Friday, April 11, 2008

The good; The bad; and the Ugly

My OB appointment update.....

The good: My OB is not concerned with my cervical length. She doesn't get concerned until it gets below 2.5. And, I have been at 3.7 vaginally with the Peri and was 4 yesterday abdominally. She confirmed that the length equates to effacement which is measured by percent when done manually and with numbers (cm?) when done via u/s. So, 100% effaced would be equal to 0 measurement, meaning ready to deliver. She thinks Dr. D, the peri, is just being safe...rather than sorry. She felt the blood clot on the cervix would not put pressure on the cervix and cause it to efface, rather it would more act like a plug (which I have actually found to be true and have thought the same thing).

The bad: My peri is conservative. Good, thorough, but cautious. My OB said she often argues with him on many things* and that he doesn't get how life altering and stressful some of his decision can be, like putting someone on weekly cervix checks or hospital admittance. However, what the peri says goes. As my OB said, she has referred me out for his expert opinion to help her monitor the pregnancy and she can't very well disregard his advice...because what if she did and then something bad happened. I get it. I really do. I guess cautious and conservative are probably good in the long run. She also confirmed that it is too late for a cerclage. At this point, it would be considered an emergency cerclage which hasn't been proven to be effective and at this point would be more problematic than beneficial (mostly because the cervic is much softer now and not as adaptable to a stich or two)

The ugly: The only bed rest I will have for this pregnancy is of the hospital variety. Do not pass go. Do not detour. I'm still pretty freaked out by that possibility, but at least I now have the formation of a plan should that occur. Not finalized, nothing confirmed, haven't had the needed conversations, but at least I have a plan in my mind that could work. My OB, bless her heart, said that if I got slapped in the hospital**, she would ensure I saw my son and even offered to have him come stay at her place which is walking distance to the hospital (my nanny won't mind, Max would fit nicely in between the baby who is 1.5 and the toddler who is 3.5, and one more kid won't matter much. :). I told her if push comes to shove she may regret that offer. She agreed that she would not put me in until at least 24 weeks and would be even willing to go to 26 weeks (because really, there isn't much point) and that she is hopeful that it won't come down to that. There are several reasons for hospital bed rest instead of at home, mostly being the drugs they use (like trabutaline) have side affects that need to be monitored because of the affects.

The plan: If my cervix starts to shorten more, she is going to put me on progesterone therapy. While it hasn't been proven to help with multiples, she felt the sample size for that is small. And, it can't hurt, may help, and heck, it's only progesterone which is an old friend of mine. Probably it would help the sleep thing. Other than the shot itself and the sore bum, I actually am quite fond of progesterone. Starting at 24 weeks I'll start visits every two weeks with her and in addition to a cervix check, I'll also get "swabbed" (forget what it is called) to measure the likelihood of delivery in the next two weeks. Additionally, she's going to start me on a round of steroids, just as a precaution, to help speed up lung development in case things go south fast. And, here I am as I type this, sitting in the lab for a 1 hour glucose tolerance test. If I pass, I still have to do it again later in the pregnancy (assuming I get that far) and if I fail, well, straight to the 3 hour one. It was all I could do to not barf up the liquid, but I didn't...although I did gag a few times. I few sips of water would have helped a bit, but alas, that is against the rules.

* My OB is the wife of my much beloved RE who was tragically killed in a car accident late 2006 leaving her the single mom of 4 young children including one who was born just a few days after he died. There is a picture we both cherish of her, me, Dr. N, and Max in the hospital after Max was born. As she said, that's what it's all about. Dr. N helping women get pregnant and Dr. P helping to deliver them...creating families. I wouldn't go so far as to say Dr. P and I are friends in a social sense, although we could be if the situation was different (like I didn't live about an hour away and we both didn't have work and small children and life that keeps us busy), but we do have a special bond. A bond much more that a typical patient/doc relationship.

** The hospital is probably only 35 or so miles from my house, but in LA traffic you need to estimate 40 - 60 minutes of travel time each way. I chose it when planning my delivery for Max because it has very high success ratings for both preterm and full term deliveries as well as vaginal vs. cesarean deliveries. It has the highest NICU rating around. And, while you need to take 2 - 3 freeways to get there, there are two different routes that can easily be used. I would have to go into Los Angeles for other hospitals with as high a NICU and almost equal ratings, but there is really only one route I can easily take and that is fraught with traffic and problems at the best of times and at high traffic times...forget it. Anyway, the hospital isn't just around the corner and Max's nanny won' t drive on freeways, not to mention who would watch him at night and on weekends. It has been on my mind and I've been worrying about it a bit since I went to the weekly cervix checks. Hopefully, I won't ever need to execute it, but this is too important to leave to chance and last minute. I need a good solid plan in place. I've got about a month to get it figured out.

Note: Written first thing this morning while doing the 1 hour glucose tolerance test, but with no time to post until now. BTW, will be surprised if I didn't pass the glucose test. I failed the first time (with Max and knew it because I felt so awful) and passed the 3 hour with him. And, it gave me a little bit of headache, but didn't feel really bad like I did the time I failed.

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