I first met Alison for management of her most recent pregnancy.
I took a past obstetric history from her…
2003 14wks MC D&C
2003 12wks MC D&C
2004 36wks Bleeding in pregnancy, spontaneous onset of labour, SVD*, healthy boy Birth weight 3515gms.
2005 8wks MC no D&C
2005 6wks MC no D&C
2006 39wks Bleeding in pregnancy, labour onset induced, SVD*, healthy girl Birth weight 2920gms.
2008 8wks MC no D&C
2008 8wks MC no D&C
2009 10wks MC D&C
2009 8wks MC No D&C
2010 39wks Bleeding in pregnancy, spontaneous onset of labour, SVD*, healthy boy Birth weight 3685gms.
* spontaneous vaginal delivery
There had been 11 pregnancies with only 3 successful outcomes and 8 miscarriages!
I admired so much her determination and perseverance.
I had no background information and there had been no “work-up” done to try to establish why she had kept on miscarrying.
Her first visit with me was when she was 5 weeks pregnant, because of her obstetric history.
I commenced checking her quantitative HCG level and her progesterone levels.
Her progesterone level was low and so I commenced her on progesterone vaginal pessaries. Sometimes the ovaries do not make sufficient progesterone to maintain a healthy uterine lining. This will predispose a pregnant woman to miscarriage. This can be corrected by her using progesterone pessaries.
I asked Alison to have twice weekly HCG and progesterone blood tests. The HCG increase is good marker of baby’s wellbeing. The progesterone check is a guide as to how much progesterone support is needed.
I next saw her when she was 6 weeks pregnant. I did her first pregnancy scan. Baby was of appropriate size and had a strong heartbeat of 128bpm.
I continued seeing her each two weeks until she was out of the miscarriage high risk period of pregnancy.
She continued the progesterone pessaries until she was 11 weeks pregnant. It was at that antenatal visit the placenta was clearly seen on ultrasound scan. Once the placenta has formed and is functioning the ovaries shut down and so are no longer hormonally supporting the pregnancy. There is then no need for further progesterone pessary support as the placenta will maintain the pregnancy not the ovaries.
Alison did not have the NIPT screening. That was because she said she would continue the pregnancy irrespective of the chromosome result. I supported her decision. I have had patients who have had NIPT screening even though they decided they would continue the pregnancy with an abnormal chromosome result. They wanted NIPT screening for reassurance, to check baby’s chromosomes are ok. Such patients are reassured with a normal NIPT result, but not with an abnormal NIPT result. When there is an abnormal NIPT result, they have an anxiety filled pregnancy. Indeed, it is usually the more anxious women who want NIPT screening even when they would not act on the result.
Alison also was diagnosed with gestational diabetes. It was mild and was able to be managed by attention to diet. No insulin was required.
There were three occasions when there was minimal bleeding. Otherwise, her pregnancy continued uneventfully. 
I induced Alison’s labour when she was 39 weeks because of her obstetric history. I did not want to risk the possibility of deteriorating placental function with her going overdue. Labour lasted three hours. She had a spontaneous vaginal delivery of a healthy boy weighing 3718gms. She was able to be discharged home successfully breast feeding her baby son.
I next saw Alison at her six weeks postnatal visit. Mother and baby were both doing well.
Alison said she was extremely grateful for my care. She was an absolute delight to manage and I was so pleased I had gone well with her pregnancy.
Alison’s obstetric story is one of determination, perseverance, and hope. I share it with Alison’s permission to give hope, especially to women have had pregnancy losses.
A woman grieves so much the loss of her baby. There is always a sadness in her heart for the baby she lost. As well here is fear in trying again in case it does not work.
Every woman has her own pregnancy journey. Some women have no miscarriages and no challenges when pregnant. But for others this is not the case. I always encourage a woman to keep trying, if it is on her heart to have a baby. I have found if she perseveres it usually works out, but so often I have found she will live with regret if she quits trying.
