Friday, July 25, 2008

Well, it never is the thing you worry about, is it?

One. I mentioned the gash, no? Yes, I see I did. In that post, I mentioned that Neosporin was applied to the wound. It turns out I developed contact dermatitis (allergy) from the Neosporin. So, now I am using a Benadryl spray on the wound and topical anti-itch cream. I asked the ob what I could use on it, and he asked to see it. He actually asked if I had fallen into poison ivy on my way out of the garden. He has also forbidden from going in that garden the rest of this summer.

Two. After last summer's little visit with food poisoning at a street fair, I actually asked my husband whether he thought I was allowed to go to the Pierogi Festival. Fortunately, he agreed and now I am 10 pounds of lightly fried, filled dough heavier. And about 20 bucks lighter.

Three. I did have some concerns about the repeat c-section, but I had mostly come to terms with it. I had fantasies about getting to the hospital well-dilated and having them let me try. However, given some new information, I am completely comfortable with the c-section. At my ultrasound (wherein we stared but did not determine the sex), it was discovered that I have partial placenta previa. Julie Alittlepregnant covered placenta previa about 900x better than I ever could, so go learn what it is there. Now, that you're back, you can see that a c-section is probably a really good idea (also placental location makes it unlikely baby will turn out of its current breech position). Sure, the placenta can migrate, and often does, but I'm not a risky person and mine was identified after 20 weeks, so we'll hope it moves, but we'll have a plan in place in case it doesn't.

So, why did I get placenta previa? Well, I've thought a lot about it, and I have some risk factors: previous uterine surgery, previous pregnancy, poor endometrial vascularization, and age over 30. And I guess I'd rather it be me (with my obsessive need to know things) than someone who elected not to have an ultrasound and did not find out until it was too late.

Even when the cervix is not covered, but the placenta is just lying low, there is a real possibility of severe post-partum hemmorage requiring blood transfusion (because uterine contractions after birth close off the blood vessels to the uterus and contractions are not as effective on the bottom half of the uterus). So, my husband is on stand-by should that be necessary (probably won't be but our blood type is the same and he's a donor and we're in a blood shortage here, so I'm keeping him in reserve and eating iron-rich foods to prevent anemia if it comes to that). I have also told my husband that if things get bad enough and any choices need to be made, they can have my uterus. I seriously doubt it would come to that, but I think it's better for him to know that up front than to have to make that kind of decision himself in an emergent situation.

Julie says, "Aside from complications of prematurity, previa babies also seem to experience a higher incidence of growth restriction and congenital physical anomalies."

Because of poor placental placement, there can be compromised blood flow to the placenta, and hence the baby. Sometimes this means smaller babies than otherwise expected. Our baby is measuring over the 90th percentile (a week ahead or so). So, at this point, blood flow to the baby seems just fine. Fine fine fine. And being ahead on growth means that things would have to get pretty bad for us to wind up with IUGR.

As for the higher incidence of congenital physical anomalies, all I have to say is everything looks OK so far. And really, I am not terribly concerned about numbers of fingers and toes and cleft lips or palates. I worry about organs and brains and those are all doing well and accounted for.

So, what do I worry about? Prematurity. That's pretty much it. Once the cervix starts to soften and thin (which can start any time here although it has a long way to go), bleeding can occur. If it can't be stopped, the baby is delivered or you are placed on bed rest until lung maturity can be assured and then you are delivered. Or, you are delivered because it's safer for everyone to be out than in. That is my fear.

If the placenta does not migrate up, there is no way in the world I will be having a baby on November 24th as I predicted (foolishly). If the placenta continues to cover the exit, the c-section will be performed sooner rather than later. In a complication-free pregnancy, I was concerned about that and wanted the extra 2 or 3 weeks of development. In a placenta previa pregnancy, I will take a healthy, live baby at 37 weeks thankyouverymuch.

I will be monitored to note the progression of my placenta. In less than 4 weeks, I will be back on the ultrasound table finding out whether my placenta has migrated away from the exit. If it has, I will sigh a big sigh of relief and go about the next 10-13 weeks of my pregnancy a little lighter with a spring in my step. If it hasn't, I will stay on pelvic rest (what, I didn't mention that?) and probably have more frequent monitoring from there on out. If it stays previa, I will probably ask about the betamethasone steroid shots to prod along lung development.

Also, if I have any bleeding, spotting, staining, hint of blood at all, I am to report to the hospital. I forgot to ask whether I was supposed to go to the ER or L&D, so I guess that's what I'll ask the doctor's office when I call them on my way to the hospital should that need arise. In the general course of my life, I am never more than 2 or 3 miles from some hospital, so I am really not that worried. I will have the next ultrasound completed before our next vacation, so we can re-evaluate whether I still want to go once we know more.

Oh, and I have not been put on any kind of light duty restriction at all (other than the aforementioned pelvic rest) so I guess I can continue cutting the grass and vaccuuming. Or something.

Well, writing down my plan and reassuring both of you (how many of you are reading this?) has actually made me feel better. Woo. Who knew?

So, to recap, I was worried about the VBAC and the progesterone supplementation when I should have been worried about the Placenta Previa.

And in secondary recap: When diagnosed prior to delivery, most mothers and babies are just fine. Fine. Maybe a little early, maybe a little small, and certainly justifiably a little freaked out, but FINE. FINE. And did I mention fine.

1 comment:

  1. Oh, I can tell I'm going to love this blog... The dishes can wait, right?

    (Insert waft of day-old eggs)

    Thanks for your kind - and hilarious - words on Moxie's blog. Made my day!