Unfortunately, we had another bout with bright red blood and a "pissed" uterus (what a nurse we like calls it) last night.
We were at the hospital for a while today.
This is expected with Erin's condition, but still frightening.
They monitored the baby and Erin's uterus and gave her some drugs to make her uterus stop being irritable (mild contractions).
They think the irritability comes from the issues with previa etc.
Erin is 21 weeks pregnant now.
They said that at 24 weeks the baby will be viable. She will be admitted to the hospital for the duration then at the latest (although it could very likely be sooner now).
Dr. Watson explained that after we get to 24 weeks they will take it day by day. Percentages of health literally shift by the day and the situation. Depending on how far along Erin gets, the baby will have X% chance at survival and Y% chance at major lifetime health issues. We'll have to weigh out the risks as things develop.
For now though, its still a zero sum game - until the baby gets to 24 weeks there isn't anything we have to decide.
They do think that Erin's bleeding will continue on and off for the duration. They will have to guage it and treat her with drugs and potentially blood transfusion depending on how things go.
It sounds like for the actual delivery they will also have an interventional radiologist on hand to help control blood flow.
We've heard most of what we heard today before, but its all becoming much more real the deeper we get into it. As you can imagine, Erin was pretty upset to have this happen again after having such a positive run the past few weeks.
So nothing really has changed - this was all expected, we just fell into an optimistic couple of weeks where it was easy to think that it was going to be smooth sailing for the duration. Clearly, its going to be a winding road from here to the eventual conclusion of the pregnancy.
Saturday, February 28, 2009
Tuesday, February 24, 2009
20 weeks 3 days
Erin had a positive appointment today with her HR OB (John Buckmaster). She and the baby remain stable.
Her cervix thickened and lengthened significantly - best they have seen it yet.
She still has placenta previa, but Dr. Buckmaster agrees that dealing with it is within Jana Reddoch (the oncologist who will assist the C-section), wheel-house (she is apparently a bit of a legend).
The baby continues to grow normally.
Dr. Buckmaster said he was optimistic after looking at ultrasound.
Originally, they wanted Erin in the hospital at 22 weeks, but now are planning on 24 (approximately March 22) weeks given today's results. This will maximize Erin's mental health which is an important aspect of our chances at success. This could of course change quickly.
They want Erin to skip next week's appointment because during this time frame they fear car travel the most.
She will go in to the hospital at 24 weeks to maximize chances of survival for the baby & ensure that she is safe. Surprisingly - if they are right on top of things babies have a shot that young. Obviously, they want Erin to get as close to 30 weeks as possible.
So we are happy for today. Yay.
Monday, February 16, 2009
19 Weeks 2 Days
We had a doctors appointment today at Northwest Perinatal.
It went reasonably well.
Erin had a tiny bit of bright red blood over the weekend. The doctors say that she is still a bit early to be having bleeding from her placenta previa, but it does happen.
The doctor said that we have 4-5 weeks until viability of the baby. He said that right now the outcome is binary: either the baby makes it or he doesn't. He said that he is most worried about the next stage: 24-28 weeks. During this stage, if Erin delivers, the baby could make it and have any number of issues.
The concern of the doctors continues to be the previa and placenta accreta. As good as the technology is today, there is still so much they can't see. All they really know is that she has previa & most likely has accreta - but they don't know how strong the lower third of her uterus is and how it will hold up as the baby continues to grow.
The HR OBs thought it would be good to have a cystoscopy or an MRI done so that they can see if the accreta is getting close to the bladder. The gynecological oncologist does not think she needs this as she would just deal with it if she encountered it during the eventual C-section. The HR OBs defer to her on this so I think we'll skip both.
Erin will most likely be heading into the hospital in 3-4 weeks. They want to keep her home as long as possible as her mental health is a factor in our success as much as anything. The less time she spends in the hospital the better from that standpoint.
My mom is coming to Portland March 8 for a month. That will be extremely helpful. Thanks Mom!
Our friends here in Portland continue to be the best - they continue to bring us dinner which is a life saver.
Erin found a book that Lauren seems to relate to on bed rest: And Mommy's On Her Side.
Thursday, February 12, 2009
Oncologist
We had the appointment with the gynecological oncologist yesterday. Man was she smart.
It was a pretty positive consult.
Our HR OBs are worried about 2 things: Erin's ability to carry the baby to 30 weeks and the surgery to get the baby and put Erin back together.
The oncologist is not terribly worried about the surgery. She also doesn't think that Erin will absolutely need to have a hysterectomy. Her key question was around what caused Erin to hemorrhage with Lauren. Once she heard how long Erin labored and pushed, she was satisfied that the cause of the hemorrhage was not some fundamental problem with Erin's uterus - just that the last time she labored too long and her uterus had no energy left to contract properly.
The oncologist will assist with the C-section. Her recommendation is to do a "conventional c-section". "Conventional" is the way they used to do it. Basically, they take the baby out from up high and leave the lower part of the uterus alone. She thinks the placenta will come out fine and if some of it is attached to the uterus and won't let go they can leave it in and it will die off naturally. If they run into trouble, she knows how to do a hysterectomy very quickly.
The oncologist's biggest concern is getting Erin to 30 weeks. Erin has to continue to be on strict bed rest and will be admitted to the hospital in 3-4 weeks for the final 8 weeks of the pregnancy. She said that because Erin is so good at following Dr's orders she has a good shot at success. She did say that lots of women go a bit crazy in the later stages of bed rest - especially when they are in the hospital. Erin is one tough cookie though, so we bet she does ok. It will be really hard on Lauren and me though not having her around. We'll visit a lot and my mother is planning on coming out to help.
It was a pretty positive consult.
Our HR OBs are worried about 2 things: Erin's ability to carry the baby to 30 weeks and the surgery to get the baby and put Erin back together.
The oncologist is not terribly worried about the surgery. She also doesn't think that Erin will absolutely need to have a hysterectomy. Her key question was around what caused Erin to hemorrhage with Lauren. Once she heard how long Erin labored and pushed, she was satisfied that the cause of the hemorrhage was not some fundamental problem with Erin's uterus - just that the last time she labored too long and her uterus had no energy left to contract properly.
The oncologist will assist with the C-section. Her recommendation is to do a "conventional c-section". "Conventional" is the way they used to do it. Basically, they take the baby out from up high and leave the lower part of the uterus alone. She thinks the placenta will come out fine and if some of it is attached to the uterus and won't let go they can leave it in and it will die off naturally. If they run into trouble, she knows how to do a hysterectomy very quickly.
The oncologist's biggest concern is getting Erin to 30 weeks. Erin has to continue to be on strict bed rest and will be admitted to the hospital in 3-4 weeks for the final 8 weeks of the pregnancy. She said that because Erin is so good at following Dr's orders she has a good shot at success. She did say that lots of women go a bit crazy in the later stages of bed rest - especially when they are in the hospital. Erin is one tough cookie though, so we bet she does ok. It will be really hard on Lauren and me though not having her around. We'll visit a lot and my mother is planning on coming out to help.
Wednesday, February 4, 2009
Another rough night
We had another rough night last night.
Erin's doctor told us to expect more bleeding as it is common with placenta praevia. He said that if it was more than what happened the first time we should call.
By 1 AM or so Erin was convinced of this and so we called. They told us to wait out the night and then to call in the morning. Erin also starting complaining of tightening in her belly.
When we called in the morning they told us to come right in. Erin's uterus had become "irritable" - she was having mild / irregular (i.e., not at a set time interval) contractions. They checked the baby and he was fine. Her cervix also was unchanged (still about 2 cm).
The doctor said that the appointment next week with the gynecologic oncologist will be helpful as she will be able to hopefully determine how fast the placenta accreta is growing and how much time we have to work with (i.e., if we can get to 30 weeks). She also may want to intervene with another surgery or some sort of a treatment as it may be heading towards placenta percreta (speaking of which my dear mother found some stories on this: here.
The doctor this morning thought that they would know more in 3-4 weeks. He thought that if they can calm down her uterus and the baby stays healthy that we will have an 80-90% chance of getting out of this with a healthy Erin and baby.
In order to calm down her uterus, they proscribed indometacin for a few days.
Needless to say, we are all a bit drained. We are holding it together though for the most part thanks to our family and friends. I'm planning on taking next week off which I hope will help our little family.
It seems like we are entering into the next really crucial phase of this. Please keep Erin and Herricle in your thoughts and prayers.
Erin's doctor told us to expect more bleeding as it is common with placenta praevia. He said that if it was more than what happened the first time we should call.
By 1 AM or so Erin was convinced of this and so we called. They told us to wait out the night and then to call in the morning. Erin also starting complaining of tightening in her belly.
When we called in the morning they told us to come right in. Erin's uterus had become "irritable" - she was having mild / irregular (i.e., not at a set time interval) contractions. They checked the baby and he was fine. Her cervix also was unchanged (still about 2 cm).
The doctor said that the appointment next week with the gynecologic oncologist will be helpful as she will be able to hopefully determine how fast the placenta accreta is growing and how much time we have to work with (i.e., if we can get to 30 weeks). She also may want to intervene with another surgery or some sort of a treatment as it may be heading towards placenta percreta (speaking of which my dear mother found some stories on this: here.
The doctor this morning thought that they would know more in 3-4 weeks. He thought that if they can calm down her uterus and the baby stays healthy that we will have an 80-90% chance of getting out of this with a healthy Erin and baby.
In order to calm down her uterus, they proscribed indometacin for a few days.
Needless to say, we are all a bit drained. We are holding it together though for the most part thanks to our family and friends. I'm planning on taking next week off which I hope will help our little family.
It seems like we are entering into the next really crucial phase of this. Please keep Erin and Herricle in your thoughts and prayers.
Monday, February 2, 2009
Update
So we had an expedited appointment today given our weekend ER trip.
The doctor said the blood Erin saw was consistent with placenta previa. He said we should expect to see that and as long as it doesn't come with cramping its ok.
As you can see from the new pictures, the baby looks great.
Erin is a bit shook up from this weekend even though the news today was good.
While nothing has changed, we discussed with the doctor the option of terminating the pregnancy again today. He said that if we did it now, there is a 1 in 200 chance that it would result in the loss of Erin's life. He said that if we continue and get to 30 weeks where there will be more blood flow, placenta accreta and perhaps placenta percreta, the risk will increase to 1 and 100. These are the same numbers we heard a month ago, but they are still hard to hear when the typical pregnancy is 1 in 10,000, you just spent a morning in the ER, and you've been the 1 and 100 before (the complications from Lauren's birth).
We are going to have an appointment next week with a gynecologic oncologist. She will assist in the C-section if it occurs. They want her on hand since Erin's case is so unique and based on her background is used to dealing with abnormal anatomy. Also, if there is placenta percreta, she will assist in the part of the surgery to deal with that.
All and all, the Dr. said he's reasonably optimistic if we continue to control the situation and prepare to have all the right resources on hand.
The doctor said the blood Erin saw was consistent with placenta previa. He said we should expect to see that and as long as it doesn't come with cramping its ok.
As you can see from the new pictures, the baby looks great.
Erin is a bit shook up from this weekend even though the news today was good.
While nothing has changed, we discussed with the doctor the option of terminating the pregnancy again today. He said that if we did it now, there is a 1 in 200 chance that it would result in the loss of Erin's life. He said that if we continue and get to 30 weeks where there will be more blood flow, placenta accreta and perhaps placenta percreta, the risk will increase to 1 and 100. These are the same numbers we heard a month ago, but they are still hard to hear when the typical pregnancy is 1 in 10,000, you just spent a morning in the ER, and you've been the 1 and 100 before (the complications from Lauren's birth).
We are going to have an appointment next week with a gynecologic oncologist. She will assist in the C-section if it occurs. They want her on hand since Erin's case is so unique and based on her background is used to dealing with abnormal anatomy. Also, if there is placenta percreta, she will assist in the part of the surgery to deal with that.
All and all, the Dr. said he's reasonably optimistic if we continue to control the situation and prepare to have all the right resources on hand.
Sunday, February 1, 2009
Latest Picture
Here is a picture of the little guy from yesterday. Hopefully, we'll get some better ones tomorrow. Click on the image if you want to see it zoom in.
He is curiously handsome just like his daddy as you can see :)
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