Friday, May 11, 2012

MFM Follow-Up

(24 Weeks 2 Days)

I thought that I would start this post off with a picture. Since I had to get dressed for a doctors appointment yesterday, I thought it would be a good time to take a belly shot. I have to say that I am liking this growing belly as it really minimizes how large the rest of me really is. 

Anyway....

I went for my follow up appointment yesterday with my MFM. I wasn't really too anxious about this appointment as I knew that I could not control the outcome, and if my cervix shortened again and was put back in the hospital, there was nothing I could do. When we arrived at the office there was a sign posted that the ultrasound department was running 60 minutes behind. Due to this, I ended up having my MFM appointment before my ultrasound. It was pretty uneventful. They had to put in a larger pessary as the weight of the baby was too much for the one that I had in. We talked about getting the steroid shots, switching over to Heparin and delivery. It was decided that we are going to hold off on the steroid shots to the very last minute. Since you can only get them twice, and they are only good for a short amount of time, I would rather save them for when they are extremely necessary. It is still up in the air when I will be switched to Heparin. Being on the Lovenox and being at high risk for preterm labor and needing a c-section, puts me at risk of needing general anesthesia for delivery. The half-life of Lovenox is pretty long, so this means that if I go into sudden labor shortly after taking my Lovenox, I wouldn't be able to get an epidural for 12-48 hours (depending on my labs). Since obviously a c-section requires an epidural, general anesthesia would have to be used which would mean that I would miss the birth of my baby and so would my husband as they would not allow him in the OR if I was completely under. Heparin has a much shorter half-life (6 hours I think) so this would be a better option. The trick of all this is trying to figure out when to switch me. Do we base it on my cervix? Do we base it on my high risk for preterm labor? Unfortunately no one can tell me what the right thing to do is. If I make it to 32 weeks I will switch at that point for sure, but what about before than? Heparin carries a much greater risk for hemorrhage than Lovenox, so putting me on it prematurely could be harmful.    

Finally, after 90 minutes from my original appointment, I got called back for my ultrasound. The baby looked great as usual and had a heart rate of 156bpm. The baby was butt up so again we were not able to get a good view of the face. The head was down, resting on my cervix, and the feet were up about two inches above and to the right of my bellybutton. After verifying that the baby was still perfect, the MFM came in to check my cervix. I immediately noticed that it looked much different. I said to the MFM "why can't I see the funneling" and he responded "because I really can't see any either". Not only did the funneling almost disappear but the shortest measurement that they got was 2.8cm when just over a week ago it was measuring 1cm. The MFM said that the cervix is very dynamic so even though we got a great reading now, in an hour I could come back and it could be down under 2cm. He said that this measurement was really reassuring though as it showed us that my cervix is fluctuating up, rather than down. I was extremely happy with this and felt very relieved. Hopefully next week's appointment will be just as good!

5 comments:

  1. So glad you got good news today. Good luck with the decisions about when to do sterriods and when to switch to heparin.

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  2. You look beautiful. Great news to hear that things are looking up.

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  3. Both Lovenox and Heparin are very effective blood thinners, and if your medical doctor prescribed you on them both it must be essential, it's all depending on what kind of clotting disorder you have. Lovenox price range

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