Friday, August 15, 2014

Previa Update

In preparation for our appointment with the Maternal-Fetal Specialist, I scoured the internet to come up with a list of questions for the doctor. Here's what I found:

-Is the previa centralized over the cervix?
-Is the previa anterior (on the front of the uterus) or posterior (at the back)?
-How far away from or over the os is the previa (the os is the opening to the cervix)
-How many cm from the os does the placenta need to be for a vaginal delivery?
-How likely is it that the placenta will move?
-What are the activity restrictions?
-How much weight can be lifted?
-How much housework can be done? Walking?
-Is the cervical length greater than 30 mm (my research told me that chances of hemorrhaging and emergency c-section increases when cervical length is less than 30mm)

As usual, the tech wouldn't give us too much information but when I asked if she could at least tell us if the previa was centralized over the uterus,  she said "It looks like it moved". Really?!? Awesome!  She didn't tell us how far it had moved but we were super-excited to hear that it had already started movin' on up.  I put a  "No!" next to my first question.  We asked her how long the cervix was and she told us 34mm.  Awesome!  I wrote that next to my last question.   We got to spend a lot of time just watching Baby O wiggle away while she took some measurements and then waited for the doctor to come in.

When the doctor arrived, he began asking questions about Ellen's age and the age of the egg (I was 40 at the time of retrieval) and then said that normally when a mother is 40 he likes to see her weekly during the third trimester.  Although Ellen isn't 40 yet (she'll be 37 in October) he said he would like to err on the side of caution and treat her as if.  That's my kind of doctor! Initially,  he said he would plan on seeing us again in 4 weeks.  As he kept looking, he mentioned that Baby O is measuring a bit small (in the sixth percentile) so he wanted to just keep an eye on him.  He said he would follow his progress and if still appeared small towards the end of the pregnancy, we would just take him a week or two early. This seemed counter-intuitive to me at first as it seems like he should cook as long as he can if he is small, but it appears that if a baby is no longer growing and getting the nourishment he needs inside the uterus, it makes more sense to take him earlier where he can be nourished outside.   After looking at our tiny Baby O, he decided he wanted to see us a week earlier and said we should come back in three weeks.

He continued the ultrasound without any mention of the placenta and I finally asked, "What about the previa?".   To our shock and amazement,  he said "Previa's gone".  What?!?  Gone, gone??? Yes. GONE.  He said if anything it was low-lying. We couldn't believe it.  When the tech said it had moved, I thought she meant maybe it had started moving out of the way and was beginning to move in the right direction. But to hear the doctor say it was gone?!? I was floored.  We asked if this is typical to see complete placenta previa resolve in two and a half weeks.  He told us he hadn't done the first ultrasound so couldn't verify it was complete, but that while previa does move, it is rare to see it move so quickly. BABY O IS SUCH A GOOD LISTENER!!!!

While we are super-relieved, we aren't able to exhale just yet.  As the doctor continued with his ultrasound he noticed an abnormality near Ellen's cervix.   He said there appeared to be a "v" shape near the cervix.  Ellen asked if this was funneling and the doctor said he didn't think so.  (meanwhile, I'm wondering what funneling is!). The doctor said he didn't think the "v" was coming from the cervix, but if it was it could be indicative of the cervix prematurely opening (hence the funnel shape).  He mentioned that it was too late to do a stich, but that it could be treated with progesterone.  He also used the term "incompetent cervix".  While I wasn't familiar with the term funneling, I had heard of the term incompetent cervix (it certainly sounds ominous!) and was aware of the term "stitch".  A stitch refers  to a cervical cerclage, which is basically a suture to sew the cervix shut to prevent premature labor. My research later told me that this is usually done during weeks 12-14 of a pregnancy- so at nearly 23 weeks we were definitely too late.  This of course, was all only hypothetical.  The doctor really didn't seem to think that we needed to be concerned, but because he is my new favorite doctor, he decided to move up our follow-up visit.  Now, instead of the four weeks he originally stated, and then the three weeks, he decided it was best to see us in two weeks. This is fine by me!

I'm going to treat the next two weeks differently than I did the last two and choose to not stress about this.  The doctor didn't really seem overly-concerned, the cervix is still nice and long, and he is on top of things.  The good news is- its an excuse for us to get another peek at Baby O.   Hopefully next time we see him he'll be growing bigger and that "v" will be gone just like the previa is!

Baby O- 22w5d

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