Questions to ask at EPAU?

[Hessy]

Dear all, hoping you can help.

I had a mmc at twelve weeks (baby died at seven) in September.

I have been trying to conceive again since getting my first AF a month after mmc. After my second AF twelve days ago, I started using ovulation sticks. I tested positive for ovulation for five days in a row. I was advised to take a pregnancy test and it was also positive.

My GP thinks the AF was probably a mc of a pregnancy from the previous cycle. He has referred me to the EPAU on Monday.

My last experience of the EPAU was not a positive one. I felt brushed off and any concerns I had were dismissed because it was a one-off and I do have a two year old DS. I felt they couldn't get me out the door quick enough.

This time I want to be more prepared. Someone has suggested it could be PCOS. Possibly the shape of my uterus. I realise they may not want to do tests until I have a third mc.

In case my mind goes blank, can you arm me with a list of questions I should ask?

Thanks in advance.

[Ruggle]

Hessy
Sorry for your loss.

I'm not sure there's much they can tell you other than check whether you are still actually pregnant.

If it's any help to know, I had a mmc at the end of July, was pregnant again on my second cycle but miscarried at 5 weeks, but got pregnant again straight away and am now 6 weeks with my fingers tightly crossed.
From my EPAU I got no useful information or advice other than "keep trying".
I don't think they will do any tests at this point. You would need a referral to a fertility specialist, and generally you won't get that until 3 in a row.

Are you sure your AF 12 days ago was actually an AF and not just a small bleed? Is there a chance you are still pregnant? Did the doc measure your hcg levels?

[Hessy]

Fingers crossed for you as well Ruggle. Congrats.

I have a thread on Conception, started asking for advice on the ovulation sticks as I thought I must be using them wrong. Consensus seemed to be that it was too much blood for an implantation bleed. But of course I want to be hopeful.

I went to GP's to ask for a blood test. But when he said mc, it went out of my mind. That's why I want to be sure to be armed with questions written down.

I'm trying to get to grips with hcg/lh stuff. Should I insist on a blood test if they don't offer one? GP only mentioned them doing a scan.

[eurochick]

Sorry you are going through this.

Some people do have period-type bleeds when pregnant and everything is fine. It happened to a good friend of mine following IVF. She stopped the drugs because she thought it had failed, had a scan at the follow up appt a few weeks later, and there was a heartbeat.

The EPAU will probably do a scan (most likely internal) to see if there is anything in there. If there is something visible, but it's not of the expected size, they might do blood tests 48 hrs apart to see if your HCG levels are rising.

I don't think they will do anything to investigate the cause if you have had another mc. Unfortunately they are so common that they are only usually investigated if you have 3 in a row (heartbreaking, imo). I think that would need a separate referral to a recurrent mc team. Not sure if this could come from the EPAU, or would need to come from your GP.

Good luck.

[Hessy]

Thanks Euro, good advice. So pleased for your friend - does she have a baby now? The bleed must have been very distressing after IVF. In some ways there is comfort from the fact I didn't even know I was (am, fx)pregnant.

[Hessy]

PS should I ask about PCOS?? Would this scan show cysts or whatever does anyone know? Can I ask about my fertility/ovaries while being scanned or is that not the EPAU's expertise?

[Ruggle]

No harm in asking. I think they check ovaries as a matter of course.

[bakingtins]

Hessy I am crossing everything for a good outcome for you. It strikes me as odd that if you had a v early MC (assuming AF was more or less on time) that could be mistaken for a period, that you still test strongly positive 12 days later. I know it's much easier on you to assume the worst, but allow us to hope on your behalf?
I had an ovarian scan as part of RMC investigations and also a blood test called AMH (anti mullerian hormone) though I know the test is not available on the NHS. There is no harm in asking them to check your ovaries, but I doubt an EPU sonographers would make a diagnosis of PCOS. Do you have any other symptoms of PCOS or has it just come up in a "recurrent miscarriage" context?

[bakingtins]

Sorry, meant to say AMH is also used as a test of ovarian reserve, so indirectly a measure of fertility.

[eurochick]

Hessy yes, that pregnancy worked out and she has a lovely 15 month old now. She had 3 big bleeds during the pregnancy.

[RicStar]

When i went to epau due to bleeding (mc) they did check everything & found largish ovarian cyst.had follow up they arranged not pcos & resolved itself. When i went for reassurance scan arranged by midwife during second pregnancy they just looked (& found) baby - now dd. Different hospitals but i think with bleeding they should do a look at everything though may not find a conclusive reason. Fx op.

[Hessy]

That's great Euro.

Ricstar I will try to get them to look for cysts.

Baking, I have a long cycle - 33ish days but no other symptoms. Someone on the conception thread suggested it (high lh levels?) as a cause for mc. I'm clutching at straws a bit I know.

I will investigate the AHM test, not heard of it before.

The pregnancy tests I've taken have had a very strong/dark line and the first day of my last 'period' was 16 days ago I've just counted. I didn't do any pregnancy tests immediately after my Sept mc so don't have anything to compare it to.

I've gone from not thinking I was pg to thinking I had mc. Feel a bit giddy at the thought that I may actually be pg. That my floor me more than the confirmation of a mc

My bleed was four days of dark blood, filling a towel over a few hours. No cramps or clots. Not unlike my usual AF.

Bloody hell I'm going to start queuing at the EPAU now at this rate. Sooooooo long to wait to hear!!

Thanks everyone xx

[Ruggle]

Have you tried a cbdigi? I would very much doubt you would get a strong positive this long after a mc, especially such an early one. I had negatives from two days after my mc at 5 weeks, and faint positives for 4 weeks after a mmc at 11 weeks.

[Hessy]

Is that a clearblue digital? Can I get them from pharmacist? I used boots own brand cheapies. Not sure what GP used. Will see if local chemist stock them. Ta x

[Armadale]

Hi Hessy,

Baking tins gives good advice (as always)

It does seem unusual to be still getting a positive test- at EPU's they usually make you do a PG test 2 weeks after a miscarriage as a safeguard as you will get a negative test if you passed all the products - this does make me wonder if the GP's theory is not correct.

HCG levels are useful at predicting what can/can not be seen on a scan - so is always worth doing.

I'm wondering where in the country you are (PM me if you don't want to say on the thread)... I'm struck by the fact that you didn't have a good experience at the EPU last time.

I feel that the quality of care and expertise varies massively at different hospitals.

Most EPU's allow self referral with a positive pregnancy test, so it might be possible to get you to a EPU where you will have a much better level of care.

[Hessy]

Thanks Armdale. I'm in SE London and equidistant between two hospitals. I keep going back to the same one in a sort of 'better the devil you know way'. You hear horror stories about them both.

I'd said to DP prior to GP appt that I wouldn't go back to the previous hospital. But when GP asked which I'd like to be referred to I asked him if there would be any benefit to returning to same one despite poor treatment and he said they would have better records of my notes. So I agreed to return there. See - I just turn into a compliant little girl in front of healthcare professionals! I just want to believe they know best...

To be fair, the actual medical treatment was fine with previous mc. It was just the manner of the staff. I understand they are busy and overstretched and do indeed see theses things day in day out. But this was a much loved and wanted baby that was very real to me.

[Armadale]

I have PM'd you a suggestion, Hessy x

[Hessy]

It's ectopic and I'm going in for surgery now. I'm a complete mess. Didn't come to EPAU with dp because didn't expect anything like this. I'm really scared.

[bakingtins]

Oh Hessy I'm so sorry! Holding your hand through cyberspace. Is your husband on his way?

[Ruggle]

Oh no! What a shock! Thinking of you!

[eurochick]

What a shock. I hope you are ok. Will your husband be there when you come round?

I'm in SE London too, so know what you mean about hospital choice around here!

[Armadale]

Oh Hessy, I'm so sorry.

What dreadful, dreadful timing, and so unfair after all you have already been through.

Is your DP able to get there & do you have childcare for your little one?

I think I'm not far from you so let me know if there is anything I can do

[Hessy]

Thank you all so much. My DP got to the hospital just before the op and was there when I woke up.

By all accounts the surgery went well. Although I'm still reeling from hearing the foetus had a heartbeat. And that one of my Fallopian tubes won't now work. They said this doesn't reduce your fertility by 50% as such. I still need to do lots of reading to get my head around all this.

I ended up going to St Thomas' EPAU and I have to say they were fantastic. Everyone was so kind and treated me with such care and dignity. The Gyne ward too. Such a different experience from my previous mc.

Thank you all for your good advice and support xxx

Merry Christmas xx

[Ruggle]

So glad that you've been well looked after. Really sorry for your loss.
I hope you manage to enjoy Christmas, and I wish you loads of luck and baby dust for the new year!
x