Tuesday, February 14, 2012

12 Weeks

Wow, where to start?!?! All I can say is thank God that I had the very first appointment of the day as I was at my doctor's office for almost six hours!! Our morning started out with a meeting with the genetic counselor that took just over an hour. She went over the previous karyotyping that my husband and I had done and how it was perfect. She then went over Down's Syndrome, Trisomy 13 and 18, and other risk factors once she took a detailed history of our families. Based on my family's history, it was decided that one extra screening would be done and that was to look for a gene for a muscular atrophy disorder. Other than that, we either didn't need or already had most of the testing. Based on my age at delivery, my risk for Down's was 1:769 and my risk for other chromosomal disorders was 1:323. She then went over our options for screening and we ruled out invasive testing right away, unless of course it was warranted by our initial results. We opted for a screening that has over 90% accuracy and this combines the NT measurement, blood work from today, and then blood work done between 15 and 17 weeks. The only results that we will get before the end of the three parts is if the initial results come back higher than 1:300. Therefore, if our risk is less than that, we will not get an actual number until after the second set of blood work which is scheduled to be drawn when I am 15+3.

The next part of our appointment was the actual scan. We had to wait again in the waiting room so I had enough time to make myself sick with worry over this. I actually completely lost it last night as I just can't imagine, after all that I have been through, a positive outcome. The tech finally called our name and we were brought back. As soon as the tech put the probe on my belly I could see how active the baby was. Every time the tech tried getting a still image so she could take a measurement, the baby would either turn upside down and stand on its head or it would do a complete somersault. Finally another tech came into help as we really weren't getting anywhere. We eventually got the CRL and the baby was measuring exactly 12 weeks so we are no longer measuring behind!! Then they got a rate on the heart (after like 100 tries as the baby hates that ) and it was 170. Then the tech started focusing in on the neck. I could feel my entire body tense up as I just wanted this part to be over. After three measurements she looked at me and said "wow, that is really good, your NT measurement is only 1.4cm". I was ecstatic! She also confirmed the presence of a nasal bone. At this point the MFM, Dr. S, came in and switched over to a vaginal ultrasound as she needed to get a good look at my cervix. The average reading that they were getting was 3.1cm which isn't spectacular, but it was acceptable. We also noted that. my cervix is completely deformed as it is bent into two different sections. She also said that there was still a tiny bit of my uterine septum left but the baby IS NOT attached to it in any way. She also looked in detail at the baby and was able to tell me that the arms and legs all appear to be normal in length and size and she also took some detailed images of the brain and was able to confirm that our baby does not have anencephaly.What a relief that was! One less thing that I need to worry about.

After this we went back and I had my blood work drawn and then was brought into the consultation room for my appointment with the Chief of Maternal Fetal Medicine. Dr. K came in shortly after we sat down and I could immediately tell that he meant business. We went over each diagnosis and medication in full detail that I had listed on my intake sheet. This is what I learned:
  1. My asthma (which is considered severe) is getting worse with pregnancy. He said that my lack of stomach muscles could actually work in my favor once we hit the 3rd trimester as it is likely that everything will be pushed outward instead of up and into my lungs. He said that I am at slightly higher risk for Pre-E (based on my asthma) and that I need to be closely monitored as breathing is rather important (duh!). He is having me followed by a pulmonologist at the medical center.
  2. I am at very high risk for Pre-E based on my current blood pressures. Naturally in early pregnancy, your blood pressure elevates and then returns to normal by 12 weeks. Apparently 5-10% of all women do not return to their pre-pregnancy blood pressure and I am one of them. My BP has been running 130-135/80-85 and he said that this is concerning given that I am so early in the pregnancy. He is going to check me next time and if it is still high, he will start me on a blood pressure medication but he warned me that it could make my asthma worse. For now I have to monitor it at home and call if it is >140/90.
  3. I also have a history of Inappropriate Sinus Tachycardia where my resting heart rate ranges between 90-110 and with activity it shoots up into the 180's. I told him that this is a benign condition and that I have my annual cardiology appointment at the end of March but he was still concerned. Since my heart rate elevates with activity and pregnancy naturally elevates it as well, he said that any strenuous activities are out of the question.
  4. He is also concerned about my diagnosis of Common Variable Immunodeficiency and the frequency and severity of the infections that I get. Given that I work in healthcare, he said that we need to be extra vigilant and I need to limit my exposure to illness. He said that he isn't thrilled that we discontinued my IvIg transfusions and thinks that maybe it is a good idea that we restart them. I am seeing an Immunologist that specializes in this a week from Friday as Dr. K feels that an expert would be better equipped to deal with this.
  5. And now for the bad news. Apparently I was somewhat confused regarding the treatment I received for my cervical cancer as I always thought that I had both a LEEP and a cervical conization. He in formed me that there was no way that I had both and it is likely that I only had a LEEP as a conization is actually the cutting away of the cervix. In fact, he said a LEEP procedure would not pose enough of a risk to risk doing a cerclage so that actually made me a bit happy. Since we were both unsure of which procedure I actually had, he decided to do an exam as he wanted to see so we knew what our options were for incompetent cervix and cerclage placement. He was absolutely stunned when he discovered that a very large portion of my cervix was cut away due to the cancer. He told me it was so severe that I am not even a candidate for a vaginal cerclage as I don't have enough of a cervix. I immediately started crying my eyes out. He said my only option is an abdominal cerclage and he is not a fan of doing them while pregnant as it is major surgery and it would put the entire pregnancy at risk. He said that this is something that should have been done prior to pregnancy. He said that our only option at this point is a pessary which would help my cervix support the weight of the baby as it grows. One positive thing is that he said that my deformed cervix (the bend in it) is actually going to work to my benefit as the pressure of the baby will not be directly on the opening as most of the weight will be on the side of the cervix given how it is positioned. My cervix was also nice and hard and completely closed so that was good. He said that the 16 week mark is where we start getting into the danger zone with my cervix so he is going to monitor me very closely. At this point my cervix is good as the length is acceptable despite the thickness being sub par, but we need to stay on top of it. He is bringing me back in 3 weeks (15+3) for a cervical check and a recheck with him. 
I have been officially released from OB and will be followed by MFM from hear on out. Dr. K said that I need to mentally prepare myself for coming out of work early. I always figured that it could possibly happen around 24-28 weeks but he said that it could be as early as 16 weeks if things look at risk with my cervix at my next visit. I was absolutely floored. I am praying that doesn't happen but at this point, after all that I have been through, I will do whatever I have to. I have a great job with a great company so I am sure that everything will turn out okay.


    1. All and all that was a pretty fantastic appointment. Yay for 12 weeks!

    2. I have been a lurker on your blog for awhile and finally thought it was important to post something regarding your recent doctors visit. I personally had a transbdominal cerclage placed while pregnant. It is a major surgery but honestly not nearly as bad as most doctors unfamiliar with it make it sound. If I were you I would contact a specialist to speak to them about your situation just for peace of mind.

      I know they typically like to do this surgery during the 1st trimester but have done them later. I went to see Dr. Haney at the Univ. of Chicago but Dr. Davis is also highly regarded and is in the Philly/NJ area I believe. I honestly would try to speak to one of them soon and get their opinion on what to do. Dr. Haney was excellent and I had a successful pregnancy as a result. My previous pregnancy unfortunately did not have a happy ending and like you, I also have to go the route of IUI/IVF so it was even more devastating so please think about it. Dr. Haney can be reached by email at ahaney@babies.bsd.uchicago.edu and he will respond usually within a few hours, he's that good!

    3. Krystyn, Congratulations on reaching such a beautiful milestone! Happy 12 weeks! :)
      So glad your appointment brought much to be thankful for!
      Thoughts and prayers! xo