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My routine checkup had me leaving the clinic filled with hopes and fears, especially after the late miscarriage with my triplets. Both pertained to future pregnancies that I may have.

Routine Screenings

Dr. Thia recommended a Pap since I had CIN 1 a couple years ago. He wanted to make sure that it’s still being kept at bay. They’re also going to check for HPV. Keeping my fingers and toes crossed that everything will be clear. 

My bile acid levels are back to normal although my liver enzyme levels are very slightly elevated. I’ll have to get another test done when I go back to see Dr. V next month. My pap results will also be ready by then and she’ll be able to determine when we’ll be ready to try again. 

I’ll be going back on HRT to regulate my menstrual cycle. We were going that my period would return naturally but it didn’t. 

What The Odds Are

I asked Dr. Thia what the chances of what happened reoccurring is, should we conceive again. He said that with a single pregnancy, the risk will be much lower although there is no guarantee. I totally understand that. With a multiple pregnancy, they will not say much if we have twins, but with triplets, they will probably counsel us to have selective reduction done. I said that we’ll cross that bridge if it comes to that again.

After everything that has happened, I honestly still feel that same as I did before – I don’t believe in selective reduction. Which is tough, because I know that I do not want to risk losing any more babies either. But yeah, when and if we reach that bridge…

Future Pregnancies

Now, in my next pregnancy, there are two ways to go about it from second trimester onwards:

First trimester –

I’ll go for more swabs for infection, as well as regular urine tests to also check for infection that may be asymptomatic. 

Second trimester –

1: Vaginal progesterone to help support and relax the cervix so that it doesn’t contract. Also, it will help to change the environment of the womb to ensure that it does not become hostile. Vaginal progesterone is supposed to be the most effective because it goes directly to the source, although some women may get shots because they work faster. 

2: Cerclage to seal the womb. While it can help lengthen the cervix, if baby wants to come out, it will come out regardless of the stitches. 

Again, Dr. Thia stressed that I had three babies and being very petite, it would have been a very difficult pregnancy. The weight of the babies probably weakened my cervix. This scares me because I don’t know how my cervix will cope with future ones.

Further Complications

Also, I had intrahepatic cholestasis at a rather early stage – middle of second trimester. Usually, it occurs in the third trimester. As such, Dr said that there’s a high chance for it to occur again even in a single pregnancy. So there will need to be close monitoring.

If my bile acids are above 100μmol/L (as it was in my triplets pregnancy), baby will need to be out at 35, 36 weeks. If it is less, then they will push it to 37 weeks. I can insist on having baby out at 36 weeks even if my bile acid levels are less than 100μmol/L, as long as I bear in mind that it will be premature. Usually it’s a delicate balance of keeping baby in as long as possible, and ensuring that it doesn’t absorb the bile and become still born.

Dr. Thia also said that the cause of cholestasis is unclear for me because it may have been due to the triplets creating a large amount of hormones, or it could be my body. It can be controlled during pregnancy with ursodeoxycholic acid, which is what I took after being diagnosed, and it goes off a few days after delivering. However, it cannot remove the bile acids altogether or prevent baby from absorbing it nearer full term.

Digesting It All

After leaving Dr. Thia’s clinic and digesting all the information I had gathered about my multiple pregnancy, and what lies ahead for our future one(s), I started to feel really down. It dawned on me that I may never have a normal pregnancy without fear of something happening.

I don’t know whether my cervix is weak or whether my womb needs more progesterone support while pregnant, or whether it was just because I had three lives growing within me. 

Hopes and Fears after Late Miscarriage

While I was with my thoughts, I actually toyed with the idea of never conceiving again. First, the fear that I may lose the baby again in second trimester due to an incompetent cervix or infection, and then knowing that any baby I have may next reach full term because of cholestasis. AND if pregnancy does go smoothly, and I do wind up with cholestasis again, and it is managed well, I will still fear losing baby at birth because of the risk cholestasis puts it in.

I don’t know if my heart can take anymore losses. And yet, I cannot deny the great desire I have to fill our home with children; for Florian to be a (damn good) father, and I, a mother. I can only trust that the medical professionals we seek will know best, and allow God to do the rest. As Florian reminded me, we are much better equipped for future pregnancies with the knowledge we know now. We have to try again or else we will never know.

One step at a time I suppose. First, let’s pray for good pap/HPV results. And we’ll go from there.

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