Case of the month Aug '08: Episode #2
Click here for episode 1
Irene and Harold are here for help because all four of their pregnancies so far have ended in miscarriage.
We talked and elicited more information. Irene worked as a nurse. She liked her job and described it as being moderately stressful only. She did not work with any radiation or chemotherapy. Harold owned his own painting business. He described his stress level as an 8 out of 10. He clarified that he didn’t have much contact with the actual paint and chemicals, but rather did management. They lived in their own condo with Harold’s parents.
Their first pregnancy was conceived on their wedding night. It came as a surprise that it happened so easily. Irene, who had previously been regular, every 28 days, missed her first period a week after the honeymoon. She did a home pregnancy test and it was positive. Two weeks later, she noted some spotting, which progressed to moderate flow with cramping. By the time, she went to see her doctor, she was bleeding like a period. She remembers that her blood pregnancy test was positive at first, but then the values proceeded to drop. She wound up not getting a D&C, but rather just passing everything naturally. Harold attributed the miscarriage to the stresses of the honeymoon and the initial moving-in process.
Seven months later, Irene was pregnant again. She went to her OB immediately and her pregnancy was indeed confirmed with a blood test. The hCG numbers went up initially, but then she had bleeding again. When she went back for another exam, her cervix was open and the pregnancy was once again lost. No D&C was done. Her doctor had examined her uterus and found it to be normal size. There was no further testing done and Irene felt confused and depressed. Being a nurse, she tried to read up on miscarriages, but did not know what to do. Their doctor told them to avoid getting pregnant for three months, so they completely abstained from sexual intercourse.
After the three months were over, they hesitatingly started trying again. They were more fearful than excited when Irene was pregnant again in two months. Per Harold’s mother’s instructions, Irene cut her work hours significantly and avoided lifting anything. She also drank a daily concoction of herbal tea that her mother-in-law made for her. Things were more promising as she didn’t have any bleeding for two months. Then, one night, Irene was having a bad headache. Their neighbors were throwing some sort of party and the music was blaring. After lying down and trying to block the sound with pillows, Irene’s stress level built and she wound up sending Harold to tell them to please turn down the music. A mild confrontation ensued and things were eventually resolved by having the police come and talk to the neighbors. Meanwhile, the stress mounted and Irene felt panicked. All of a sudden, she started bleeding. They rushed to the emergency room. An ultrasound was done, which showed a sac in the uterus, but no fetus. Because of the heavy bleeding, Irene underwent a D&C. This time, her OB ordered some testing, which consisted of chromosome tests on Irene, but not on Harold. The test was normal. Before Irene could tell me about her fourth pregnancy, we took a break. She was tearing up too much for us to continue.
Click here for episode 3
