please help, pregnancy problems resulting is late losses

[megancannon]

i am 22 years oldi don't smoke drink or do drugs. i got pregnant for the first time at 20, i had my first ultrasound at 9 weeks everything looked normal & my babys heartbeat was 170bpm. a few days after my first ultrasound i was laying down & felt a gush, i was having very heavy bright red bleeding. bleeding stopped 5-6 hours later. i was seen by doctor she did an ultrasound baby was good & heartbeat was around 160. doctor was not sure where the bleeding came from but told me to spend a week on bed rest. when i was 20 weeks i randomly started having contractions. we went to the hospital doctors discovered i was 2cm dilated & my bag of water was bulging. i was put upside down in the bed & doctors started medication to stop my labor. the 2nd day  my water broke & our son died 22 mins later. the pathology report showed chorioamnionitis & intraplacental & subplacental bleed. our baby looked ok though. doctors gave me the ok to get pregnant after 6 months. 8 months later i became pregnant. at 5 weeks i began cramping, went to the er and had an ultrasound and there was no baby. approx 3 months later we tried again.i was seen once a week by the fetal specialist & once every 2 weeks by a normal doctor. i had ultrasounds almost every week. everything looked good & our baby was growing appropriately. my cervix was checked once a week & was always the correct measurements. at 16 weeks i suddenly experience very strong cramping. i went to the er & found out i was 1cm dilated. at L&D i was then contracting every other minute. doctors could not stop my labor & our daughter was delivered 9 hours later after a few pushes. my water never broke. all the pathology says is a macerated fetus & 2 vessel umbilical cord. doctors did several blood test and all that has came back positive was my ANA and SSB is there anything you can think of that would cause the problems i had with my pregnancies?

[megancannon]

My husband and I both had a chromosome analysis done and both came back normal. My rheumotologist did do all the lupus test and everything was negative. we opted out of doing autopsies on our children because they had already been through so much and i just couldn't do it, but the doctors said they were correct weight and height and looked normal.

with all the ultrasounds i had while i was pregnant would the doctors have notice an abnormality with my uterus? i just had a ultrasound done last month so doctors could look at my uterus, ovaries, cervix etc when i was not pregnant and they said everything looked normal.  i feel like we are running out of options and this is so confusing!

[Elaine Brown, MD]

Hi!
I'm sorry for the delay in response--was very ill for awhile
I'm also sorry that you 've been through so many losses!  

Many second trimester losses are caused by fetal problems, such as birth defects, and a 2 vessel cord is consistent with some other problems such as cardiac and renal abnormalities.

An ANA can be very non-specific depending upon the titre.  Lupus would definitely need to be investigated further though. Lupus anticoagulant and anticardiolipin antibodies should be checked.  If you were my patient, I think I would discuss a chromosome analysis with you too for both parents.

It is also odd that you have contractions so early on.  That makes me want to consider the possibility of a uterine anomaly such as a septum.  To rule this out I would want to do a 3D saline ultrasound, HSG or MRI.  If a septum is present, sometimes it can be removed and can make a definite  difference in outcomes.

I hope there is something here that is helpful to you.  I hope you have a healthy child in you very near future!

Good luck!
Dr B