The Overdue Update – Good News and Not-So-Good News

Wednesday’s appointment with the Maternal Fetal Medicine specialist (aka Perinatologist) was long. Three hours at the hospital long.

An hour of that involved a very detailed Level II Ultrasound. Just over half an hour involved speaking with the MFM and an OB Resident completing her residency in MFM. They were both very helpful, calm, pleasant and kind. Two thumbs up there. Let’s call them Laverne and Shirley.

Laverne and Shirley confirmed and advised us that:

1. Azulito/a does not have an open neural tube defect including Spina Bifida or anencephaly. That is the unabashedly excellent news.

2. I have several large lakes (pools of blood and/or clots) in this baby’s placenta (as I did with the Miracle Toddler’s placenta). This when combined with (a) a high level of alpha-fetoprotein (AFP) at ~16 weeks as I had (yielding the positive maternal serum screen result for Spina Bifida) and (b) high inflammatory cytokine (including NK) levels as I have had in the testing done during this pregnancy through Dr. Braverman’s office put me at risk of placenta accreta or placenta percreta though the latter is much more rare.

3. I am at increased risk of baby developing intrauterine growth restriction (IUGR) and preeclampsia as a result of the problems evident with my placenta. This warrants further monitoring as the second trimester draws closer to an end and I approach the third. This was the same advice Dr. Braverman gave me and my family doctor blew off.

4. Placenta previa diagnosis is confirmed and that also needs to be monitored. There shall be no further intercourse. If I see so much as a hint of blood I am to go to emergency immediately. I am to refuse all internal exams and advise I’ve been diagnosed with placenta previa. This sounds very dramatic but truthfully it is the least of my worries at this moment. It could resolve itself although Laverne and Shirley noted that the placenta has not moved in the past 3 weeks despite notable growth in the size of my uterus. This goes on the wait-and-see list for me, without any fanfare to speak of.

Both placenta accreta and percreta are serious. They basically involve the placenta invading either the uterus or surrounding organs. Not good may be understating it. When not diagnosed and treated this has led women to bleed to death during childbirth. Thankfully I will be monitored every 3-4 weeks if no further complications are detected (more often if so) starting at 25 weeks. My next MFM clinic ultrasound is March 19, 2015. Amen for that.

Dr. Braverman said the placental lakes indicate poor vascularization. Of course he had forecast this being certain to develop if untreated due to my various genetic and inflammatory immune issues. The fact that we are seeing this despite aggressive treatment is disappointing but in his view not surprising and consistent with my blood test results of the past few months. While I wish I had fallen on the lucky side of that line I am deeply grateful that my immune issues and I are finally being taken seriously here at home (by everyone but my family doctor so far it seems). I am so relieved not to have to keep fighting my family doctor’s skepticism and endless challenges or push-back to the risks Dr. Braverman has identified.

I will end this here on that note of gratitude and add to it my deep and enduring appreciation for all of the love, support and kindness you have shown me and Azulito/a on this journey. From the bottom of my heart: Thank you, friends.

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18 thoughts on “The Overdue Update – Good News and Not-So-Good News

  1. I was also at risk for placenta accreta and did enough reading up on it to scare the bejeezus out of me. I hope that it does not end up being the case with you – but at least they will be prepared for it if it does become an issue. I am hoping and praying and cheering for you. Hugs

    • I knew the risks and complications with accreta and percreta going into this appt from past life doing med-mal defence. Never knew lakes were correlated with the risk (more so with high AFP not attributable to ONTD). I am scared but trying to take it one day at a time and I definitely take much comfort in knowing I no longer have to beg to be monitored. Thank you for the hope, hugs and prayers. I can’t tell you how much I appreciate all three. Good thing these babies of ours are steadfast on their missions to come home to our arms. Thinking of you.

  2. I’m happy to hear you got some good news and that finally the doctors are listening to you. I’m sorry to hear that their is still obstacles for you and baby. Sending prayers to you and baby.

  3. What a road this has been for you. So very glad you are being monitored. Will be thinking of you both and hope the next few months go by so fast until your little one is here safely.

  4. Sounds like the MFM people are on the ball. I had a similar experience during my pregnancy – I had complications involving the cord/placenta which my regular ob kinda washed over. It was such a relief when I finally got to see the high risk ob at the hospital and she took it very seriously. I wonder sometimes if some doctors think they shouldn’t be totally straight with a delicate pregnant woman?… I mean for me if I even get a whiff of that it makes me way more nervous. Coming from the fertility world, you expect all the complicated and unpleasant facts. Not sure if that’s your family doctor’s deal, it sounds more like they’re just out of their depth.

  5. So glad and relieved for you to read there is no NTD, and that the MFM appointment went better than some of the others. I don’t know much about the placenta issues but I am hoping that the placenta previa resolves itself for you. And it’s so good that you are being taken seriously and they are monitoring you. I hope that gives you a sense of peace that at least they are “on your side” now, so to speak. It all seems so scary and you are so strong. Hugs.

  6. I have to admit I had never heard of some of the issues you spoke of. I am so sorry girl but it sounds like you and your doctors are on top of things. And girl…I admire your strength! You and baby are sub fighters and I am inspired by you! Xo

  7. Thank goodness Azulito/a does not have NTD. What a relief that must be. I’m sorry to hear about the placental issues and blood pooling. I’m glad that you have Dr. B and your specialist for support and keeping a close eye on it. On the bright side, if you had something similar during your pregnancy with Miracle Toddler, perhaps everything will go alright in the end. I certainly hope things resolve, my friend. Thanks for your update.

  8. I’m thrilled Spina Bifida and anencephaly were taken off the table – what a relief!! Sending you love, and wishing you peace as you wait out a few pretty big items! As you know, I’m here if you need anything!

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