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Just pregnant? What happens next?

Shieva Ghofrany: [00:00:00] Continuing on with pregnancy loss awareness month or miscarriage awareness month, October. I wanted to discuss, again, we've done this before, but what are some of the things that might happen when you first find out you're pregnant, so you find out you're pregnant, you've peed on the stick, it says positive or there's a faint line, and then what?

Well, first thing is call your doctor's office if it's regular office hours, and ask them when you should come in. Typically, we say you should come to the doctor's office somewhere between seven to eight weeks from your last period, assuming you have a fairly regular period because your last period, assuming it's pretty regular, meaning 25 to 35 days.

will be about two weeks before you've ovulated, two weeks before the egg came out, which means two weeks before the egg and the sperm met. So when you actually go see the doctor and they tell you that you are eight weeks from your period, it really means six weeks from when you got pregnant. And that's important to know [00:01:00] because people are very confused about what they're supposed to report.

So your doctor's office will probably say to you, when was your last. And you'll tell them, and then they'll calculate on their app or on this little plastic wheel we have when you're about seven or eight weeks pregnant, and they'll tell you to come to the doctor's office. Now if you have a wildly irregular period, The last period and the day you've ovulated might not really coincide with that two week period.

So you might wanna point that out to them if you know it. Many of us don't know it. So you've called, you've made your appointment, you've just missed your period and peed on the stick, which means by definition, if you've just missed your period, you're about four weeks pregnant. That means you gotta wait another three or four weeks from then to go see your doctor.

And here's what might happen a couple days after your positive pregnancy test, you. Start to have spotting or bleeding. If it's a little bit of spotting, a little bit of bleeding, and you're not soaking through pads every 30 minutes, then you do not need to go to the emergency room. In fact, don't go to the emergency room, especially now during covid.

First of all, [00:02:00] emergency rooms are meant to be for emergencies. While I'd love to say they're there to comfort you and make you feel good, they're not. They're really there to take care of all of us who have true emergencies like emergency surgery needed, or a heart attack, or a blood clot that went to your lung.

Something where if you are in that situation, you want those doctors available for you. You don't want those resources spent on having to comfort people who are merely spotting without having any other problems like pain. Okay, so please avoid the emergency. That said, if you have bleeding, like you're soaking through pads every 30 minutes, certainly call your doctor and she may direct you to the er.

And certainly if you're having spotting or bleeding associated with pain on one side or the other. As opposed to just cramping like a period, then you certainly should call your doctor and she may also direct you to the er because that's a situation where we want to make sure that there is not an ectopic pregnancy, meaning a pregnancy outside of the uterus that is often growing in the tube.

While that is rare, it is something that we do consider an [00:03:00] emergency because the tube can actually burst. So let me repeat. If you have a little bit of spotting, a little bit of bleeding, maybe mild cramps, like a period, please call your doctor's office, but do not rush to the emergency. But if you are soaking through paths every 30 minutes or having pain on one side or the other, you should absolutely call your doctor's office, and she will probably tell you to go to the emergency room unless she can see you in the office in an emergent fashion.

Okay, that's very important. Now, let's say you have that spotting or bleeding and a little bit of cramping and you call the doctor, most likely, if you're gonna say, okay, it's very common to have spotting or bleeding, it does not necessarily mean you're having a miscarriage. But we do need to check it out because there are a couple things we really need to look into, and she will likely have you come to the office either that day, the next day, within a couple days, sometimes, especially if it's the weekend, we're gonna instruct you to rest.

Put your feet. And just wait until you can see us in the office so that you don't again, have to go to the er. Now, why [00:04:00] would you have spotting or bleeding? Well, one reason might just be that your cervix, that looks like a little donut, a little opening, right? That's the opening to the cervix is very delicate and what we call fryable, meaning the littlest thing that touches it because it's so filled with blood supply from the pregnancy can cause the cells and the surface to slough off and cause bleeding.

And sometimes that bleeding is bright red and watery and sometimes it's. Bright red and watery means something. Touched it right away and it came out right away. The bleeding brown means old digested blood. So something touched it a couple days before and then it sat in the vagina and got digested and came out as old, sticky, tacky brown discharge.

That is old blood. What things could be touching it? Well, a penis. A vibrator or if you exercised or lifted something heavy, or if you had a big bowel movement where you were pushing, these are all things that might irritate the surface of the cervix. Now, none of these things is dangerous. If that happens, you did not cause a miscarriage.

We can promise you of that, but we might advise you once we've seen you to not lift [00:05:00] so many heavy things, not put something in your vagina and maybe take it easy and not. Not because those are gonna cause miscarriages, but because those might precipitate more bleeding and freak you out. Okay? We can't tell you to stop having a pooper or a bowel movement, so we're not gonna advise that.

Now you've called your doctor, you've said I had some brown, I had some red, I'm not in pain, but I'm having some cramping maybe. And she's gonna say variety of things, but most likely some variety of come on into the office in the next couple days and let's make sure it's all okay. And she will first look inside your.

With the speculum exam or second, because sometimes you do the ultrasound first and then the speculum exam. Sometimes you do the speculum exam first and then the ultrasound. It just depends on, frankly, the order in which you came into the office and what else is going on logistically. But when we look inside the vagina to look at the cervix, we wanna see is there that friability of the cervix We talked about, is there a polyp sticking out of your cervix?

It's your cervix closed. If we have something that we can point to, like, look, your cervix itself looks like it bled, or there's a polyp, [00:06:00] which is a little benign growth sticking out of your cervix, that's what caused you to bleed, then we feel rest. But we'll often still do the ultrasound, especially if we have access to an ultrasound machine.

The ultrasound is the only way for us to really do one of two things. One is prove that the pregnancy is in your uterus, because the biggest reason to have you come into the office if you have spotting or bleeding early in pregnancy is, believe it or not, not your emotional comfort. While that is so important, but I think we all agree that your safety is of paramount importance and what we need to rule out.

If you have spotting or bleeding early in p. Is the ectopic pregnancy, meaning the pregnancy growing outside of your uterus and in your tube potentially or elsewhere in your pelvis. And the only way to do that is to look with an ultrasound and be sure that we see an intrauterine pregnancy, which we don't always see very early in the pregnancy.

Sometimes you will not see absolute evidence of it until between five and seven weeks of pregnancy, depending on when you had your period, how strong your machine is, and what features show up on that ultrasound. So your doctor will [00:07:00] look inside your vagina, then she'll do an ultrasound to help rule out.

Next topic, number one, and ideally rule in a viable pregnancy, meaning she'll see a sack growing in the uterus. She'll see the little grain of sand that's that little nugget, what we call the fetal pole. And that's the actual baby growing. And ideally, if you're past five and a half, six, seven weeks, she'll see that little flicker, which is the heartbeat, and that's how she can tell the pregnancy is.

Until we've seen that flicker, we actually cannot say the pregnancy's. But we can say things look okay, I see a sac growing in your uterus, therefore it's not an ectopic. And therefore, most likely if we wait in the next week or two, things will transpire, things will grow, and we'll see that little flickering heartbeat that is the hardest period of time because you just have to sit on your hands and wait.

And I think many patients become confused in this situation because as doctors, we're busy and we don't always talk enough about what's going on. So patients go home going, I don't get it. Am I pregnant? And the answer is yes. You're. And yes, most likely it's in your uterus. And hopefully it's gonna be [00:08:00] viable, but only time will tell.

And those are the times where we don't exactly know why you had spotting or bleeding. Sometimes it's the surface of your cervix. Sometimes it's an area around the sack of the uterus. It can just be an area that we don't even see on the ultrasound. Or sometimes we see a little bleeding behind the uterus, behind the sack, within the uterus called a subchorionic hematoma.

So there are various reasons for the bleeding. Believe it. Sometimes it's a urinary tract infection where you bled from your urine but you didn't know it or rectal bleeding, and you didn't realize that you had a hemorrhoid. So there are many different reasons, the majority of which are not dangerous, and often you will have a viable pregnancy.

That said, there are times where you don't, where either the heartbeat is there, but looks very slow, where the sack looks. or the heartbeat is there this week, but next week it doesn't show up. Or that little fetal pole that your doctor can measure to see if it's consistent with how far we think you are pregnant is lagging behind by enough that we're concerned.

And this is a really emotionally charged [00:09:00] situation because if you ever look at an ex explanation of benefits from your insurance company, they'll use very onerous terms like threatened abortion, which means a miscarriage that is about to happen or potentially going to happen, not for. But maybe, and we don't like using those terms as doctors, but we're bound by them, by the insurance companies because we have to use certain codes in order for the insurance company to know what we've done.

And the term abortion does not necessarily mean a voluntary interruption where you've stopped the pregnancy. It literally just means the pregnancy has stopped for multiple different reasons. And so the term threatened abortion, if you see it, will often yield upset and sadness and sometimes. But it is merely a clinical term to mean you're spotting or some other feature is happening that makes your doctor a little bit concerned that you might be having a miscarriage.

Okay? So those are the things that might happen in the early part of the pregnancy, but rest assured that once you get past that hump, if everything stops bleeding, you're likely gonna be [00:10:00] okay, and you're going to actually move ahead and have a viable pregnancy. Okay? I hope that helps. We're gonna do more about this during pregnancy loss awareness month, right?