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.

You can always refuse to be scanned but in my expereince Drs aren't very good at explaining themselves. They just say "oh, I'll refer you for a scan". You then think it must be of medical importance and going to tell the Dr something. Rather than for you to realise that its giving you 5 seconds of reassurance only for you to start worrying just as bad as you walk out the door. So you just go along with it.

I've been a frequent flyer at our EPU this year, what with two early mcs and one (so far successful) pg with a hell of a lot of bleeding in the first trimester.

Ectopic pg HAS to be ruled out, no question.

But I also think it is utterly cruel to tell a woman that she is almost certainly miscarrying, and then leave her weeks on end, wondering if the baby inside her is dead or alive. In the case of the second mc and first trimester problems with this pg, I would have gone stark, staring mad had I been left to wait. Which no doubt would have had extensive financial implications for the NHS.

OP, YABU, both for dismissing the mental/emotional side of mc, and for missing the real issue, which if anything was your friend not being prepared properly for the possibilities.

But very possibly she was and just clung on to hope. In which case no-one was at fault and it's just a sad situation.

So you would rather she wait till the 12 week scan to find no heart beat - and be even more traumatised by it? Some friend you are! I'm taking it you have never had a miscarrage?

We had years of infertility issues, followed by three miscarrages at 6, 8 and 12 weeks - one ofwhich was ectpic which could be life threatening. Those early scans with both my non successful and successful pregnancies were essential.

"She is entirely new to the world of ttc and babies and I just think it would have been kinder for the GP to sit her down and say "you are almost certainly miscarrying, unfortunately we cannot tell at this stage lets do a test in two weeks". Instead she went off to the hospital all excited about her first scan."

OP you are being BEYOND unreasonable as someone with NO history of fertility problems or miscarriage I was in and out of EPU up to the 16 week mark, I can guarantee she did not go off all excited about her scan, I can guarantee she was terrified.
If my GP had told me I was miscarrying (how could he possibly know) the pain would have been too hard to bare, especially with a 2 week wait to confirm or disagree with said GPs opinion.
The staff at my EPU were incredible, from your post I am guessing you have not been through this and therefore you cannot imagine what it feels like to bleed constantly, live in fear of going to the toilet even, let alone living in fear of every scan!

Your 'friend' should drop you like a hot potato, you are clearly severly lacking in empathy for her!

I had an early scan when I was 6 weeks as I was getting quite severe abdominal pain. YES a lot of pregancies end in early miscarriage and what will be will be - but I think their reason for doing it was not to reassure me, or to try and save the pregnancy, but to make sure the pregnancy was not ectopic which can result in maternal death if not spotted early and is a very real risk with symptoms such as spotting/abdominal pain.

Had spotting at 8 weeks, so had scan.

Obv should not be done routinely, but if there is bleeding, why not?

Also wanted to say that bleeding doesn't neccassarily mean you are miscarrying. I have bled with all my 6 pregnancies due to ectopic, haematoma(blood clot) in the womb that burst, after riding a bike, after a fall etc - but in 3 of my 6 prenancies i was still pregnant.

oh... YABVU

cant even be bothered to argue the point - but you seem like a complete fool for thinking some thing as simple as scan shoudlnt be offered to people who have real and genuine concerns over their health or health of their baby.

Yes my GP once told me I had miscarried and i insistedon an early scan. The EPU diagnosed a haematoma (blood clot) in the womb. I bled so heavily there were pools of blood spurting over my bed and was so sure it was the end.

"But I also think it is utterly cruel to tell a woman that she is almost certainly miscarrying, and then leave her weeks on end, wondering if the baby inside her is dead or alive"

You see I think it was utterly cruel to leave her clinging to the hope that after a pregnancy test on the day she missed her peiod followed by a week of heavy bleeding and seeing an embryo with no HB there was a possibility the pregnancy was still viable.

"So you would rather she wait till the 12 week scan to find no heart beat - and be even more traumatised by it? Some friend you are! I'm taking it you have never had a miscarrage"

No of course I am not suggesting that. What I was saying was that if you do a pregnancy test the day you are due and it is positive but start spotting within days and bleeding heavily within the week and ectopic pregnancy has been ruled out (and I add that because I didn't know about bleeding alone being a symptom but I do now - just in case yet another person wants to comment without actually reading the thread) then is it not obvious that you have had a miscarriage?

And yes I have been in that situation and yes I did assume it was a miscarriage and no it wasn't plesant or easy and I haven't anywhere on this thread suggested it is but I think it would actually have been a lot harder to accept if I had gone to the drs been scanned, seen an embryo told to come back in two weeks.

And finally guacamole of course I am not lacking in empathy - I know it is horrid for her, as I have said from the begining I think it is enormously sad but I think that sadness was exacerbated by enabling her to cling to the hope that it might all be ok, when in all likelihood it wasn't going to be.

YABU and making too many assumptions about your friend and her feelings. It does not matter what she's told you in the past, she will have had her own very private fears and dreams about this pregnancy. She may not tell you everything about her appointments. Please accept that unless you are her, you don't know everything re. this case.

Early scans are essential when there are bleeds or pain or history. I bled for 12 days after testing positive. I didn't demand a scan straight away but when the test kept being positive I was worried because I knew all about ectopics. Now my case is a bit different because I'd had fertility treatment but I think any woman with my bleeding would've needed a scan. Luckily I got told to go for one at five weeks so they could see where the pregnancy was. I was terrified and excited - it's possible to be both, you know. Nothing could've prepared me for either good or bad news. In the end I did get good news but got another scan two weeks later so they could check it was still developing normally. It's sometimes possible to have one pregnancy in the right place and one elsewhere, or for a bleed that is accompanying an otherwise ok pregnancy to suddenly get more serious.

It sounds like the problem is not with the fact that she was scanned but that her doctor and the EPU didn't explain to her what the likely outcome was if there was no heartbeat to be seen - though tbh I would have thought that most people would realise it was not a good sign.

"You see I think it was utterly cruel to leave her clinging to the hope that after a pregnancy test on the day she missed her peiod followed by a week of heavy bleeding and seeing an embryo with no HB there was a possibility the pregnancy was still viable."

there WAS still a possibility that the pregnancy was viable, nancy. that is why they ordered up the second scan. i think you are being really obtuse now.

nancy I had almost exactly what you are describing and it turned out that I had miscarried one twin. I had another episode of very heavy bleeding several weeks later and I am still pregnant. I don't think my story is that uncommon either.

But the point is Nancy that there was a little hope for her. If I understand correctly she was first scanned at about 6 weeks and then at 8 weeks. Many times even with a healthy pregnancy they wouldn't see the hb at 6 weeks. HB doesn't start until sometime between 6 and 7 weeks AFAIK. And at that stage may be obscured from view by the rest of the yolk sac etc. So there was a chance and it's only fair they won't say a mc for definite until a few weeks further along, because it might be OK. And the only way to confirm it a few weeks further on is another scan.

It is something you start to understand after you've been through it a few times. With my last pregnancy (my 3rd pregnancy following two previous miscarriages) I didn't go and see my GP until I was 8 weeks as I didn't want a scan until I was 8 weeks. I wanted to get to a stage where they could say yes or no, not maybe. But that's my personal choice, not imposed on me.

"And finally guacamole of course I am not lacking in empathy - I know it is horrid for her, as I have said from the begining I think it is enormously sad but I think that sadness was exacerbated by enabling her to cling to the hope that it might all be ok, when in all likelihood it wasn't going to be."

Why in all likelihood was it not going to be okay? When did you become such an expert in early pregnancy? In my first scan all they could see was a sac, I had to come back 2 weeks later also... Even though I had continued to bleed there was a baby there... A GP (without the ability of X-ray vision) could not possibly tell if a patient was miscarrying or not.
I didn't miscarry I have a gorgeous 7 month old DS, but the EPU were tremendous, I cannot praise them enough.

I know a scan at 6wks was a lifeline to me.

I know that the thread has moved on from the title - but it needs reiterating that there are sometimes really good reasons for offering early scans.

My first pregnancy failed at 10wks. Bleeding - A&E - test - positive - probably OK - come back in the morning - scan - ERPC. 3 months of backwards and forwards with the Drs because of intermitent heavy bleeding, eventually got examined, sent for scan, admitted, another ERPC. 2 wks later rescaned, carted off to another hospital to start chemo. Ban on TTC for a year, monitored for the rest of my life.

When, much to everyone's surprise, particularly the consultant with whom we had the appointment arranged for me to get the actual date that month to start IVF, I got pregnant naturally, of course the worry was that the MP would come back again. I think the chances dropped from 1 in 20,000 to 1 in 100 - and if I'd managed to be 1 in 20,000 its very easy to see how you got to 1 in 100. So, I was scanned at 6wks.

No finger nails left by then. To see that little blip of a heartbeat on the monitor was wonderful. And I was rescanned at 9wks for peace of mind. OK, it left me with 3 weeks of terror - and indeed, every wait between appointments left me thinking 'what if'....

For me, blood tests are very unreliable. My last 2 MC have been monitored quite carefully in terms of follow up - my blood tests can take 3mo to get nearly back to normal.

Nancy I think that you've hit a very raw nerve with lots of people - I know that you've changed your mind as a result of the thread, at least to some extent.

Its done to save the lives of women with conditions such as ectopics and molar pregnancies.

Its done to help those suffering recurrent miscarriges a diagnosis (ie at what point did the pregnancy end - no bloods can tell you that).

Its also used to diagnose a range oviarian and cervical cancers etc - again to save lives.

To rule out ovarian cysts which can cause you to produce pregnancy hormones and symtoms (even a positive test) but not actually be pregnant - again no bloods can diagnose that with any certainty.

And the facts about cold hard cash:

The hospitals have already paid for the ultrasound machines and are paying for permanent full time staff to cover scanning.

This means that even if early scans were stopped there would be NO SAVING as the equipment and staff would still be there and have been paid for.

OP, you've no idea and have clearly posted this to get "noticed" here on MN.

Whatever your reasons, you've been incredibly insensitive towards a lot of ladies here and caused upset.

Ignorant and not very nice.

I bled for 16 weeks (on and off), not spotting, full on major bleeding. My baby was fine, your friend's baby might have been fine (unfortunately it wasn't). If someone would have said to me 'You are probably miscarrying we will find out in 2 weeks', I'm not sure how I would have dealt with it.
Instead I was referred straight to EPU who told me they could not see a baby but this could mean one of two things... And when I returned, I did not return excited I returned terrified, I left terrified but reassured that at that precise moment I was still pregnant.

My 1st scan was also at 6 weeks, so it was too early to see the heartbeat and they explained that this was the norm at this stage. It was an awful weeks wait but I knew that there was still some hope. I was so convinced I'd miscarried before the scan I was ready to hit the vodka! Thank god for early scans is all I can say!

"You see I think it was utterly cruel to leave her clinging to the hope that after a pregnancy test on the day she missed her peiod followed by a week of heavy bleeding and seeing an embryo with no HB there was a possibility the pregnancy was still viable."

but what's the alternative? Leave her another six weeks wanting to know if everything is ok?

I can't work out what you are suggesting here - that they tell her the pregnancy is definitely not viable after the first inconclusive scan?

that they give her the pills or a D&C after the first inconclusive scan because it's somehow kinder than checking 2 weeks later which is standard practice?

When I had my miscarriage it was a missed miscarriage which was discovered at 7 weeks - no heartbeat, small embryo (Smaller than my dates). I had to wait 10 days for a second scan before they would allow me to have the pills needed to get the miscarriage started. It was horrible but I knew it was necessary and there's no way I would have just gone ahead with taking the pills without a second scan.

Presumably your two miscarriages were not missed miscarriages but very heavy bleeds? Didn't you get scanned at all OP, both times?

"No of course I am not suggesting that. What I was saying was that if you do a pregnancy test the day you are due and it is positive but start spotting within days and bleeding heavily within the week and ectopic pregnancy has been ruled out (and I add that because I didn't know about bleeding alone being a symptom but I do now - just in case yet another person wants to comment without actually reading the thread) then is it not obvious that you have had a miscarriage?"

yes, but why are you asking this question again when several people have said that it's not obvious at all and you have accepted that you didn't really know wnough about things like ectopic pregnancies to hold an informed view on the situation.

Maybe I am being obtuse because her treatment has been so different to my personal experience of miscarriage and actually those of others I know who have had miscarried at the 5/6 week stage.

She is the first person I knew of (before posting this thread) that had had a heavy period like bleed prior to 6 weeks and was scanned. Including myself I can think of 5 woman I know who have experienced this but not sought medical attention. I assumed that was what was "normal" when it was a first loss. I have a colleague who was scanned very early in her pregnancy due to a possible ectopic but she had severe abdominal pain and flu like symptoms.

Is the bottom line then that early miscarriage (before 6 weeks) can and should only be diagnosed by a scan?

fuck off OP. I have had twelve miscarriages and nearly died from an ectopic pregnancy. if I get up the pole again I will have regular scans. I sincerely hope that if ytou are ever offered an early scan you would turn it down, and i also hope to god that your friend has a better support system in place.