzinsmama (Apr 30, 2011)

@Sleepymama, that is a lot of loss to have to deal with in such a short time, and overall. I'm so sorry you have had to deal with this. ((hugs)) Thanks for sharing your betas with me. Mine started out so low... maybe this is less indicative of ectopic, I don't know. Another test tomorrow.


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## Sleepymama (Oct 9, 2003)

I think betas can be all over the place. I did a ton of research. Some seem to be "normal ish" and some are low and stay low. It just depends on where it implants. From my surgery pathology it looked like mine implanted in the narrowest part of the tube right next to the uterus which makes me surprised that I had no pain before rupture and my betas did get that high. Hope you got some useful info yesterday.


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## tenzinsmama (Apr 30, 2011)

No ectopic that they could find.... I had a laparoscopy and DnC on Friday night, immediately had to go to the hospital after my Friday morning u/s. Radiologist reported that it looked like 'gestational trophoblastic disease'. Waiting for pathology report, which will take seemingly forever... I am feeling so broken right now.:crying:


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## Sleepymama (Oct 9, 2003)

Is that a molar? I haven't heard of it. I'm sorry. Are they still monitoring your betas?


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## tenzinsmama (Apr 30, 2011)

A complete or partial molar is a sub type of gestational trophoblastic disease, as is invasive mole, choriocarcinoma, and two other kinds that are actually quite rare.


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## Sleepymama (Oct 9, 2003)

@tenzinsmama any update on test results? Was it molar?


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