Thursday, July 26, 2007


Dr. Favorite just called. I feel much better. She's just so calming. She talks me off my ledges without patronizing me, belittling my fears, or smoothing over risks.

Main points:

1. The uterus was about the size of a fist when they saw the previa. There aren't many places for it to sit down that *don't* threaten to or cover the cervical os.

2. The bulk of it is posterior, which means they were looking around/through all sorts of stuff when trying to see it clearly. They're looking for shadows, basically. It's possible that things are better than they thought.

3. She may have hinted that the perinatology group can be a bit, well, alarmist.

4. She thinks there's a reasonable chance it could still migrate.

5. Even if it doesn't, it doesn't really change our plans for managing the risks for this pregnancy, but adds in a c-section at 36 weeks after an amnio to check for lung maturity. Note: 36 weeks falls on December 23rd. Merry Christmas.

Then we discussed the plans for managing my old nemesis, preterm labor with a cervix that doesn't stay shut. She seemed surprised that the perinatologists don't want to put in a cerclage. I explained that they weren't convinced I really have an incompetent cervix and she practically snorted. I get the feeling her money is on a progressively shortening cervix over the next month or two followed by a cerclage. Place your bets now.

In other news, I am done with my grading. Lab reports: graded. Final exams: graded. Raw numbers input into spreadsheet: check. All I need to do now is set my curve, assign letter grades, and submit them to admissions and records. And then, I am DONE with the summer session. Hooray!! We leave on Tuesday for 2 weeks at my parents' house. H and I are hoping to leave D with my mom and sneak off for a couple days at a B&B here. Wonderful.

Wednesday, July 25, 2007


I think I got a little spoiled at the RE's office. They were professional and competent. People answered the phones, transferred you to the appropriate staffer if they couldn’t answer your question, and even (gasp!) called when they said they would. Even better, the person who called was often armed with exactly the information I wanted to know.

It was glorious.

Now, of course, we're back with our old OB/Gyn practice, with occasional forays down the street to the perinatology group. So far I've been in to the OB office once and then went to the perinatology group for the nuchal scan that turned up the placenta previa. Our next appointment with our OBs is on Monday.

So, there I was, minding my own business, when a referral to the perinatology office dropped into my mailbox. I got it yesterday. It was dated last Friday, and says that Dr. Favorite at my OB office is referring me to the perinatology office for a “consultation and scan.”

I applied a little mental energy to the situation and concluded that Dr. Favorite must have seen a report on the unusual placenta from the perinatology office, read it, and said “Oh no! Poor May and H! Let’s get them some more information from the high-risk experts on how this will likely affect this pregnancy!” She then put in for a referral for us to go back to the peris, look and see what the placenta has been up to, and talk it over with one of the perinatologists. Makes sense, right? This is one of the reasons I have been reluctant to insist that our care be transferred entirely over to the perinatology group. Dr. Favorite is always looking out for me, and never hesitates to send us over to the perinatologists if she feels they can handle something better than she can, but overall we get a level of care at the OB office that I’m not sure we could duplicate anywhere else.

So, I called and left a message for Dr. Favorite’s assistant, saying I had received the referral, and that I was assuming it had something to do with our new placental issues, and was there a particular week of the pregnancy in which she’d like me to go see the perinatologists?

Dr. Favorite’s assistant called me back and said that she had the results of our scan and not to worry, they were all normal.

(Um, excuse me, but WTF?)

I explained the situation to the assistant and she paused, and said she’d talk to Dr. Favorite and let me know. This all happened yesterday.

This morning I discovered a message on my cell from Dr. Favorite (whom I have not yet seen or spoken to in person this pregnancy) saying congratulations on the pregnancy and that she had my first trimester screen results, which were normal. If I wanted the exact numbers I could call her; she’d be in today until noon and all day tomorrow.

So, I called back and tried to get her personal voicemail. No luck. I was transferred back to her assistant’s voicemail, where I left another message saying I had gotten Dr. Favorite’s message this morning, but there still appears to be some confusion. I've had the results of the first trimester screen for a while now. Do they want me to go back and see the perinatologists again regarding the placenta? If not, why did I just get this referral? Have they even received a copy of a report on the scan in which we discovered its strange and unusual characteristics? What’s going on here, people?

And now I’m waiting for a return call. And grading another enormous pile of lab reports. Ugh.

As H says, "Our health care system in action." Sigh.

Saturday, July 21, 2007


I read it. I'm done. It took me most of the day. I can now lift my self-imposed media blackout so that I didn't inadvertently discover how it ends.

Wow. It's all over. Sniff. H read me the last one aloud when I was in the hospital, pregnant with D. It's the end of en era.

Off to bed. Feel free to send me an owl if you want to discuss the book.

Friday, July 20, 2007

Nuchal Results are Back

And they look nice. My particular favorite is the mere 1 in 10,000 chance that this baby has trisomy 13 or 18. The Down's risk wasn't nearly that low but was still "in range," or screen negative.


I'm watching my friend's son today (he's 15 months) in addition to D. Two kids. Wow. A taste of the future, one would hope! I'm starting to show a bit. It's easier to hide a pregnancy longer when you never really got out of the maternity clothes from the last one. I think my students are starting to suspect. We did a lab last night in which they do urinalysis on urine samples that they provide. There were many inappropriate jokes, but one student made a big production to me about how, if we wanted to, we could see who in the room was pregnant right now. I was tempted, but I kept my mouth shut. I haven't told any of the other faculty yet except the department chair, who needs to know in case things go south and he needs to find a replacement for my fall classes. I'm seeing a few of the other faculty next week, though, so I may have to let the cat out of the bag at work at last. One of them was the department chair 2 years ago when I called her one day and said, um, I can't give the two exams I'm supposed to give tonight, and by the way, I'm in the hospital and won't be finishing the semester.

That was fun. Let's hope that doesn't happen again anytime soon, shall we?

Wednesday, July 18, 2007

Placenta Update

OK, so here's how last Thursday went down.

Nuchal translucency scan: too early to be completely sure, but the word in the ultrasound room seemed to be that the results would probably be fine regarding our risk of a chromosomal trisomy like Down's Syndrome and the like. Full report in 5-10 days after they get the blood work done, etc. And, much to my surprise, it was a transabdominal scan. I got to keep my shorts on. Very civilized.

The fetus is starting to measure rather large for its gestational age. I am concerned that gestational diabetes is looming. This is a minor concern at this point, because of the real "uh oh" moment. The ultrasound technician was very bright and cheerful as she completed her photographs and measurements and said she'd be gone for a few minutes and then the doctor would be coming in.

Doctor? Coming in? My blood pressure shot through the roof. Doctors being fetched during routine ultrasounds has never worked out well for me, and Thursday was no exception. She returned alone, however, and said the doctor wanted her to do a transvaginal ultrasound to see if she could get a better view of the placenta, which looked weird. She still was having issues clearly seeing what she was looking for, so in came another staffer, who then went off to grab the doctor out of a room where he was currently WITH ANOTHER PATIENT. Up went the blood pressure another notch.

Well, to summarize the next few minutes, the placenta looks funky. It's definitely covering the opening to the cervix. This is called placenta previa, and it can be very bad. However, when diagnosed early in pregnancy, it quite often resolves over time as the uterus expands and drags the placenta upwards, away from the baby's potential exit to the world. This would be good. But, this being one of my pregnancies, it isn't that simple. The placenta isn't in one large mass as it should be. A lot of it is on the posterior side (this is good, between my uterus and my backbone) but there appears to be an extra extension crossing the cervical opening and setting up shop for itself on the anterior side. No idea if that will affect the possibility that the placenta may migrate away from the cervix over time. Here's something on wonky placentas.

Interestingly enough, some of the complications during my pregnancy with D were eventually revealed to involve an extra lobe to THAT placenta, which (1) may have been sent out after part of the original placenta peeled away from the inside of the sac after there was a bleed in there (this is called a subchorionic hematoma), and (2) this extra bit of placenta was so deeply dug into the wall of the uterus that it wasn't delivered with the rest of the placenta, and indeed lingered there malevolently until I started hemorrhaging uncontrollably 5 weeks after D was born, and wound up in an ambulance and then had emergency surgery. Placentas that are too deeply attached are called placenta accretia. Also of note: a major risk factor for placenta accretia is placenta previa. Fabulous.

So, best case scenario: this spontaneously resolves itself over the next few months and causes no more trouble than the state of panic that can currently be found in the Problem Uterus Household.

Middling scenario: the placenta previa remains where it is, but my cervix behaves itself until 36 or 37 weeks, thus not causing any vaginal bleeding or loss of blood supply to the baby, which is born via uneventful planned C-section 3 to 4 weeks before my due date. Merry Christmas, everyone.

Other scenarios, of which I am considerably less fond, include:

(a) cervix begins effacing and dilating early, causing attached placenta to pull away in places, causing vaginal bleeding, panic, and likely hospitalization, tocolytic drug therapy, and bed rest. I'm guessing the likelihood of this scenario increases when one considers my history of preterm labor. It this is the case, let's hope it starts as late as possible. They would hold off delivery as long as it seems safe for the baby, and me, but premature delivery seems quite possible.

(b) Part of the placenta is so deeply embedded in uterine wall that upon removal of the placenta, uterine bleeding cannot be controlled, necessitating blood transfusions, and/or a hysterectomy. Possible maternal death.

(c) Cervix misbehavior during pregnancy is rapid and causes unexpected and complete detachment of the placenta (this is placenta abrupta), leading to severe bleeding, loss of blood and oxygen supply to fetus, yadda yadda yadda. Possible maternal and fetal death.

Today I choose to stick my fingers in my ears and loudly sing songs from the new Springsteen release. There's absolutely nothing we can do about this except watch and wait. And, importantly, we have advance knowledge. This is a good thing. We can be as prepared as possible for whatever may be coming.

However, I am mourning the loss of "there's a 70% chance you'll have a completely normal pregnancy." I’m in week 13 and I just used the phrase "maternal and fetal death." I wish we hadn't discovered this so early.

Ignorance is indeed bliss.

Monday, July 16, 2007


I hate puns.

People around me know this, and thus attempt to torture me all the more. My father and H in particular. My father-in-law stayed with us this past weekend, and so last night H and I took the opportunity to go see the new Harry Potter movie after we'd put D to bed. This is the one where Harry and the gang start their secret Defense Against the Dark Arts lessons, which take place in the hard-to-find Room of Requirement. I should mention this was only the second in-theater movie I have seen in, oh, the past year or so, so it was an event.

Unfortunately the occupant was parked firmly on my bladder, so I spent much of the exciting conclusion to the film squirming around in my seat. As we crossed the parking lot after we left the theater, I was speculating that what we needed was a sort of instant-expanding uterus that went from walnut to watermelon sized at, oh, let's say 37 weeks or so. H suggested that maybe the answer was some sort of external uterus where you could park the occupant at inconvenient times. He even suggested a name.

Wait for it...

The Womb of Requirement.

What do you think? Shall I just smack him with a two-by-four?

Friday, July 13, 2007

Spoke to OB

New instructions:

Pelvic rest.

For those of you who have never experienced this delight, it basically boils down to NO SEX.


Thursday, July 12, 2007

Nuchal Fun

Today's visit to the perinatology clinic was eventful. It seems likely that the nuchal screen results will come back normal. We won't know for a week or two. The measurements were low, though, which is very good.

But, during the scan, they noted some irregularities to the placenta. I am still processing this and consulting Dr. Google and I have someone at my OB office trying to get a copy of the report so that I can ask one of the doctors some of the nine million questions that I now have, all of which completely escaped me this morning when the perinatologist looked me in the eye and said, "Do you have any questions?"

Anyway, it's not an immediate crisis, but it looks like we may be adding a new layer of complexity to an already high-risk pregnancy.

Damn it.

Wednesday, July 11, 2007

Screening Time

Tomorrow I'm going in to my perinatology clinic for a nuchal translucency screen. I got the last possible appointment I could have gotten that both works with my schedule, and is also before I'm too far along to have the test done. Unfortunately, it's at 8:30 AM and it's pretty far away. I am going to be grouchy tomorrow. And I teach that night until 10:15 PM. It's gonna be a long day. We're paying out of pocket for this test since I'm under 35. Insurance companies are so arbitrary about what they will and will not cover. On the other hand, this pregnancy isn't costing me a $15 copay every time I go in for an office visit, and with cervix checks every 2 weeks from 16 weeks onward that would certainly add up if the pregnancy went full term.

Ha! Full term! Ha ha ha ha ha... Whew. That was a good one... [wipes eyes]

So... I didn't have this done with D so I'm not sure what to expect in terms of turnaround time on the results. I'm not even sure which doctor I'll be seeing. I do know they require cash up front. I hope they accept checks too, or it could be a very short appointment.

I am still going to my stroller walk workouts. I'm nervous about it but my doctor assured me the exercise would be good for me. I'm careful not to get my heart rate up too high and that I don't get overheated. Still nerveracking. I'm going to stop the minute anyone sees anything wacky going on, cervix-wise. There are women doing these workouts that are clearly nearing the ends of their pregnancies and they do more than I do-- I skip the big hills, etc. I wish I was so comfortable in my pregnancy that I wasn't worried about walking up and down a few hills.

I guess I don't really have much to say today. I'm still buried under the pile of grading I got last Thursday. Speaking of which, writing blog entries isn't getting me any closer to being done with that. I guess procrastination time is over for today.

Wednesday, July 04, 2007

Happy Fourth!!

I meant to post yesterday after my first OB appointment, but I was just too grouchy. It went fine, in terms of the fetus (it's now a fetus!!!)-- measuring right on, wiggly as a worm, good heartbeat. BUT, what a colossal pain in the ass. I left my house at 11:40 AM and got home at a quarter to six. A little long for a doctor's appointment, don't you think? I'd forgotten how long appointments at my OB's office can take. Ugh. I shall break it down for you:

11:40 AM: depart for day care lady's house.

12:00 PM: drop D off so I can pay $40 for her to nap nearly the whole time I'm gone.

12:01 PM: reflect that I ought to go into the daycare business.

12:02 PM: remember the 6 years I spent getting my PhD and ponder what being in your house all day with 4 small children must be like.

12:03 PM: decide things are just fine the way they are.

12:30 PM: after driving a total of about 30 miles from house, arrive at chinese restaurant where meeting H for lunch before appointment.

12:31: restaurant closed for fourth of July.

1:15 PM: finish lunch at restaurant next door and head to doctor's office up the street. Doubt husband's navigational abilities only to be proven wrong. (I hate that.)

1:30 PM: emerge from depths of parking garage to arrive on time for 1:30 appointment.

1:30-2:00 PM: sit in waiting room.

2:00 PM: escorted back for weight and blood pressure check after having given urine sample (first of the day).

2:01 PM: assistant doesn't know how to use scale properly, or else I magically lost 20 pounds since yesterday. Ponder speaking up and decide to let it go and see how they react next time when they think I've gained 25 pounds in three weeks.

2:05 PM: finish disrobing and sit on exam table in inadequate paper vest and paper square for covering bottom half.

2:05 PM to eternity: remain on exam table as bladder slowly refills.

2:45-ish: nurse practitioner comes in with inch-thick chart, which she has clearly been browsing through. Nurse practitioner immediately disappears to fetch medical records I brought from RE and gave to receptionist.

2:50- 3:00 PM-ish: have lovely conversation with nurse practitioner regarding history of preterm labor. Decide will do what perinatologist recommended, which is transvaginal ultrasounds every 2 weeks starting at 16 weeks to look for a shortening cervix or evidence of funnelling. Discover must go back to perinatologist and pay out-of-pocket for nuchal translucency screen since I'm under 35 and they don't do them in the OB office anyway. Get lab slip for OB blood panel and thyroid hormone levels. Have exam, swabs, etc.

3:00 PM: nurse practitioner departs and says doctor will be right in for ultrasound.

3:05 PM: ponder emptying bladder before ultrasound.

3:05:15 PM: doctor comes in. This is the new one since I had D, who we've never met. Plans of reunion with Dr. Favorite fade.

3:06 PM: doctor fails to get clear ultrasound shot of fetus since fetus is being cruelly squashed by increasingly full bladder. Doctor claims has never had to ask a patient to empty bladder to get good picture. Doctor applies increasing pressure with wand against full bladder. Doctor chides me for allowing bladder to get so full and irritate already well-known-irritable uterus.

3:07 PM: doctor becomes apologetic after I testily remark that bladder was completely empty when I was first escorted into exam room about an hour ago.

3:10 PM: doctor mercifully asks me to go empty bladder.

3:13 PM: doctor gets a quick grainy ultrasound picture and measurement of fetus and immediately vanishes.

3:15 PM: H and I make another appointment for July 30th and gratefully leave the office.

3:15 - 4:00 PM: I fight early rush-hour traffic to do what should have been a 20 minute drive to pick up D.

4:00 PM: take D across street to lab and give 8 or 9 gallons of blood for lab work. Experience first attempt to provide clean catch urine sample (second of day) while juggling a 21-month-old.

4:30 PM: sit in traffic jam due to terrible car accident at intersection on way home.

4:55 PM: emerge from traffic jam and drop off prescription.

5:25 PM: emerge victorious from pharmacy with barely intact sanity.

5:25:15 PM: start car and gas light comes on. Groan and slap forehead.

5:35 PM: arrive at nearest gas station and fill up car.

5:45 PM: arrive home with 45 minutes to spare before need to leave for work and give 2.5 hour review session to lab students.

You can perhaps see why I did not, in the end, post yesterday. Having slept somewhat of a full night (my class doesn't end until 10:15 and it's a fair distance away) I am feeling somewhat more refreshed today. But, I do not want to have to repeat this experience every 2 weeks. What to do? I love the doctors at this practice, and they were great during the chaotic disaster that was my pregnancy with D. Plus, they deliver at the hospital with the best NICU for micropreemies and the special unit for bedresting pregnant ladies. We used to live much closer to their office, but we moved out here to Siberia right after D was born and I don't want to switch to someone local. If I did, and we had more preterm labor fun and this baby was delivered early, the hospital up here would send the baby in an ambulance down to the hospital this practice delivers at anyway, leaving me stranded in the Siberian hospital and far away from my terribly sick child. I think I'm just going to have to deal with the distance and leave things as they are.

Sigh. Off to decorate my flag cake. Firework fun tonight!! I hope D doesn't panic.

Sunday, July 01, 2007

I was getting a bit cocky there, wasn't I?

Today appears to be freakout time for me again--I am telling myself over and over again today that we are much more likely to lose this child to prematurity/preterm labor than a late first-trimester miscarriage. This is how I reassure myself. Great!!

I think distraction is the name of the game. We took D to the beach this morning and she ran around and threw cars down cliffs and got hit in the face with big waves and dug big pools and the tide flooded them. She loved it. She collapsed for her nap when we got back and she's still sacked out. Once she wakes up, though, we're going grocery shopping to get a few nights' worth of dinners and stuff for the Fourth. We're going over to a friends' house for BBQ and I'm responsible for dessert. I'm leaning towards this. Patriotic, eh?

H is currently attempting to turn up enough of our hideous clay soil in the backyard so that we can mix in some planter's mix and get a bed in reasonable enough shape to (finally) plant our herb/vegetable garden. We got all the plants yesterday so now we have to get them into the ground before we kill them from neglect. This has happened before. We are not gardeners. But we try.