P.U.L.

I'd been looking forward to announcing the impending arrival of our third child on this blog. I thought I might even have some early sonogram pictures to share. Although I don't normally get such early sonos, I was having vague symptoms and my doctor decided to run some tests to make sure everything was normal. Unfortunately, it's not.

Yesterday I had a sonogram, and I started getting the impression from the ultrasonographer that she wasn't seeing what she expected. She was scanning the fluid sac in my uterus several times without taking measurements (more than what seemed to be the usual amount of redundancy in a scan) and she kept shifting her position as if trying to see something hidden by viewing it from a different angle. It reminded me of the way I tend to try and look around corners in a first-person computer game by peering into the edge of the monitor without actually advancing my character. It was a strong enough feeling that I felt compelled to ask straight out if everything was normal. She was professional enough to dodge the question without letting her concerns leak into her voice, but I still wondered whether she dodged all questions as a habit, or just the ones with bad answers.

Three incredibly long hours later, my OB's office called. The nurse confirmed the bad feeling I'd gotten from viewing the sono: they weren't able to find any obvious embryonic structures in the fluid sac in my uterus. It's possible that I'm just not quite as far along as I thought. But with the normal hCG levels they tested on Wednesday, they are also concerned that I may have an ectopic pregnancy. Two different abstracts on PubMed estimate (from an admittedly small sample size) that 3% to 9% of ectopic pregnancies have "pseudogestational sacs" - a simple fluid build-up within the uterus.

I've done a fair amount of Googling to try and figure out what I get to look forward to, as the nurse who called only said I'd have to repeat my hCG today and, when pressed, agreed that probably there would be a repeat sonogram. "Dr. Google" talks about scary-sounding things like diagnostic uterine curettage if ultrasound remains inconclusive. Assuming, of course, that I don't end up in the ER before that time with severe cramping.

That's the really scary part. Not knowing whether I am carrying life or death for my child (or even for me, though the risk is low) is keeping me awake at night. The worst part is knowing that if my pregnancy is confirmed ectopic (currently I think I fall into the technical definition of a PUL: pregnancy of unknown location), I will probably have to choose an abortion. I have always been pro-life, and I am finding that it's much easier to say in theory that this is one of those no-question exceptions than to be staring at the prospect of making the real choice for oneself.

All I can do now is wait and pray.