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.