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Stopped birth control pills to have baby. Noticed bleeding. No the time of periods. What can this be?

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Practicing since : 1999
Answered : 1586 Questions
Dr. Raichle,

Sorry for the length, I just want to make sure you have all of the necessary information.

I have a question about the accuracy of early ultrasounds for dating a pregnancy. I slept with someone late night on XXXXXXX 18 on a brief break from usual partner (which I believe was the last day of my period, but they are irregular and I am not 100% positive). We used protection - condom from start to finish (didn't break), birth control pills (BeYaz - but I missed a pill or two), and Plan B 55ish hours after the encounter. I continued with a new pack of birth control pills on XXXXXXX 20 (one day late - was supposed to start XXXXXXX 19). I was with a different partner for the remainder of XXXXXXX - Feb. I stopped birth control mid cycle because we decided we would like to start trying for a baby. I stopped birth control pills on Feb 1st or 2nd and had bleeding from Feb 5-8th. I believe the bleeding was normal (used tampons for 4 days), but it was not at the time I would expect a period. What is the cause of this? Could it have been implantation bleeding or was it from coming of birth control?

I had my first ultrasound on 4/1. It was performed ABDOMINALLY and dated me 7wks due 11/18/13. Is it accurate even though it was performed abdominally? I had another ultrasound on 4/26 dating me 11w,3d CRL 45mm EDD of 11/12/13. Another scan on 5/14 dating 14w,1d CRL 82mm EDD of 11/11/13. Another 6/18 dating 19w,0d EDD 11/12/13. Another on 7/5 dating 21w,3d EDD 11/13/13. Another 8/12 dating 26w,6d EDD of 11/12/13. Another on 9/5 dating 30w,6d (4 days further along) with EDD of 11/8/13.

Is it possible that the sperm from XXXXXXX 18 survived (birth control didn't work), all of my ultrasounds were off a month, the bleeding in February was implantation bleeding, and I conceived on XXXXXXX 18? I have read varying things about the average life of sperm and the accuracy of ultrasounds.

I have talked to my OB, but would like a second opinion.
Posted Wed, 23 Oct 2013 in Getting Pregnant
Answered by Dr. Timothy Raichle 17 hours later
Brief Answer:
Sorry about the delay - easily sorted out!

Detailed Answer:
First of all, do not focus on the irregular, confusing bleeding as this is the least accurate way to figure out what is going on. The ultrasounds are accurate and your best way to figure out when you conceived. Sperm can survive for about 72 hours after intercourse, no matter what you read on the internet. With regard to the accuracy of ultrasound, it is very accurate, but the 'error' increases as you get further along. For example, the ultrasound at 31 weeks was the least accurate ultrasound. Here is what I think:

1. While the ultrasound on 4/1 would have been your most accurate scan, performing it abdominally made it less accurate. If that was the ONLY scan that you had, then I would use it for dating the pregnancy, BUT...
2. You had FIVE followup scans that placed your due date right at 11/12. These seem to me consistently more accurate, especially at points in the pregnancy where differences in 'growth potential' of different pregnancies is minimal.
3. So, based on the irregular cycles, inaccuracy of the 7 weeks scan, and followup scans that consistently agree with a due date of 11/12, then I would consider your due date to be 11/12.
4. Based on a due date of 11/12, conception likely occurred right around 2/19. Based on the average life span of sperm, let us consider the fertility window to be 2/16 - 2/22.
5. Intercourse on 1/18 was NOT the father of this baby
6. You conceived shortly after going off of the pills 2/1
7. Finally, the bleeding after discontinuing the birth control pills 2/1 was a normal withdrawal bleed related to stopping the pills.

I really hope that this helps and please let me know if you have followup questions!!
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Follow-up: Stopped birth control pills to have baby. Noticed bleeding. No the time of periods. What can this be? 3 hours later
Thank you for your detailed reply! I have also talked to my OB about this situation and she gave the same response, I just wanted a second opinion.

This is what has made me nervous again about this situation.

When I was 29 weeks pregnant I fell down the stairs. I went to L&D and found out I was having contractions. I got a shot to stop contractions, got an ultrasound to measure cervical length (it was 3.25cm) and they thought I was in the clear. Well a week later (30w,3d) I went to be monitored again because I was having cramping, and they found out I was having contractions and had been all week. The again gave me a shot to stop contractions and well as oral medications, gave me a steroid shot for lung maturity, checked my cervix, and took an ultrasound. My cervix was dilated to a 1, in the "anterior position" (she said that meant it was closer than expected), and softer than she would expect at 30 weeks. The ultrasound measured the baby 4 days earlier than expected - her head circumference and abdominal circumference were measuring around a week ahead, while femur length and BPD were measuring a few days behind. The EFW was 3lbs, 10oz. The ultrasound tech commented that the baby had hair on the ultrasound (possible?). Her measuring ahead and weighing 3lb 10oz seems HUGE to me at 30 weeks. Is it possible that the dating is off and I am actually a month ahead based on this information?

What is the average EFW for 30/31 weeks?
If I pregnant from 1/18 encounter I would have been around 34, almost 35 weeks correct?

I am just scared that the preterm labor contractions, being dilated, and her measuring ahead means that I am actually further along than I thought.

On the internet I have read that you cannot determine paternity based on ultrasounds. How is it possible in this case?

I am on bed rest until further notice and have also started having pain near my left hip/pelvis. It feel like something is there. I know the baby is there, but she was in the breech position last ultrasound, but lately she seems a lot lower. Is it possible that she is already engaging? Isn't it too early for that? Again would this mean I am further along?

I am sorry for the long messages, I am just so nervous.
Answered by Dr. Timothy Raichle 4 hours later
Brief Answer:
You are over-thinking everything.

Detailed Answer:
First of all, I am not even going to entertain the idea of conception around 1/18. This just is not possible, and we went through this is great detail - you need to get that out of your head.

Second, you cannot determine paternity on ultrasound, but as I stated, you know when you conceived - none of what they are telling you leads to any different conclusion.

Based on a due date of 11/12, right now you are exactly 31 2/7 weeks pregnant. Ultrasound is not accurate, and a discrepance of ANY measurement that is within a week of your current gestational age is less than the error in ultrasound - i.e. from what you are telling me, the ultrasound actually once again confirms the current due date and is normal.

Next, at 31 2/7 weeks, the baby weight about 3.31 lbs.

You had a fall and what sounds like a "placental abruption" which is bleeding from the placenta causing contractions and preterm labor. This is not uncommon in this scenario and it sounds like you have gotten good care and that the baby is doing okay. That being said, if you RIGHT NOW are having pain and pressure, you really need to call your OB. If you were breech on ultrasound, they need to schedule a followup scan to assess if the baby has flipped - at the latest at about 36 weeks.

I hope that this helps!
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Follow-up: Stopped birth control pills to have baby. Noticed bleeding. No the time of periods. What can this be? 24 hours later
Dr. Raichle,

Thank you for your reply. I have gotten everything checked out again and it seems that I just have an "irritable uterus."

I understand when you say that you are not going to entertain the idea of conception taking place from the XXXXXXX 18 encounter, however this has been a huge level of concern/stress for me throughout this pregnancy. Is there no way the baby is just smaller than normal/slower growing, thus causing the discrepancy? Or that my ultrasounds are all off? I know it doesn't make sense, and it is most likely my guilt plaguing my thoughts, but I just don't want to be caught off guard if it is possible that it is the other guys baby.

I just get nervous because I wasn't great at taking birth control pills, the bleeding was irregular (and I have read so much about implantation bleeding/bleeding during pregnancy) and I got strep shortly after this encounter - which I have heard is an early pregnancy symptom.

Is there ANY way XXXXXXX 18 could have contributed, or is it 100% invalid? 4 weeks just doesn't seem like that much. Is paternity testing necessary?

Just having contractions make me nervous.

Also I read where you said babies at 30/31 weeks are around 3.31 pounds. I understand that ultrasounds in the third try are inaccurate, therefore I shouldn't worry that my baby is measuring a little ahead (3lb 10 oz).

Sorry again for asking many of the same questions. I just get nervous.
Answered by Dr. Timothy Raichle 30 hours later
Brief Answer:
Thank you for the followup

Detailed Answer:
You have to trust the ultrasounds, especially the early scans that consistently agree with one another. This is well detailed in my original response. If there was a growth problem, it would have been seen as a trend over time, with the fetus slowly falling further and further away from where it is supposed to be based on the due date you were given.

Perhaps a paternity test would put your mind at ease. While I trust the ultrasound, this is actually the only 100% way you can put this to rest. This is best done after the baby is born.

But that being said, look at my original response. I reviewed every date you gave me and carefully calculated about when conception had to occur. Run this by your OB/GYN and see if they agree - I think that they will!

Given the error in ultrasound of about 10-15%, there is not difference between 3.3 and 3.625 lbs!

Again, good luck!!
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Follow-up: Stopped birth control pills to have baby. Noticed bleeding. No the time of periods. What can this be? 8 hours later
Thank you so much for taking time to explain everything to me in detail. I do trust your opinion and have also talked this over with my doctor and she has given me the same answer. I guess I just have trouble trusting things I can't see sometimes. I also read a lot on the internet alot which doesn't help.

2 more questions:
1. Do you think I should get a DNA test no matter what, or only for my peace of mind?
2. If I end up having the baby early, conception date does not change correct?

Again thank you for taking time out of your busy schedule to help me!

Answered by Dr. Timothy Raichle 3 hours later
Brief Answer:
Only for your peace of mind.

Detailed Answer:
You have two OB/GYN's who are telling you the SAME thing. The ultrasounds do not lie. You either need to trust our professional opinion, or get the paternity test. If in 10 years you are going to wonder who is the father, then you need to have the test done.

You can read things on the internet, but in general, you have no idea who wrote them. This interaction is legitimate - I am a Board-Certified OB/GYN. You can easily google me and confirm this. Your doctor is also likely Board-Certified. This is the same assessment that I would have provided to one of my own patients.

Finally, if you deliver preterm, it does NOT change the due date - you have already more ultrasounds than you needed that all confirm the same thing!

Good luck!!
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Follow-up: Stopped birth control pills to have baby. Noticed bleeding. No the time of periods. What can this be? 13 days later
Dr. Raichle,

I have another question. I am currently 33w, 4d pregnant. I got assessed yesterday since I have had issues with preterm labor. My cervix was dilated to a 1cm (hasn't changed since 30wks) and the baby is at station -2. I have noticed that she recently seems lower than before. This is my first baby. Is this bad? I just heard that babies don't drop until closer to the EDD & I still have 6+ weeks to go.

Also previously you stated that an abdominal ultrasound at 7 weeks is less accurate & you wouldn't trust it. I agree, but out of curiosity, what would be the range of accuracy for an abdominal ultrasound at 7 weeks (more that +/- a week?)? It just looks like a little blob in the picture ha!
Answered by Dr. Timothy Raichle 27 hours later
Brief Answer:
Happy to help!

Detailed Answer:
First, in women having their first kids, they tend to 'engage' in the pelvis earlier than in pregnancies where women have had kids before. So the idea that this child could 'engage' or drop into the pelvis is totally normal.

Second, given the evaluation yesterday that showed NO change in your cervix in almost a month, then it sounds like you have nothing to worry about in terms of an impending delivery. Also, once you reach 34 weeks, the efforts to stop labor are remarkably less that before 34 weeks, because the outcomes at 34 weeks and beyond are very good.

Finally, a VAGINAL scan at 7 weeks is very accurate. An ABDOMINAL scan at 7 weeks is not as accurate, and this also depends on your weight, position of the uterus, position of the fetus, and fullness of your bladder. I would say that the error of an abdominal scan at 7 weeks is +/- one week.

I hope that this helps!
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Follow-up: Stopped birth control pills to have baby. Noticed bleeding. No the time of periods. What can this be? 1 hour later
Ok thank you so much. This is my first baby. It just seems like she is very low, so it made me nervous. My doctor is taking me off Procardia & bed rest at 35 weeks. In your experience, do most women with PTL make it to term, or close, once stopping their meds, or is labor fairly quick after stopping. I was also encouraged that I had not dilated any further. Is station -2 mean she is engaged or does that just mean she has dropped lower in the pelvis? When they engage early is there still a chance of making it to term?

Thanks for clarifying about the abdominal ultrasound. I was very skinny prebaby and my bladder was semi full (probably where the variance of 6 days between ultrasound dates come in). OBGYNs that I have talked to say they would not trust an abdominal ultrasound at 7 weeks, which I understand, but I didn't know if this meant because it could be wrong by a week or multiple weeks. Just seems like it couldn't be too far off since it looked very small & not like a fetus at all. When do they start looking like a fetus on abdominal ultrasounds?

Sorry for all of the questions, I just get curious about all of this stuff!
Answered by Dr. Timothy Raichle 1 hour later
Brief Answer:
I hope that this helps..

Detailed Answer:
In all likelihood, given that you have made it this far without delivering, the chance that you will deliver soon after stopping the Procardia is very small. Most women delivery between 39-41 weeks, and this includes you. We make our best guesses when treating women that we think are at risk for delivering early, and looking backwards, it does not look like you are at great risk, because you simply have not delivered for an entire month since the worry about early delivery began! -2 position is just a description of where the head is in relation to bony landmarks within the pelvis. This position is 'un-engaged' and means nothing in terms of predicting when you will deliver.

With regard to the ultrasounds, I know that you are still questioning the timing of conception. I have clarified this extremely well in my prior answers. In general, before 10 weeks, it is easiest to look vaginally. After 10 weeks, it is just as easy to look abdominally (in a skinny patient).

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Follow-up: Stopped birth control pills to have baby. Noticed bleeding. No the time of periods. What can this be? 21 hours later
Thank you so much for calming my fears about delivering early. I want her to be as healthy as possible. We are unsure if she is still breech or not. She has been XXXXXXX breech since week 29. Is it possible for baby's to drop when they are breech? My doc thinks since she is lower that maybe she turned & the hard bump up top seems a little wide (according to her) to be a head, but I still mostly feel movements down low.

Also I have a question about ultrasounds. I know they are not accurate in the third trimester, but I am curious about the abdominal circumference measurement. I had an ultrasound at 26.6 weeks and the AC measured slightly small at 217.4mm the 24%, but at 30.3 weeks the AC measured a week & three days large at 272mm at 72%. It just concerns me that over 3 weeks the percentile jumped almost 50%! Is this a cause for concern, or possibly just a growth spurt. I have only gained about 3lbs since 26 weeks. Her head was also measuring large at 30w by a few days, but FL and BPD were measuring a few days behind. Thanks!
Answered by Dr. Timothy Raichle 5 hours later
Brief Answer:
See below...

Detailed Answer:
Yes, even breech babies can drop into the pelvis, but they are less likely to do so. But this is easily determined with an ultrasound.

These fetal measurements are all within the normal range. There can be error in the ultrasound, especially for the measurement of the AC which is the hardest to get accurately. I would consider that there is no significant difference between 24% and 72% as they are both well within the normal range. The estimated fetal weight %ile is what you should focus on, and this should be in the range of >10%ile or < 90%ile.

I hope that this helps!
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Follow-up: Stopped birth control pills to have baby. Noticed bleeding. No the time of periods. What can this be? 2 days later
Thank you for your detailed answers! Last questions:

I drank before finding out I was pregnant (not everyday, but a few times socially - twice heavily). I found out I was pregnant March 6. I believe the heavy times were the 2nd and 4th weeks of Feb.
I also had a sinus infection. Could these complications have harmed the fetus?

Also for the past few days I have been having diarrhea & feel "off" - hot & clammy. Not running a fever last I checked. Is this normal for 34+2 weeks?

Answered by Dr. Timothy Raichle 13 minutes later
Brief Answer:
Hello again...

Detailed Answer:
First, with regard to the drinking issue, please refer to one of my original answers:

1. Based on a due date of 11/12
2. You conceived around 2/19
3. 2/2 and 2/6 were BEFORE you conceived, so not an issue

Second, given the vague nature of your symptoms, I would go in to your OB to get checked out - these could be signs of labor or blood pressure problems. This is probably nothing to worry about, but in all cases of patients in our clinic calling with similar symptoms, they would be seen

I hope that this answers your questions.
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