to think early pregnancy scans should not be offered on the NHS

[nancydrewrocked]

OK I am prepared to be flamed but I couldn't help thinking this when I spoke to a friend recently. So tell me why I ABU.

Friend has just started ttc. No difficulties, no previous history. 2nd month of trying she gets a +ve the day her period is due. Two weeks later another scan no HB. Friend understandably very upset.

But I can't help thinking this would have been easier on her if the GP had gently told her to go home take it easy and then done a blood/pregnancy test in 2 weeks. It also strikes me as a enormous and unecessary cost, especially when many areas no longer offer routine 12 week or nuchal scans.

I am a bit confused then.

The OPs friend went for an early scan because of bleeding, so there was a reason for that scan.

most pregnant women don't get offered a scan until 12ish weeks.

it's not the norm to offer a woman a scan before 12 weeks.

aitch I have moved the goal posts re the first scan because you have told me (and I have accepted) that bleeding alone is a sign of ectopics. I was wrong re this point. I accept it. I have apologised. I am down on my knees

I have maintained from my first post that they should have managed expectations. If it would have been wrong of her GP to do this because of the chance of ectopic I accept this. However once this was ruled out by the first scan I question why no one else did and the need for a second scan?

presumably because it wasn't ruled out. you can really only rule an ep in, tbh. if you can't say for sure, you must scan again.

I had bleeding with my first pregnancy at 6wks.

What should they do?
Ignore it?

THe problem seems to be lack of explanation by the GP.

I knew I was going to find out if I was still pregnant.

Also, there was every chance there would be a heartbeat at her next scan.

When I had one and there was just a sac, I was told to come back the next time to see if there was a HB.

It was only then that the MMC was diagnosed because I was supposed to be well along enough to have seen a HB.

I haven't read all the thread but I have had three miscarriages, all early.

When my Mum was TTC, in the 50s and 60s, you did not go to the Doctor until you had missed two periods.

When I had my miscarriages, well with two of them anyway, I would have had no real idea I was pregnant, had I been of my Mum's generation (there were no tests then either). That may have been a good thing, I suppose . . . it would have saved me some heartbreak.

And yet . . . the first m/c I had, I also had a high temperature and needed antibiotics, so maybe if I'd had no idea/no scan/no treatment I'd have had some awful infection left untreated to do my fertility real damage.

My friends sister was told by her GP that she was almost certainly miscarrying to go home and come back in 2 weeks for a blood test. Her dh came home that night to find her lying unconcious and her hips covered in blood. It was ectopic and the gynaecologist told them she probably wouldn't have made it if her husband had been only 10 minutes later getting home.

So OP YABVVVVVVVVU

aitch pretty sure they did rule it out at the first scan, they could see the embryo or sac (I'm not sure which exactly) in the uterus hence their willingness to treat the pregnancy as a possibly viable one.

Anyway again I am sorry if I upset anyone, I have learned something re ectopic pregnancies and I will accept that I have been unreasonable.

Well I am really sorry that I have depleted the nhs coffers so heavily as with 6mc I am now on a first name basis with every member of our epu.
Tbh I think your friend achieved a major triumph getting into the epu with a first pregnancy. It is I feel often regarded as Fort Nox.

"However once this was ruled out by the first scan I question why ... the need for a second scan?"

because there was no heartbeat detected! Isn't that reason enough? Surely you wouldn't make someone wait another 6 weeks when they could medically manage a suspected miscarriage in the meantime?

You are talking about a specific case with bleeding and trying to apply it to all early pregnancies which isn't right. Most women who have had no problems in early pregnancy just wouldn't have been given the first scan and so wouldn't have needed or been offered a second scan.

The second scan is in case they have the dates wrong and there will be a HB at the next scan. If there isn't and you haven't MC by then there is a risk of infection which often only has bleeding as a symptom so you wouldn't be any the wiser and it can be serious and cause long term damage.

At that point you are given your options in terms of managing it through ERPC or waiting but at least they can monitor it and intervene if required.

It also depends what they did see on the first scan. In ectopic pregnancy you can easily get a "pseudosac" in the uterus that looks like a gestational sac but isn't, and it can be very difficult to spot a developing embryo on the ovary or fallopian tube. So if there wasn't a clear fetal pole/embryo, even without a heartbeat, they'd need to scan again to make sure that what they were looking at was a real gestational sac rather than a pseudosac (as well as for the reasons around dates, etc.)

I think every GP's surgery that sees pg women ought to have a machine to hand and the expertise to operate it. Given that the average age of first pg is older now, and that women have more sexual partners in their lives, it is a prudent public health measure to scan more rather than less frequently.

Do you know what? This thread is prompting me to post my first ever

OP - YAB BEYOND U. But seeing as you've accepted this, I don't intend to add anything to the many excellent posts from others explaining why.

I think AIBU was possibly the wrong place for you to attempt to find out why your friend was offered two scans not one.

DuelingFanjo

I was called a fool becasue I said that EPAU use the same scanners and staff that maternity do. Thats what I was called a fool about as apparantly I'm wrong.

It was only after this that I pointed out that I work in the mat wing so I know for a fact that they are the same.

Everything else I posted I made clear was my personal experience as someone who has had bleeds and miscarriages in early pregnancy.

yes, it's really not very clear with ectopics. for example, they don't tend to see a sac around the tubes, but they might see some bleeding, or 'free fluid' as they call it. they might also see a sac in the womb, which may be a pseudosac, or indeed a twin. managing a heterotopic twin pregnancy where one is ectopic is very tricky.

and a sac with no heartbeat, well, that is just grim. for a person's mental health (once they are in the system they do deserve an answer, i think) the second scan is an act of kindness of which the NHS should be proud.

YABU for all the points made above, and I'm glad you have admitted the points about ectopic pregnancy.

But just to answer the thing about cost to the NHS, and time the scanner is in use etc- I had an early scan at 6 weeks due to a bit of pain. I would never have asked for it myself, wasn't overly concerned, but the GP (very correctly) wanted to rule out ectopic pregnancy. They saw a HB at 6 weeks, the baby was in the right place. So the hospital didn't offer me the 12 week scan- just assumed everything was ok and scanned me again at 20 weeks, when all was fine. Not sure if this is common practice, but I'm confident that any inconvenience which my early scan caused was balanced out by missing the next one. I refuse to have any regrets about it.

Look, if I hadn't had several early scans, after 2 epsodes of heavy bleeding I'd be sat here now drinking vodka and eating pate instead of browsing the mothercare catalogue!

You really can't wait 6 or more weeks to know what's going on.

I had 5 scans with my last mc. Each and every one of them was deemed necessary by the doctors looking after me. I don't feel guilty that I wasted NHS resources.

Maybe once an ectopic has been ruled out then Drs should ask women if they want furhter scans if they carry on bleeding. Some women may feel reassured by more scans and some such as myself found them to be of no benefit.

Just to add to my post- even if scans do cost time and money that doesn't mean they shouldn't happen. They are often essential for the health of both the baby and mother (and mental health is important as well). I just meant it's wrong to assume that anyone who is scanned early is costing more money IYSWIM.

one can always refuse to be scanned... doctors aren't pushy for them ime.

emptyshell

At my hospital, Miscarriage, Happy Pregnant ladies, women having abortions, women having ovaries scanned to find out they are probably inferilte... All sit together in the same waiting room for the same scan. I wished to god we had a seperate room when I was sat with all the smiling happy pregnant women finding out my ovaries were swollen and covered in cysts.

But as I said earlier I still think women should have as much access to early scans as they need.