QuestionHi, I had a miscarriage 3wks. ago. I was 3 days from being 17 weeks along. I had seen the baby and heard the heartbeat just 2 weeks before. The miscarriage was without warning (no bleeding, cramping, etc.). I was on a walk with my husband and children when I suddenly felt something like a balloon in my vagina. I sat down on the sidewalk and my husband ran back for the car, went to the ER, delivered a baby boy. The Dr. said the baby had been dead about 2 weeks. Anyway, at my check up, my reg. obgyn said the placenta looked fine, and sometimes these things just happen. I went to see the Dr. who saw me in the ER. She showed me the pathologist report and said I had an infection! "severe acute chorioamnionitis and acute funisitis". I told her that I went in at about 12weeks because I felt I was leaking fluid. My obgyn did an u/s and said the fluid levels were fine. He said that there are more vaginal secretions during preg. I told him that I had never leaked and did not have this during my previous preg. He just said the levels were fine, and every preg. is different. Anyway, this other ob who saw me in the ER was surprised he didn't do a pelvic then. She said she would have checked me and put me on an antibiotic. My question, the baby was alive at 14 weeks, I started leaking at 12 weeks, did i leak because of an incompetent cervix or did I my cervix fail (miscarriage w/o any warning) because of an infection? Which came first? I kept asking my regular ob if I should abstain from sex because I felt I was leaking, but he just reassured me everything looked fine. Why didn't he tell me about the infection at my follow-up after I loss the baby? It seems he was keeping this fact from me.
AnswerDear j.k.,
I very much wish this had not been the outcome of your pregnancy. Unfortunately, there is just no simple, black or white answer for you.
An incompetent cervix happens in about 1 out of 100 pregnancies. Almost 25% of babies miscarried in the 2nd trimester are due to incompetent cervix. Most commonly, a weakened cervix can be caused by one or more of the following conditions:
-Previous surgery on the cervix
-Damage during a difficult birth
-Malformed cervix or uterus from a birth defect
-Previous trauma to the cervix, such as a D&C (dilation and curettage) from a termination or a miscarriage
-DES (Diethylstilbestrol) exposure
Incompetent cervix is not routinely checked for during pregnancy and therefore is not usually diagnosed until after a 2nd or 3rd trimester miscarriage has occurred. Once diagnosed, the treatment is a cerclage (essentially stitching the cervix closed), but if you actually had begun to leak amniotic fluid, you would not have been eligible for a cerclage anyway. And the "balloon" you felt may have been an intact bag of waters coming through the opened cervix. If the amniotic sac had been compromised and leaking, many times there will be a fluid gush through an open cervix instead of an intact sac bulging through.
It's like the chicken and egg scenario... you just may never know. But hindsight is always 20/20. And I will say that one of the most common "complaints" of pregnant women is "I feel wet down there all the time". 98% of the time this is due to the increased vaginal secretions which occur during pregnancy. And absent the other common complaint encountered with an incompetent cervix (a heaviness felt in the pelvis), I'm not sure I could fault your doctor for feeling more assured after checking your amniotic fluid levels via ultrasound. The ER doctor is not in the same position in hearing the same pregnant stories/comments every day. Like I said - 20/20 hindsight....
If you truly feel that your doctor was intentionally withholding the information about the infection, pursue it further. Call back and ask if anything else has been found in the reports as to what may have caused the miscarriage. If he does not offer the information again, tell him the ER doctor said something about amniotic infection. Let him elaborate. Ask if this might have contributed and, if so, what would have caused the infection. Here's the thing - you want to feel comfortable with the doctor you see. You definitely don't want to distrust him in the future, so you need to clear things up in your own mind.
Again, I very much wish you weren't having to go through this, but unfortunately you may never have the answers you are looking for. In that regard, you may have to try to find some acceptance in the reasoning that sometimes, for reasons which we mere mortals don't always know, these things do happen. I know it doesn't help while you are still hurting and so disappointed, but at times that is the only answer we have if we are being completely honest.
I wish you well and will send hopes of comfort your way.
Brenda
