How much blood can I lose before I should worry about internal bleeding?

kait3210 · April 2014

Hi there,

I was 9 weeks pregnant until... now. Early two mornings ago I had period-like bleeding, so we went to the ER. The doctor saw that the placenta was very slightly detached, but the baby still had a heart beat. He said to just hold in there and come back in a week. That afternoon I lost loads of blood. Loads. Also a thumb-sized chunk that I assumed had to have been my "olive sized" baby. I figured the worse had happened, but at least it was over. But then, the next day (yesterday) at work my husband talked to a Gynecologist (he works in the ER). She said it could have been just a piece of placenta, and I should come right in, which I did. She, along with a second doctor, could see the baby was still attached, but neither could find a heart beat. Also the placenta was much more detached. There is the small possibility that they just couldn't find the heart and somehow s/he is hanging in there, but I don't think so. In my two previous ultrasounds there was never any difficulty finding the heart, and these two ladies were poking around there pretty good (I could barely walk right afterwords). Also, I just don't feel pregnant anymore-- which I have from conception. My breasts are no longer tender, I have more energy (even with the sadness), I can feel it's over.

So to the point. The two doctors yesterday want me to come back in two days, I think they are worried about internal bleeding since the baby is still attached. I have been bleeding steady since yesterday, with steady increase. I have already lost at least as much as I would on a normal period. My period blood is normally thicker, like it would sit on top of toilet paper, and is a deep red color. This blood is thin, it soaks through the toilet paper like the a scrape to the knee would, and is a bright red color. Could that mean I'm bleeding my own blood, rather than just the uterus lining? I am also in a fair amount of pain, cramping and some dizziness.

I'm handling it emotionally, but I have no idea if this is normal, or if I am bleeding internally and should go find my husband at work (the ER). Could anyone who has gone through this loss before share with me what it was like for either a normal miscarriage or one with complications?

Thanks so much in advance to anyone who can lend my some reassurance!

DanandVan · April 2014

I had a complicated loss last week at 8 weeks. I was literally gushing out blood, way more than a pad could hold. It was also mixed with what I guess would be amniotic fluid. I had to have 2 blood transfusions because I lost so much.
I would go back to the ER, esp since you are experiencing dizziness. I am so sorry you have to go through this. Praying for the best for you.

kait3210 · April 2014

Thank you so much, ladies. For giving me a better idea of what is normal-- well healthy, we're all different. Since my initial post I've taken a hot bath. Something I've missed these past 9 weeks and I turned the bath water red. Standing up to wash my hair there was a constant movie-murder-scene like flow down the drain. I've passed some... solids, too. It comes in gushes where I can't leave the toilet for a few minutes, then it slows enough that I can waddle around with a washcloth between my legs for a few (it's pretty ridiculous. I don't have pads big enough, maybe pregnant women should be told to buy a box, in case of the worst). The point of the waddling is to gather a few things because I'm heading to the hospital as soon as my husband gets home. I'll follow up on whether on not I have been overreaching and I'm actually perfectly fine. Here's hoping! Again, thank you so much for sharing your thoughts and experiences on this pretty tough topic. --Kait

stephy1221 · April 2014

I am so sorry you are going through this. I will be thinking of you

gabbagal · April 2014

@kait3210, let us know how everything went at the hospital

meredithcarole · April 2014

@kait3210‌ I am not sure why there would be a risk of infection (and I have heard of many using the bath to miscarry), but I was told not to take a bath, use a tampon, or (obviously) have sex. May be worth double checking with your doctor. That advise to me, though, may have been D&C related. As for bleeding, if you are showing any signs of shock (dizziness, weakness, fainting) go to the ER.

kait3210 · April 2014

I wanted to follow up on on what happened next, for posterity. Last I posted I was heading to the ER.

To recap, I was bleeding what I thought, but was not sure, was too much most of the afternoon. I had terrible cramps (along with back pain, I pulled my back two days before the m/c started, which was two days before I started this thread. Suspicious timing, but the pain was sharp like like muscle pain.) I was really miserable.

I then took a hot bath because I had missed taking them during my pregnancy and if I did end up needing to go to the ER, I was already "ripe" for a shower (it's been a tough and eventful few days) and besides a courtesy to the doctors looking up my who-who I could end up having to stay the night, and would start feeling gross really fast.

Anyway, the bath was lovely. And the water remained soapy-grey-blue for the beginning. I had almost been expecting to turn the water red, since I could to it to the toilet in a minute. I enjoyed my soaking. Then the water between my legs was red. Red, not orange or pink. In the time it took me to dry my hands and get my phone (seconds, I had it ready in fear I could go faint and need to call for help) to call my husband, the whole tub was red as fruit punch. I started draining the bloody water. I was in a squatting position then and I passed what I think was the baby, but I'm not sure, everything I've passed has been just bloody-ball-masses. The bleeding was clearly too fast now and I had no doubt I needed to go to the ER.

It took 20 minutes for my husband to get home. I put a few fast thinks together. I hadn't eaten due to the pain and the bath and the blood, so we grabbed a slice of pizza while getting into the car.

I made the car ride without bleeding through to the seat, that goodness. But as soon as I stood up, I had to beeline it to the br to pass some more pieces. My husband had just left the ER, so his colleagues were expecting us, by the time I was out of the bathroom, he was waiting outside with my papers to go up to the Gynecology ward. They were expecting us too, so we went right in to the ultrasound room. While my husband and the doctor were going over the basics (the two ultrasounds I had in the past two days), I had to run to the bathroom again to pass more pieces. Not even 5 minutes had passed since I left the ER BR.

So we do the ultrasound exam. The younger doctor who had been with us up to now calls in an older colleague to join. I'm slowly starting to sit in a pool of my own blood on the exam table. They say there is still a lot attached and it needs to be removed surgically immediately. I believe a CnD, but they didn't use that term. The older doctor asks when I last ate. It was on the car ride there. She then proceeds to yell at us both since we can't do surgery if I have a full stomach (I'll vomit under anesthesia). Some phone calls are made to the OR where I hear my doctor (I consider her mine now) debates with the surgeons about how yes, I've eaten and can't have surgery, but I'm bleeding "a fontanella"-- like one of the ever flowing roman drinking fountains. I haven't mentioned before, I live in Rome, Italy.

We head back down to the ER, to sign me up for emergency surgery, take some blood, insert one of those IV hook-up to my arm (uuhhg), and give me an IV of saline and something to help my blood clot. I start to feel like I might faint now. I think the excitement had been keeping me from feeling the blood loss before. Not I'm just in a room with the first, younger, doctor typing up my case on a computer. By the time the IV is all in, I feel a bit better though.

We head back upstairs to the Gynecology ward and I get a bed in a double room (with a roomie who's had a hysterectomy), some adult diapers, and a hospital gown. By the time I'm changed, my blood results are in and my hemoglobin is actually high enough that no one is worried anymore that I am going to drop dead any minute. Surgery is put off until morning. I spend my first night in a hospital ever.

This may be an Italian thing, but I'll include it anyway. I didn't really understand how the CnD was going to stop me from bleeding. I didn't understand why I needed it since it seemed the content of my uterus was leaving on its own at a pretty good pace (it had been three days now since I started bleeding and two since I lost the baby's heart). Also, I was bleeding much less at this point, the next morning. Asking these questions I got pretty nasty replies along the lines of that I could sign a waver if I refuse surgery and go ahead and suffer-- ok, not that bad, but she stormed out on me. Asking what my chances were that it would all just exit on its own my doctor actually said she "doesn't have a degree in mathematics"! My husband had told me she is a very good doctor but a little "rustico".

I got my husband to call (he had gone home to sleep last night, since he had to work this night) and talk to her. Italians are always nicer to each other and being a colleague probably helped, too. Via him, I found out that there was still (amazingly!) a lot of content in my uterus and it was strongly attached with blood vessels that were going to break when the next piece came off and I would start bleeding like a fountain again. Also, that the bleeding had slowed because of the blood thickener medicine they had given me, I had not made a miraculous recovery, like I had thought. So I agreed to the surgery and immediately there was yelling down the halls to prepare a room for me down in the OR.

Rolling me down to the OR, we passed the Gynecology nurses station, where they realized I had not signed the releases. I couldn't read them, so a doctor read a summery of it to me. She went over the possible complications, like that a hole could accidentally get punched in my uterus, and then they would need to remove the whole uterus.

This destroyed me 1000 times worse than losing the heartbeat on my 9-week-old baby. The loss of a fertilized egg that was too weak to live compared to the threat of never being able to have children. Ever. My mother lost the use of her uterus in a surgery, so it didn't seem the far off chance that they said. And how could I ever live with myself if the worse happened and I loss my uterus in a surgery I may not have needed? The CMA's pushing my bed were a comfort and reminded my it's not a big deal procedure, I'm not getting cut open, so I didn't yell to turn the whole thing around and send me home.

My husband made it back the the hospital in time to hold my hand before I went under. The anesthesiologist was good as what she does and I woke up feeling 2 seconds had gone by. I was surrounded by doctors getting ready to move me out of the operating theater and back into a wheely bed who were able to tell me right away that it was over and it had all gone well. "My" sassy older doctor from the night before had stayed beyond the end of her shift to do the procedure. Which was a comfort, besides the kindness, that I was going to have a skilled doctor and one who knew my story and had been with me through this all.

Back in my little room someone put a new adult diaper on me and I was given two IV's back to back. By the end of the second, I was dying to get out of my bloody, sweaty plastic diaper and clean up all the dried blood and iodine. I had been back in my room for 4 hours, marinating in my own juices. I had been afraid to go to sleep, because I thought it the IV fluid finished I would get air in my veins. An idea my husband had no shortage of laughter for later, but never the less, I didn't know better so I didn't dare sleep. I was still a bit too woozy to enjoy reading and in no mood for the struggle of watching Italian TV either. They were a long and miserable 4 hours.

I was eventually released from my tether of an IV, cleaned myself up, and was given broth and applesauce for lunch which tasted *amazing*. Hunger is the best seasoning, and I had been told I wouldn't get lunch, so it was a nice surprise. I stayed in the hospital that night, too. But I never saw another doctor. My husband worked that night, but the ER was so busy he couldn't visit me until long after I was asleep. The next morning (today, actually), a group of student doctors crowded around my who-ha for my exit ultrasound exam. They whispered to eachother in Italian, rather than explain to me what they saw. Which, at this point, made me want to knock their heads together. They told me my uterus was empty, at least. So then I just had to wait for the head of the ward to get out of surgery to sign me out if the hospital. Which took two and a half hours. Amazing how quick they were at getting me in, and how slow there were to get me out. Even with new people waiting for beds now. This must be an Italian thing.

In defense of the Italians, all of this didn't cost a dime. Pretty nice, since I'm self employed. If I had happened to have been visiting home just now, I would probably be preparing to declare bankruptcy on top of the other loss.

So that is my story. I didn't have much choice on the CnD, but it seems pretty nice. I have been just spotting a little, but even that seems to have stopped. I couldn't have gone through a week (or four!) of days like the one I headed to the ER. I'm glad it is all over now, though also knocking on wood since I've thought it was "over" a dozen times by now.

Miscarriages are not at all like I thought. It's not like TV, where the woman wakes in the night to bloody sheets, goes to the ER, then is home by the first rays of sunlight with it all over. Maybe I have a heart of ice, but for me the physical aspects of the m/c have been worse than the emotional. Maybe the grief will come later. I like to think I'm an eternal optimist, and remember it's my first and we will most likely be fine next time. My husband is having a hard time. Sometimes he gets whiny about it and I get upset at him for thinking of himself and not being supportive to me actually going through it all, but I know that's not fair.

I will summarize the previous posts and my own story to answer my original question:

"how much blood can i lose before i should worry about internal bleeding?"

==> If you are bleeding through a heavy-flow pad in less than an hour, that's too much. If blood is "gushing" out of you at a rate that you can't leave the toilet, that's too much. If the blood is bright red, brighter than period blood, that is a good indication that it is "your" blood, not just the lining of your uterus coming out and you need to get medical attention immediately.

Again, thanks ladies, for being there with me thought this! All is (knock on wood) good now.

--Kait

Eveiii · April 2014

I'm sorry so for your loss. Such a horrible thing to have to go to the hospital but I'm glad you did and they looked after you and you got the treatment you needed. Hopefully physically after all this your body starts to feel a bit better.

I completely understand about the IV bag emptying and the fear of getting air in your veins because I had the exact fear when I was on two of them and refused to sleep. So if it's any help your not alone with that one.

I send you lot of hugs, loves and pray x

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