July 02, 2015

Q: I am about 14 weeks pregnant and I am seriously worried about the risks I am taking in keeping this child. I would love to have another child but when I had my first one I was in labor for 2 days and hemorrhaged for 2 hours afterwards. I almost lost my uterus. I've been pregnant before and have miscarried. So is keeping this one going to be a huge risk factor? I'm already experiencing a lot of abdominal pain, and this just doesn't feel normal. I'm scared.

A: I can understand why this must be scary for you. That was a long labor, and bleeding to the point where a hysterectomy is being discussed is a big deal. The important question is, though, why did you have a postpartum hemorrhage? There are many reasons that women suffer from excessive bleeding after delivery and some are more likely to recur with subsequent pregnancies than others. For example, a postpartum hemorrhage that occurs from atony (a condition where the uterus gets lazy and doesn't contract after delivery) is less likely to occur again compared to a postpartum hemorrhage from a placenta accreta (a condition where the placenta grows into the muscle of the uterus). So this would be an important discussion to have with your practitioner, who knows your full obstetric history. Regarding your miscarriages, again I am speaking here without knowing your medical history, but they are most likely not related to what happened during your first delivery. Miscarriage is common, occurring in up to 33% of all pregnancies. That's a 1 in 3 chance for most women. The risk increases with increasing maternal age and any pre-existing medical issues that a woman may have. The good news is that you are already 14 weeks so most experts would agree that you are past the point where most miscarriages happen. Lastly, let's talk about your pain. Abdominal pain in pregnancy is common. Most of the time, it can be attributed to the uterus growing and stretching, as well as all of the surrounding tissues and ligaments stretching. But, there are certain things that cause pain during pregnancy that can be dangerous. If your pain is daily, severe and is associated with other symptoms, such as vomiting, diarrhea, vaginal bleeding or fever, you should talk to your practitioner immediately. It's always best to discuss any type of abdominal pain with your practitioner to let he or she decide if it's normal or not.

Answered by Dr. Michele Hakakha