Thursday, January 1, 2015

Updates

Of course the first post of the year should say something special or exciting or something I've learned over the past year.  So sorry if you're disappointed -  mostly this is an update after my MFM appointment on Monday.

I thought the appointment would be the OB check in, since I was referred by a fertility clinic.  It takes this office 3 days to 'properly process' a referral and I assumed incorrectly that accepting me as an OB patient was part of it.  The poor receptionist was a total moron (even though she seems like a perfectly nice person).  The office I visited (not the only office location) shares space with an OB clinic.  When she found out I didn't have an OB she thought it was a great idea to go ask the OB clinic if they'd take me as a client, surprisingly they did not want to handle a triplet case.  (I wanted to slap my forehead.)  At the end of the appointment she didn't know how to make an appointment for my official intake or my 16 week follow up, she had to call me back the next day.

After the adventure of getting checked in, we sat and waited for the ultrasound.  It was scheduled to be 90 minutes.  The ultrasound tech was amazing, she was great and chatty without being too detailed.  She confirmed the twins were MonoDi and she said that still has a risk for twin to twin transfusion, but that the doctor would talk with me more about that.  She chatted about other triplet clients that she saw and how they did (nothing scary!).  I asked her if any of the doctors in the practice delivered and she confirmed that all of them did.  She wouldn't really give us a referral, but when my husband said he wanted a straight shooter she told us what doctor he would probably like.  I convinced him I didn't want a straight shooter, I want a calm and caring doctor that will only tell me something if I need to know.  I cannot be stressed out about every little possible thing.

Speaking of stressing out, since all the babies looked amazing on the screen and all were measuring 1-3 days ahead (baby A is only measuring 1 day ahead and he has his own little placenta - get it together baby A!) you'd think I wouldn't be too nervous to speak with the doctor, but I was SO NERVOUS.  (The ultrasound was only about 20 minutes too, which was nice.)

Now, again my problem is that I wanted to see a doctor that was maybe going to deliver, but I saw a fill in doctor who is amazing and very nice and who would be wonderful to see if you were just going in for a quick opinion on your single or double babies. 

The first thing she mentioned was that I have a subchorionic hematoma, which I only know from Don't Count Your Eggs and so my immediate question was 'is it going to take a baby out?'.  She said no and looked at me like I was crazy (I'm not crazy! Though Maya had this issue 5 weeks earlier in her P).  It's apparently well on it's way to resolving and is super common in IVF patients, it also might explain my early pink spotting.

So all the news that affects what we can do:
  • Circulage and progesterone therapy to slow pre-term labor in multiples has not been shown to help, they would not recommend either of these.
  • Preeclampsia is more common in IVF patients so we need to watch it.  (I wonder if she brought this up because I was super nervous and my heart rate was 80 and my blood pressure was higher pre-discussion.)
  • Twin to twin transfusion syndrome is a possibility and we discussed treatment and options, but then I was told it only happens in 5-10% of cases.  I'm not discussing plans about that! That was about my chances (from one doctor) on my getting pregnant naturally. 
  • It's mostly impossible to do the blood tests for genetic disorders.  The defects can get diluted because you have 3 babies in there.  Basically they have to rely on ultrasounds or amniocentesis if there are symptoms.  I'm all ok with the ultrasounds, but will probably not want to do invasive tests unless there is a sign of a huge problem.
  • Growth restriction can happen, but we'd be looking for that later in the pregnancy.  I've barely popped now and my uterus is still much larger than a normal single pregnancy, so I feel like I've got lots of room for them.
  • All my placentas are on the back - which means I will be pummeled with 6 tiny fists and feet soon. Can't wait!
Mostly hilarious
  • I told her it was an egg donor, she asked how old (the donor is 21) and then she immediately asked me if there was a danger of hyperstim.........                  Uh, no, because I haven't stimmed for 6 months.  It mostly made me laugh, clearly she was stuck on the standard IVF portion of questions.
  • I do not need to actually eat 4,000 calories a day, but I should try to eat as much as possible.  This MFM said that babies grow to their genetic predisposition until 24 weeks and then food matters.  Not sure I believe her, but I'll go with it.
  • She thought, barring anything occurring, I should be able to work until 24 weeks.  At that point I may just physically be too big to drive.  When I told my coworker the next day she offered to pick me up, and then she pointed out our boss had a big truck.  I asked her if she was going to load me in the back like I'm a cow and make me moo while doing it?  She laughed (I know what she's planning!)
It was very nerve wracking, but I'm glad it's done and I'm glad they all look healthy.  It's scary to think I won't have another scan until 16 weeks.  After that I get a scan every other week and I'm not sure that's better because I'm still scared, but at least I'll be monitored.  Trying to stay positive every day and make it to at least 28 weeks. 

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