Well I saw Dr J today but mostly saw the resident. Unfortunately I did not get the news I was hoping for. I kind of had a feeling that would happen. I did however find out that my lupus anticoagulant levels came back normal on the repeat I did. So we've ruled out a blood clotting disorder.
Dr J is pretty much in the same thinking as Dr T. That based on Brennan's full term pregnancy a cervical issue is unlikely. He feels based on current studies that placing a cerclage without proof of incompetence can be more dangerous than not and that the studies indicate outcomes seems to be no different. They usually do not dx IC unless as person has had 3 losses (can you imagine??) or maybe if they catch cervical shortening in the act via u/s and no other found reason.
He said that he thinks I have about 75% chance of having a perfectly normal pregnancy.
So the plan he presented to me was similar to that of DR T. Once I get pregnant I will have my early care with Dr M of course. My NT will be booked at the peri/MFM clinic I don't know if they will check the cervical length at that time since they said they can't measure it until 14 weeks.
At 16 weeks I will start bi-weekly or weekly cl (cervical length) checks (my choice). Dr J usually places or recommends placing a cerclage once he see the cl go below 1.5cm. This scares me A LOT. All the literature I read says <2.5 is the danger zone. But again if I feel that I want a cerclage it's up to me.
I will also have a special u/s around 18 weeks to check the blood flow etc to the placenta. The reason for this is because Gavin's placenta was on the small side for the gestational age. I don't know what could even be done if there was a placental problem like that.
I am pretty scared/confused. It's almost like your damned if you do, damned if you don't. I could get an early cerclage everything could go great or I could miscarry. It would be my fault. Or I can wait and see and end up having another preterm delivery or complications from an emergent cerclage....again my fault for not following my gut.
I forgot to ask a few questions. I hate it when that happens...don't you?
4 comments:
I think, while I am not Dr T's biggest fans, he's one of the most aggressive and conservative docs I know, and if he says that he wouldn't do the cerclage, I would trust him.
The thing I often have to remember, when doing research, is that the american private insurance system leads to some procedures, drugs and occurrences that aren't actually good evidence based medicine, but are performed because they are cost effective or because doctors are worried about being sued or because they can bill more for them.
I don't know if that helps, but I do know that these are really hard choices, and you do the best you can with what you have. If worrying and thinking could save babies, both of us would have ours in our arms.
Mrs. Spits....I do agree that procedures etc can be overdone and over perscribed in the U.S. The more the Dr does the more money he/she makes. There isn't quite the same incentive here.
It's so hard to trust.
I know Dr T is one of the best but it's still hard to trust....and leave everything in the control of others....people who aren't so personally affected by loss.
I'm sorry this is all so awful for you. While 75% chance of a normal pregnancy is encouraging, the flip side of those numbers (25% chance of a problem) isn't entirely reassuring.
As Mrs. Spit noted, there doesn't seem to be much in the way of evidence that cerclage actually helps according to my OB, who was one of the top OB's in Korea (albeit not a MFM).
I know that you just want someone to say "this is the problem, and here is now we will fix it." It really doesn't seem too much to ask. Sigh.
The problem with odds is that up to the day prior to Gavin's delivery I probably had 95% or more of a chance at a healthy term delivery. I fell on the wrong side with much better odd.
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