Need some opinions!

Published Dec 18, 2006

15 Posts

Hi, I'm trying to collect some opinions here and would appreciate any input so when I talk to my OB next I can bring up some questions.

I had signs of miscarriage 9/24 of this year, and subsequently had a D&C performed 9/29/06. My HCG level at the time was around 27,000. I should have been 9-10 weeks pregnant, but all we saw on ultrasound was a sac that measured about 5 weeks.

Initially after the D&C, I had very little bleeding and felt fine. About a week after the D&C, I experienced heavy bleeding and clotting, and ran a temperature of about 100. We figured I had an infection, and so antibiotics were prescribed and things slowed down. I had intermittent bleeding/spotting, and at my six-week check-up I was in the clear to try again. I continued to feel pregnancy symptoms, though. I was weepy and fatigued, and occasional headaches. At four weeks post-partum I had taken a home pregnancy test that was +, and since I had read somewhere you can have HCG levels up to 8 weeks post partum I figured it was normal.

About 7 weeks post-partum, I tested again at home and had a + test. The next day, however, I had more spotting that turned to heavy bleeding and I passed a huge clot. I went to the OB's office, and we decided to get my HCG tested. At that point, I was about 125. A couple days later, 89. The week after, 59.9. At that point we discussed methotrexate. With it being a chemotherapy medication, I wasn't real keen on trying it and just asked if there was an alternative (I rather would have had another D&C, but that was just my personal fear). My OB said since my levels were so low, we could try progesterone to bring on a period, hoping that would clear things out.

The second day of being on progesterone, I experienced pulmonary embolus (both lungs). After the PE, we did the methotrexate. As of Dec. 13, my level was down to 17, so we planned to test in 3-4 weeks again to ensure it went to 0. On Dec. 15, I was at work and basically hemmoraged. I was going through a pad every half hour to 45 minutes, blood trickling in the toilet, and passing clots about half the size to the size of my fist. Wasn't able to get into the OB's office until 1:30pm, and by then things had slowed down.

They ran a CBC and HCG. The HCG was down to 13, and CBC checked out fine. My hemoglobin was a little low. (I am also on warfarin, and my OB doesn't believe the warfarin caused the bleeding -- he believes it's still leftovers from the D&C.)

My question -- what should the next step be? I'm not at all comfortable with "observation" with being nearly 3 months post-D&C. Hemmoraging at work isn't another option I'd like!

Any opinions out there on what to be the next step? Thanks!