Sonohysterogram and oddly shaped uterus?? Anyone else have experience?

spatter1 · June 2015

Hi again,

I learned I have an arcuate shaped uterus back in January but my Dr. didn't see a reason to do further testing at that time because we weren't having fertility issues and it didn't appear that I had a septum. Flash forward to the beginning of April when I get my BFP, and then to May 1 when I had my d&c. My Dr. decided at this point I should have a sonohysterogram to look into my uterine shape before we start trying again. She wasn't convinced that it had anything to do with my miscarriage but wanted to cover all bases before we TTC again. I had the sono today and it was an awful experience. I was warned there could be some cramping when they inject the saline but omg those were not like any cramps I've ever had! It hurt quite a lot and I was very uncomfortable. The whole time the radiologist and the ultrasound tech were talking to each other but not answering any of my questions. I know for liability reasons they can't really, but it was very unnerving! I heard them say things like "blood clot" "horn" "septum" but not in any conclusive way. When they were finished they radiologist told me it looks like I might have a polyp or some leftover tissue from the miscarriage in my uterus. Now on top of wondering what kind of shape my uterus is in, I'm terrified I have to have another d&c to remove the remaining tissue. The waiting to hear from my obgyn is the worst part. Has anyone had to have a follow up d&c because over leftover tissue? Anyone else have experience with an oddly shaped uterus? From what I have found there isn't a lot of information out there on arcuate shape, nor is there information on how much, if at all, it can affect pregnancy.

Thanks for reading!

Sarah

carrieandr · June 2015

I'm sorry you had to go through that. I just commented on your other post about how I had a light period and found out I had hcg in my system 3 weeks later. I bled a lot for 2 weeks after my d&c, stopped for a day, spotted for a few days and then a smooth piece of tissue came out. It looked different from a clot. All bleeding stopped at that point. After some reading, I think it was a bit of placenta that may have still had blood flow to it for a while. It would explain the heavy bleeding and the fact that I still had hcg 8 weeks after my d&c. (This is totally a guess. I didn't ask the dr about it.)

I don't know if any of that info helps you. I hope you get answers from your dr soon!

MrsGargoyle · June 2015

I swear some of the really bad cramping with an SIS has to do with how fast or slow the tech or doctor inflates the catheter balloon in the cervix. Some folks just bang that thing open and you are left feeling like they are tearing your uterus open. My doc started inflating much slower after I asked her to, when I have those kinds of procedures now, it's not so bad.

As for an arcuate uterus, that is usually nowhere near as serious in it's implications for pregnancy loss as a bicornate uterus, where there are two distinct horns, instead of a generally triangular-shaped uterus with a top that gently indents. However, the cause of the arc is really important. If it is just general anatomical shape, not really a big deal, but if it is being caused by a septum, it can be a really big deal.

Talk very carefully with your doctor about a hysteroscopy instead of a follow-up D&C. This is a direct visualization of the inside of the uterus. S/he can take care of the retained tissue or polyp while she is in there, but most importantly, she can look at the actual tissue over the arc. Septums are NOT always clearly defined thin walls growing down the center of the uterus from the top. They can be very wide and shallow, covering the healthy tissue underneath. This can result in a blastocyst implanting in the septum tissue and growing until it fails to make a vascular connection (septum tissue is like scar tissue, no blood flow), resulting in a miscarriage. The ONLY way to see a wide, shallow septum is direct visualization through a hysteroscope.

For an operative hysteroscopy, you are under general, they place a catheter balloon and flood your uterus like with an SIS, but you are in an outpatient OR and they include a camera and tool package in the catheter. This lets the doctor see inside you with the camera, and then remove anything that needs removing while there. With retained tissue, they can use a small tool to grab it and remove it. With a septum they can use micro-scissors or a cauterizing knife to cut away the septum until they reach healthy tissue below. Be aware that micro-scissors are best, with the least chance of unintended damage to the healthy tissue, and it takes training to do this right. Because of this, have an agreement with your OB in writing, that if a septum is found, s/he will not remove it but refer you to an RE. An RE is board-certified in Reproductive Endocrinology and Infertility, and has the expertise to handle the procedure, as well as important aspects of follow-up care, such as a uterine balloon, worn for a short time to prevent the newly exposed tissue from sticking to itself and forming scar tissue, as well as estrogen therapy, to help healthy endometrial cells to grow over the newly exposed tissue.

At this point, the best thing you can do is to become your own advocate. Don't agree to any procedures without asking a ton of questions, get a second opinion if you aren't 100% comfortable. And, most importantly, be aware that structural issues in the uterus is reason to be referred to a specialist (an RE), and you should fight for that if your OB drags their heels.

spatter1 · June 2015

Thank you both so much for your replies! The information about the hysteroscopy is so helpful. I'm still waiting for a call from my Dr. to hear for certain what they saw (or think they saw) and what the next course of action should be. This information gives me a lot to consider and bring up when I talk to my doctor. I really love my obgyn and was especially impressed with how she handled my miscarriage. However, after my appointment yesterday and all the questions raised by the radiologist about follow up after my miscarriage I'm worried that she isn't taking all the steps she could be. For example, should I have had my HCG tested since my d&c? Should I have had a follow up ultrasound after too to make sure my uterus was clear?

I really just want this all behind me so we can start trying again, but also don't want to get pregnant again only for it to result in another loss because of something going on in my uterus that could have been treated. I want answers and I'm getting so frustrated that nothing seems clear. It could be a polyp, a blood clot, leftover tissue, a septum... I mean jeez!! None of those things sound good and all of them sound very different so why can't they tell what it is?

Thanks again for your responses!

Sarah

carrieandr · June 2015

My doctor didn't test my hcg or do a follow-up u/s after the d&c. The only reason I got my hcg tested recently was because I had a BFP at 7dpo and wasn't sure if I could trust it.

MrsGargoyle · June 2015

spatter1 said:

Thank you both so much for your replies! The information about the hysteroscopy is so helpful. I'm still waiting for a call from my Dr. to hear for certain what they saw (or think they saw) and what the next course of action should be. This information gives me a lot to consider and bring up when I talk to my doctor. I really love my obgyn and was especially impressed with how she handled my miscarriage. However, after my appointment yesterday and all the questions raised by the radiologist about follow up after my miscarriage I'm worried that she isn't taking all the steps she could be. For example, should I have had my HCG tested since my d&c? Should I have had a follow up ultrasound after too to make sure my uterus was clear?

I really just want this all behind me so we can start trying again, but also don't want to get pregnant again only for it to result in another loss because of something going on in my uterus that could have been treated. I want answers and I'm getting so frustrated that nothing seems clear. It could be a polyp, a blood clot, leftover tissue, a septum... I mean jeez!! None of those things sound good and all of them sound very different so why can't they tell what it is?

Thanks again for your responses!
Sarah

It is probably too soon to say that your OB isn't doing enough, especially if she is the one to have ordered to SIS you just had. That is an unusually proactive decision on her part, you usually don't see that kind of testing until you are with an RE. Where you will want to make sure she keeps being proactive is in her response to the results of the SIS. If she advocates going home and waiting to see what happens, then I'd be looking for a second opinion. As for a repeat 48 hcg, in my opinion, that would be a good first step, in order to help rule out complications such as a molar pregnancy. Don't let Dr Google scare the shit out of you when you look that up, it is really very rare and if identified relatively early, usually doesn't require more than a repeat D&C or hysteroscopy to remove tissue for culture, and 6 months of hcg testing to make sure there is no relapse. I have known a few women who have gone through it. But, the repeat hcg test will give a pretty fast answer as to whether your levels are falling reasonably (no retained tissue), holding steady or barely falling (retained tissue), or rising (possible molar tissue). I know it's frustrating that nothing seems clear, but it is the limitation to visualization methods. The SIS is really great for seeing 2-D slices of structure, but it is just two-way return time of sound waves that differentiate between different densities of tissue, it can't differentiate between tissue types (blood clot, scar, septum, retained tissue). While they are in there, they likely switched to view blood flow which can sometimes identify retained placenta, but it only helps identify one possible issue and can't rule out others. Let us know what your OB says when you talk to her.

spatter1 · June 2015

Thanks for the support! I heard from my doctor late last week and she said everything looks NORMAL! =D> She said I have a tiny blood clot (less than 1cm) that should come out with my next period. I told her I bled a decent amount after the procedure and she said it's possible they flushed it out. She also said that my uterus is normal shaped - no horns, no septum! She gave us the go ahead to start trying again if we're ready. I could not be more relieved. Thank you all again for the support through this stressful couple of weeks. I'm sure there will be more tough times but today I am feeling positive. Hope you all have a good week!

carrieandr · June 2015

I'm so glad to hear your good news!

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