Sunday, May 18, 2008

Action, Anticipation

I finally got my courage up and called the Maternal Fetal Medicine service at our local hospital to schedule a preconception consultation... I was worried that I would have to justify or explain, but the receptionist calmly scheduled the appointment and said she'd send a preconception consultation packet - apparently they do these all the time. She scheduled it for May 28th (eek!), which is faster than I thought I'd be able to get in, but it will be good to get answers. Because I work at the accompanying university doing maternal and child health research, it was a bit complicated to figure out who to see without saying to a current or future boss, "So, um, I'm going to be trying to get pregnant in the next 6 months; you cool with that?" I ended up asking for the doc, let's call her Dr. Special, who backs up the hospital-based midwives who I delivered with last time - she also does preeclampsia research, so hopefully she'll be up on the latest.

Things I'd like to get answers/opinions on:
- My current risk profile for preeclampsia?

- I know I need to keep losing weight, but where should I realistically try to be to minimize risk?

- Should I continue on the Aldomet or try to get off of it? Chronic hypertension was unmasked last time I was pregnant, but I am currently well controlled on a low dose of Aldomet - an anti-hypertensive that is considered reasonably safe during pregnancy

- Right before I was pregnant with M, I was tested for abnormal clotting factors... One of them, lupus anti-coagulant was higher than the normal range. This could be important because these clotting factors are implicated in repeat pregnancy loss (ding!) and pre-eclampsia (ding! ding! we have a winner!) Usually, they test again in a month or two, because one reading can be false positive/negative... They didn't test me again b/c I got and stayed pregnant with M. My question for Dr. Special will be: Should I be tested again? If so what will we do? Low dose aspirin (see question below), low molecular weight heparin?

- Should I take low dose aspirin? - That's where the latest pre-e research is pointing...

- If so, when should I start? Some people start early in pregnancy to help with implantation... The thought is good implantation & vascularization results in lower risk of pre-e

- Can I deliver with the local free-standing birthcenter midwives with routine monitoring by Dr. Special? - The birthcenter midwives have admitting privileges at the hospital...

- If so, when/how should I be monitored by Dr. Special?

- If not, can I deliver with the hospital-based midwives? When should I be monitored by Dr. Special?

- When I had an epidural during M's delivery, I had a really bad allergic reaction to the mastisol (type of adhesive) they use to tape down the epidural catheter - it looked like a chemical burn and took 25 days of prednisone to calm down... I also got a staph infection from the hospital, so it was a huge mess... I am not planning to have an epidural again (see: freestanding birthcenter midwives), but if I am induced again for pre-e or another medical emergency, I know I may want one, especially if I am on pitocin and have to labor in bed like last time... My question to Dr. Special will be: Is there anything else they can use or do to tape the catheter down?

So, um, I guess I have a few issues to discuss... I'll let you know how it goes.


Penny said...

I hope the visit and ensuing tests shed light. Good luck at your appointment!

Kittie "Kat" said...

You are SO over my head, but just know that I'm praying for you!

Kittie "Kat" said...

You are SO over my head, but just know that I'm praying for you!

Kittie "Kat" said...

I don't know why my comment posted twice last time, but isn't it time for an update???? (and pictures?)

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