WOW !!
You could get an entire high risk OB education with your wife. I have seen alot, including abdominal cerclage, etc. I can truly say I have never seen or known anybody with heterotopic pregnancy. Thank goodness it has resolved without surgery.
Have a peaceful New Year,
Herb
Showing posts with label Heterotopic Pregnancy. Show all posts
Showing posts with label Heterotopic Pregnancy. Show all posts
Thursday, January 1, 2009
Even Strangers Concede...
James is working on a search for an MFM/Perinatologist in Wisconsin. When following up with his client yesterday, an OB who serves as president of the group, he shared our recent obstetrical experiences by e-mail. (They'd talked about the fact I was expecting when they met recently, so James caught him up on the heterotopic pregnancy and its progress.) James thought his response was hilarious, but I'm not sure I agree:
Tuesday, December 30, 2008
On Growing, Collapsing, and the Grace of God
Today, we had a follow-up sonogram after a few scary, sketchy days. We were warned at the last two sonograms to anticipate fluctuating hormone levels as Baby B began to deteriorate, but when we watched my progesterone level drop from 35 to 20, we were really concerned. Particularly, when the drop came with several days of intermittent spotting.
Over the last three blood draws, the climb in my HCg level slowed remarkably going from 25,009 to 30,055 to 37,969. Again, such a change was predicted -- even a drop was mentioned -- but to watch what should be a predictor of health slug by was worrisome. The doctor, though, is wholly unconcerned. In fact, at my exam he was nearly celebratory, even pumping his fists in the air, saying "Yay!"
As a precaution with regards to the declining progesterone level, and maybe to shut me up, Dr. K (my OB/GYN) doubled the supplement I'm taking. Really, I'm not sure that he anticipated a 15 unit drop in four days, and since I'm at the stage where historically my levels bottom out and cause a miscarriage, I think he's either unwilling to take a chance, or more willing to appease me. Regardless of his motive, I'm grateful that he's so conservative and not willing to take one change lightly. In two weeks, the placenta should be fully functional and I'll begin weaning off the supplements completely, moving back down to one per day, then one every other day, and so on. Two weeks more seems like a lifetime.
At today's scan, we were all able to see that Baby B's gestational sac is making clear progress in deterioration. Dr. K recalled the last results on his computer and reviewed Dr. T's images, and was confident that our worries have decreased. He had a difficult time getting clear measurements because the edges of the gestational sac show signs of bleeding (which is likely related to my increased spotting) and are hazy with debris as it collapses in on itself. He said there is still a chance of ovarian rupture until the gestational sac is completely gone, and advised me to take pain on the left side or increased bleeding seriously. Dr. T (my MFM/Perinatologist) will follow up in a week, but based on the rate of deterioration since Wednesday, Dr. K wondered if he would see anything at all. We'll know for sure in six days.
Seeing how the sac had deteriorated was rather bittersweet. We're so pleased I don't have to have surgery at this stage and risk the life of Baby A, but at the same time, watching something so lovely disappear is disheartening -- especially when Dr. K was able to identify the location where the fetal pole (heartbeat) likely began and ended.
To clarify, though, we are not ungrateful. It is such a relief to be at this stage growing a baby that is safely implanted high above my cervix -- a baby who has a strong and healthy heartbeat and who is now measuring three days ahead of schedule. It is such a relief to not be forced into deciding to kill one baby to hopefully save another, while really risking both. It's a relief now to imagine that my pregnancy could become very much like a normal pregnancy, and that there could be days ahead absent of questions and concerns. Based on the fact that we've seen a healthy heartbeat and accurate growth now four times, there's a very good chance the day will come that we'll bring home another baby.
Our Heavenly Father has been far more gracious to us than we could have every hoped He would be. We are awed by His mercy, and we are humbled by His love for us. Saying "Thank You" for all this is just not enough...
Over the last three blood draws, the climb in my HCg level slowed remarkably going from 25,009 to 30,055 to 37,969. Again, such a change was predicted -- even a drop was mentioned -- but to watch what should be a predictor of health slug by was worrisome. The doctor, though, is wholly unconcerned. In fact, at my exam he was nearly celebratory, even pumping his fists in the air, saying "Yay!"
As a precaution with regards to the declining progesterone level, and maybe to shut me up, Dr. K (my OB/GYN) doubled the supplement I'm taking. Really, I'm not sure that he anticipated a 15 unit drop in four days, and since I'm at the stage where historically my levels bottom out and cause a miscarriage, I think he's either unwilling to take a chance, or more willing to appease me. Regardless of his motive, I'm grateful that he's so conservative and not willing to take one change lightly. In two weeks, the placenta should be fully functional and I'll begin weaning off the supplements completely, moving back down to one per day, then one every other day, and so on. Two weeks more seems like a lifetime.
At today's scan, we were all able to see that Baby B's gestational sac is making clear progress in deterioration. Dr. K recalled the last results on his computer and reviewed Dr. T's images, and was confident that our worries have decreased. He had a difficult time getting clear measurements because the edges of the gestational sac show signs of bleeding (which is likely related to my increased spotting) and are hazy with debris as it collapses in on itself. He said there is still a chance of ovarian rupture until the gestational sac is completely gone, and advised me to take pain on the left side or increased bleeding seriously. Dr. T (my MFM/Perinatologist) will follow up in a week, but based on the rate of deterioration since Wednesday, Dr. K wondered if he would see anything at all. We'll know for sure in six days.
Seeing how the sac had deteriorated was rather bittersweet. We're so pleased I don't have to have surgery at this stage and risk the life of Baby A, but at the same time, watching something so lovely disappear is disheartening -- especially when Dr. K was able to identify the location where the fetal pole (heartbeat) likely began and ended.
To clarify, though, we are not ungrateful. It is such a relief to be at this stage growing a baby that is safely implanted high above my cervix -- a baby who has a strong and healthy heartbeat and who is now measuring three days ahead of schedule. It is such a relief to not be forced into deciding to kill one baby to hopefully save another, while really risking both. It's a relief now to imagine that my pregnancy could become very much like a normal pregnancy, and that there could be days ahead absent of questions and concerns. Based on the fact that we've seen a healthy heartbeat and accurate growth now four times, there's a very good chance the day will come that we'll bring home another baby.
Our Heavenly Father has been far more gracious to us than we could have every hoped He would be. We are awed by His mercy, and we are humbled by His love for us. Saying "Thank You" for all this is just not enough...
Saturday, December 27, 2008
On Indiscretion and Disappointment
Despite our news on Christmas Eve, we had a lovely, low-key holiday. It's still nice to have this sweet secret, though I'm quite sure it's not much of a secret anymore. At James' urging, I mentioned this pregnancy to a handful of people, who have shared our news with another handful of people, and now, following a few unexpected conversations and e-mails, I'm not sure we have news left to share. I'm beginning to wish I would have held firm to my original plan of not telling a soul until I was scheduled to give birth.
My complaint is not necessarily about the fact that people know of our pregnancy. It's more about the fact that we weren't given the chance to make the announcement we wanted to make when we reached a point where we felt safe and comfortable discussing our progress. I'm hurt that people I love and trust could disregard me so completely, just for a juicy bit of gossip. I'm frustrated that I now have to deal with people who have no idea what they're talking about sharing their unwelcome opinions. I'm sad that I have to deal with others so scornful I can nearly feel their negative energy burning through my chest. Knowing that others I wouldn't normally welcome near a more vulnerable me share in my news adds a burden I absolutely didn't want or expect to deal with.
I don't feel ecstatic about this pregnancy, but rather reservedly hopeful at best.
I'm a long way from being "safe," and I'm afraid of this 7-9 week range.
If I lose this pregnancy now, exactly what I hoped to avoid by keeping things a secret is guaranteed to crash down on me.
That disappoints me deeply.
My complaint is not necessarily about the fact that people know of our pregnancy. It's more about the fact that we weren't given the chance to make the announcement we wanted to make when we reached a point where we felt safe and comfortable discussing our progress. I'm hurt that people I love and trust could disregard me so completely, just for a juicy bit of gossip. I'm frustrated that I now have to deal with people who have no idea what they're talking about sharing their unwelcome opinions. I'm sad that I have to deal with others so scornful I can nearly feel their negative energy burning through my chest. Knowing that others I wouldn't normally welcome near a more vulnerable me share in my news adds a burden I absolutely didn't want or expect to deal with.
I don't feel ecstatic about this pregnancy, but rather reservedly hopeful at best.
I'm a long way from being "safe," and I'm afraid of this 7-9 week range.
If I lose this pregnancy now, exactly what I hoped to avoid by keeping things a secret is guaranteed to crash down on me.
That disappoints me deeply.
Wednesday, December 24, 2008
Gone for Good
The sonogram today confirmed Baby B is gone for good. While there was no notable deterioration in the gestational sac at this point, there was no growth to speak of and still no heartbeat. Based on blood levels and scan results, it's probable that the baby died sometime between Thursday and Monday.
My perinatologist brought two colleagues into the room during today's scan, and their consensus was not to recommend surgery at this point, but rather to continue the watchful wait. There is still a risk of ovarian rupture, but the growth level of the gestational sac between Monday and today was minimal. As a result, a rupture is not necessarily anticipated.
Despite having another baby we won't meet until Heaven, we're so grateful for today's news. If a heartbeat would have been present in Baby B today, my OB would have pushed for surgery to remove the ectopic pregnancy, and general anesthesia in the first trimester could be damaging -- even fatal -- to Baby A in my uterus. Also, by waiting and allowing the baby to be slowly reabsorbed, its corpus luteum will continue benefit the overall pregnancy. The doctors plan to rotate weekly scans until Baby B is completely gone.
My perinatologist brought two colleagues into the room during today's scan, and their consensus was not to recommend surgery at this point, but rather to continue the watchful wait. There is still a risk of ovarian rupture, but the growth level of the gestational sac between Monday and today was minimal. As a result, a rupture is not necessarily anticipated.
Despite having another baby we won't meet until Heaven, we're so grateful for today's news. If a heartbeat would have been present in Baby B today, my OB would have pushed for surgery to remove the ectopic pregnancy, and general anesthesia in the first trimester could be damaging -- even fatal -- to Baby A in my uterus. Also, by waiting and allowing the baby to be slowly reabsorbed, its corpus luteum will continue benefit the overall pregnancy. The doctors plan to rotate weekly scans until Baby B is completely gone.
Tuesday, December 23, 2008
Collecting My Thoughts
I've had the information about the condition of our pregnancy for about 24 hours now, and I think it would be a good time to collect some of my thoughts. I still feel stunned and disappointed by the news. I was hopeful yesterday's scan would bring clarity -- one or two, healthy or not. Instead, I have more questions than ever. I'm frustrated at the timing of the news here at Christmastime. Where I felt excited and happy, I now feel concerned and distracted. I'm also no longer allowed to leave town, so the plans to see my family have been completely cancelled.
But all of those are small things compared to my health and the health of this pregnancy and these babies.
First to explain, a heterotopic pregnancy is not a vanishing twin pregnancy. A heterotopic pregnancy is a combination intrauterine and ectopic pregnancy. Heterotopic pregnancies are somewhat common in women who have IVF, but spontaneous heterotopic pregnancies are more rare. A heterotopic pregnancy most commonly includes an ectoptic pregnancy in the fallopian tube. A pregnancy anywhere else -- the cervix, the ovary, or the abdominal cavity -- is less common.
It's true that the twin in my ovary could deteriorate if it has indeed died, but there's a chance that it might live. If the baby lives, the pregnancy could become quite dangerous, potentially killing the baby growing in my uterus, ending my chance at further reproduction, even leaving my life at risk. If the baby dies, well, that's another baby gone.
God is a God of miracles, but in this situation, it's hard to know how to pray.
But all of those are small things compared to my health and the health of this pregnancy and these babies.
First to explain, a heterotopic pregnancy is not a vanishing twin pregnancy. A heterotopic pregnancy is a combination intrauterine and ectopic pregnancy. Heterotopic pregnancies are somewhat common in women who have IVF, but spontaneous heterotopic pregnancies are more rare. A heterotopic pregnancy most commonly includes an ectoptic pregnancy in the fallopian tube. A pregnancy anywhere else -- the cervix, the ovary, or the abdominal cavity -- is less common.
It's true that the twin in my ovary could deteriorate if it has indeed died, but there's a chance that it might live. If the baby lives, the pregnancy could become quite dangerous, potentially killing the baby growing in my uterus, ending my chance at further reproduction, even leaving my life at risk. If the baby dies, well, that's another baby gone.
God is a God of miracles, but in this situation, it's hard to know how to pray.
That Which I Don't Understand (by James)
I am sitting in dark, cold hotel room in Grand Rapids. Michigan, trying to make sense of the recent developments of the pregnancy. I'm confused. I'm not sure what to pray for or even how to pray. It all seems surreal. The odds of a heterotopic pregnancy with one of the twins in the ovary is so rare. Yet, this is where we find ourselves.
I'm ready to get back home and be with Amanda and just hold her and love her and tell her how proud I am of her for being strong and fully relying on God. The same God who has brought us out of tough situations before will do the same again. No matter what the situation or outcome, I cannot deny he is working in our lives.
7 weeks today. For that, I am grateful. A strong heartbeat. A good position in the uterus. I pray for your continued growth Baby A.
For you Baby B, I'm overwhelmed by your presence. I can't understand many things. What I do know is that even if you have passed on, you are still a creation of God that has been given to us.
Tomorrow is a big day and will be more telling of things to come. Please pray for wisdom from the MFM and clarity for us.
God is good all the time and all the time God is good.
I'm ready to get back home and be with Amanda and just hold her and love her and tell her how proud I am of her for being strong and fully relying on God. The same God who has brought us out of tough situations before will do the same again. No matter what the situation or outcome, I cannot deny he is working in our lives.
7 weeks today. For that, I am grateful. A strong heartbeat. A good position in the uterus. I pray for your continued growth Baby A.
For you Baby B, I'm overwhelmed by your presence. I can't understand many things. What I do know is that even if you have passed on, you are still a creation of God that has been given to us.
Tomorrow is a big day and will be more telling of things to come. Please pray for wisdom from the MFM and clarity for us.
God is good all the time and all the time God is good.
Monday, December 22, 2008
The Good News and The Bad News
We had our follow-up sonogram today, and the doctor came in joking about how many babies we were going to have. We reminded him that we were there to indeed check for multiples, and his joking tone became excited as he remembered my blood results and the report from the perinatologist the week prior.
When the sono began, the doctor had no problem spotting the beautiful baby growing in my uterus. "Just one," he said. I felt a little disappointed, having been so sure that the numbers and my symptoms could not be wrong. "Are you sure?" I asked. "The perinatologist mentioned the other thing was a little high up in the uterus." Just one, he clarified again.
We watched the heartbeat, feeling very excited. After a moment or two, he standardly scanning the rest of my pelvic region. He examined the outside of the uterus, the right ovary, then the left. When he got there, he went round and round, zooming in and out, and I could see what he saw. "There's a gestational sac here," he said, pointing out all the parts. He continued to check and measure and print and document, then agreed with himself that it was indeed a gestational sac, and I had a heterotopic pregnancy.
A heterotopic pregnancy is a pregnancy where there's both a growing intrauterine pregnancy, and a pregnancy outside of the uterus. Most commonly, the baby growing outside of the uterus grows in the fallopian tube. In very rare cases, it grows in the cervix, ovary or abdomen.
Instances of heterotopic pregnancies are on the rise with the increase of frequency of IVF, but spontaneous heterotopic pregnancies are rare. With my baby growing on my left ovary, I find myself in the rarest of rare situations.
During the sonogram, the doctor was unable to find a heartbeat in the heterotopic twin, and the "ring of fire" (bloodflow on the sonogram) was not complete, reaching only the top and bottom of the gestational sac, instead of completely circling it as it should. My doctor is hopeful that the absence of a heartbeat and the incomplete ring of fire means the baby has died, is deteriorating and will eventually be reabsorbed by my body. But, because it's still so early in this pregnancy and not totally unusual to not see a heartbeat at this stage, he's sending me to be scanned again on Wednesday. If there is growth or a heartbeat, he'll want to discuss surgery -- by Friday, if he can make me.
At this point, that's too overwhelming to consider. I've decided unless I'm in actual imminent danger -- like, hemmoraging or something -- I'm delaying surgery for at least a few more days. There are many things to consider, many pros and cons to the various approaches, lots of decisions weighing heavily on our hearts and minds. I'll lay out my thoughts in some posts over the next couple of days. Meanwhile, please keep praying for me and for my babies. (Such a bittersweet thing to say...)
When the sono began, the doctor had no problem spotting the beautiful baby growing in my uterus. "Just one," he said. I felt a little disappointed, having been so sure that the numbers and my symptoms could not be wrong. "Are you sure?" I asked. "The perinatologist mentioned the other thing was a little high up in the uterus." Just one, he clarified again.
We watched the heartbeat, feeling very excited. After a moment or two, he standardly scanning the rest of my pelvic region. He examined the outside of the uterus, the right ovary, then the left. When he got there, he went round and round, zooming in and out, and I could see what he saw. "There's a gestational sac here," he said, pointing out all the parts. He continued to check and measure and print and document, then agreed with himself that it was indeed a gestational sac, and I had a heterotopic pregnancy.
A heterotopic pregnancy is a pregnancy where there's both a growing intrauterine pregnancy, and a pregnancy outside of the uterus. Most commonly, the baby growing outside of the uterus grows in the fallopian tube. In very rare cases, it grows in the cervix, ovary or abdomen.
Instances of heterotopic pregnancies are on the rise with the increase of frequency of IVF, but spontaneous heterotopic pregnancies are rare. With my baby growing on my left ovary, I find myself in the rarest of rare situations.
During the sonogram, the doctor was unable to find a heartbeat in the heterotopic twin, and the "ring of fire" (bloodflow on the sonogram) was not complete, reaching only the top and bottom of the gestational sac, instead of completely circling it as it should. My doctor is hopeful that the absence of a heartbeat and the incomplete ring of fire means the baby has died, is deteriorating and will eventually be reabsorbed by my body. But, because it's still so early in this pregnancy and not totally unusual to not see a heartbeat at this stage, he's sending me to be scanned again on Wednesday. If there is growth or a heartbeat, he'll want to discuss surgery -- by Friday, if he can make me.
At this point, that's too overwhelming to consider. I've decided unless I'm in actual imminent danger -- like, hemmoraging or something -- I'm delaying surgery for at least a few more days. There are many things to consider, many pros and cons to the various approaches, lots of decisions weighing heavily on our hearts and minds. I'll lay out my thoughts in some posts over the next couple of days. Meanwhile, please keep praying for me and for my babies. (Such a bittersweet thing to say...)
The Cooperative Twin --
in the uterus where it belongs.
The Rebel Baby --
laying low in my left ovary.
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