Wednesday, August 15, 2012

Week 23: Less pressure is good pressure

THANK GOD FOR PERINATAL ASSOCIATES OF NORTHERN VIRGINIA!! I am so glad to be back in NOVA for the quality medical care these doctors provide that I cannot even begin to articulate how relieved I am.  No offense meant to the people in Vermont that want to go to Fletcher Allen, but sign me up for comprehensive, careful prenatal care for this and all future pregnancies please!

So, as it is probably obvious, I had my first prenatal appointment back in VA yesterday afternoon.  They ran a second level-II ultrasound to double check what results were found in VT and were able to confirm with greater clarity that the baby is in fact a girl and that she is healthy.  They looked at my blood sugar logs and used the word "impressive!" to describe my self-care - GO ME.  Unfortunately, amazing diabetes control aside, the doc confirmed that there are several complications on top of my insulin dependence that makes the remainder of this pregnancy risky:  elevated Alpha Fetoprotein (AFP) levels, a partial Placenta Previa and very high risk of preeclampsia.  Let me explain:

1)  Each fetus creates a protein called Alpha Fetoprotein that is present in the fetal serum and amniotic fluid.  As a standard test between weeks 14-22, docs check the level of AFP in the maternal bloodstream to ensure that it is within normal levels (no higher than 2.0). Simply by being diabetic, the range for normal levels of AFP are lower and therefore more sensitive (no higher than 1.9) than non-diabetics; my level is 3.25.  Fortunately this abnormal number is not directly correlated with my diabetes and there was nothing I could have done to prevent it, but unfortunately it does present issues that need to be addressed on top of my diabetic-pregnancy care.

So what does this mean?  Well the initial assumption with elevated AFP levels is the presence of neural tube defects (such as Spina Bifida), which we have thoroughly ruled out through the comprehensive level-II ultrasounds.  Great right? Heck yeah... but we don't know what is causing the elevation now and that creates concerns about the structure of the placenta.  I'll be going into the doctor's office every three weeks for the time being so that they can check fetal growth and if she isn't growing at the appropriate rate for her gestational age (which she currently is) that means she isn't getting enough nutrients through the placenta and we may need to deliver her early.

2) Well the doctors in Vermont were wrong - I am not previa free.  The great news is that my Placenta Previa is in fact a partial and does have a possibility of sorting itself out between now and delivery, however the doctors here in VA are unwilling to say that it "will" move because it is much lower and closer to the cervix than it ought to be.   There is nothing that I can do to fix it and ultimately it is a wait and see what happens situation, so all I can do is hope for the best and work on damage mitigation. Between now and delivery I need to do everything in my power to make sure that I am not making the situation worse: no heavy lifting (anything over 10 lbs; btw GW weighs 36 lbs now), no exercise and increasing amounts of rest.

Keep your fingers crossed for me that the placenta continues to move up and reduces complications with delivery!

3) The new concern as a result of my diabetes mixed with both the placenta previa and elevated AFP is a higher risk for preeclampsia.  Preeclampsia is pregnancy hypertension or elevated blood pressure that results in extremely dangerous situations for both mom and baby.  If I am actually diagnosed with preeclampsia I will likely need to deliver Baby early, but for the time being I am in pre-preeclampsia mode.  So while my blood pressure is currently fantastic (yesterday it was 105/62) it can go up almost instantaneously and whatever great number I had before wont matter.  Unfortunately there isn't anything I can do to ward off preeclampsia, but I can keep an eye out for the symptoms of it and be able to respond quickly if and when it does set in.



So... the long and short of it is that my diabetes is under tight control, but that does not affect the presence or treatment of the other complications.  Worst case scenario, each individual complication is solved by emergency, early delivery so any hopes I had to make it all the way to week 38 are pretty much shot.  I'm taking things one day and one week at a time right now and trying to keep my blood pressure and stress as far down as possible.  I anticipate with HB's ACL reconstruction surgery on Friday, GW's upgrade to a real bed (buh-bye crib!) and my anticipated insulin resistance that it'll be a difficult task to keep my anxiety down, but I'm doing everything I can and the certainty of that at least makes me feel better.

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