June 22, 2009

blah, blah, blah, pregnancy induced hypertension, blah, blah, blah

A long post that will really only be compelling to those interested in pregnancy induced hypertension or the general category of scary pregnancy stories: abbreviated version - things are fine.

Had a good OB appointment on Friday. My BP was up ever so slightly (hopefully just because I was late and raced up the stairs to the office). But it gave me a chance to ask some questions--and I actually got some good answers!

I don't know if I ever accurately reflected how stressful the hypertension issue was last time. I originally made my blog public with friends and family who knew we were doing IVF as a way of letting them know what was going on without having to ask questions that might have been difficult (or me having to give difficult answers, particularly when I didn't feel like talking about bad news). I didn't want to scare anyone too much and those of you to whom the pregnancy-induced hypertension issue is important already knew enough to be scared for me. It's also just my nature to be weirdly level and pragmatic about things I can't control, so I tended to share key details but might not have really expressed the sense that we were always right on the edge of a dire situation.

I'd actually been dealing with hypertension for five or six weeks last time before I thought much of it myself. I was admitted to the hospital for monitoring several times, during which my BP would always eventually drop, usually after two hours or so of lying still connected to the monitors. It never rose much above the danger mark of 150/90 and I never had any other signs of preeclampsia, so it didn't set off major alarms with my OB.

But when I went to the MFM at 32 weeks it was another story. The IUGR was detected, and I started to learn about all the risks facing growth restricted babies (including stillbirth and motor and neurological disabilities). This was a big shock since all the time I'd been monitored for hypertension by the OB, I was repeatedly told the baby was very healthy. She looked great on the monitors but the fact was her growth had slowed and dropped from the normal curve. It is possible that small babies just run in my family (I was about five pounds) but IUGR was consistent with the drop off in development at a late stage after hypertension had set in, and finally with the terrible condition of the placenta at delivery - very small, fragmented, and calcified. The connection to hypertension is that the blood doesn't flow well to the placenta and so the baby doesn't have as much nourishment as it should.

The worst part was in the final weeks before I was induced - I hadn't expected so much of that decision to fall on me. I thought there would be some sort of medical standard for assessing the risk/benefit trade-off, but because the MFM and the OB have different ideas about how much risk to tolerate, it all culminated in a conversation with me stretched on a gurney in the hospital, my OB explaining the risks of underdeveloped lungs, and asking me if I wanted to go through with the induction. I decided to trust the MFM, who I adore, and who had said to me "I just really think this baby is going to thrive when we get her out of there." And of course she did.

Anyway, all of that is a long way of explaining why I'm a bit hung up in trying to understand this whole hypertension thing this time around. Of course my main focus has been on whether there's anything that I or the medical team can do to prevent a repeat performance. My primary OB said to me at the first appointment: "Basically the only way to be sure this won't happen again is to not get pregnant. That's not to say you shouldn't get pregnant, but the fact is this is your body's response to pregnancy, and its not your fault and not something you can necessarily control." But the interesting fact I learned on Friday is that pregnancy-induced hypertension only repeats in a second pregnancy about 15% of the time. Now of course I have found myself on the short side of the odds before, but that's still nice to know.

My normal BP is in the one-teens. I think it was 112/75 at my first OB appointment this time. It was at 126/something at the second and 130-something/80 at this latest appointment. All of these are very much in the normal healthy range, but the fact is they are higher than normal for me and they seem to be creeping up. So I asked about medication. This was another tricky thing last time, some docs thought I should medicate, others disagreed, saying we didn't want to "shock" the baby by suddenly dropping my BP, afterall, the baby appeared to be thriving in the high BP conditions until we saw the IUGR in the final weeks. So I had wondered if it would be wise to start medication earlier this time, at the first sign that BP was increasing, to maybe somehow head it off before it was so high. I've asked this question before and keep getting answers like "We just have to keep a close eye on it and see," but this time I got a clear answer: no. We don't want to medicate unless we absolutely HAVE to because there are some risks with medication. We need to keep monitoring it, but the hope is that I will be in the 85% who don't have to go two rounds. I am to stay well hydrated, watch my salt, and not get overly worked up about it. Which all sounds good to me.

June 6, 2009

Halfway

Hard to believe it's 20 weeks already, where has the time gone? I'm feeling fine and everything seems to be on track so far. Next scan to check for IUGR is about four weeks away. Piper's "sprained ankle" has continued to bother her and two weeks later she still has a limp so we saw an orthopedic specialist and it turns out she has a tiny fracture in her shin. My poor baby has been hobbling around on a broken bone. It's apparently not a big deal, very common and healing fine on it's own. They expect it to be sore for a while, thus the limp. We go back in four weeks just to be sure its healing properly.

She's a trooper and otherwise doing well. Seems like such a big girl to me lately. When J comes home she says: Hi Daddy! When I give her a much-requested pretzel she says: Thank you Mommy! Yesterday when she was playing in the tupperware cabinet and I said it was time to get in the car she first put it all back and closed the cabinet before meeting me at the garage door. (Don't get the mistaken impression that we are the center of calm and order. This was a fluke, related to the fact that kids her age do enjoy take-it-out, put-it-back games. If they happen to quit the game after a put-it-back rather than a take-it-out stage you're just lucky.) Despite our fair share of tantrums and time-outs, she's been a happy girl lately. She learned the word on Sesame Street and when I picked her up from her nap yesterday she started beboppin and dancin around saying "happy happy happy."

The passage of time has been on my mind lately. These 20 weeks have flown by and I see Piper's babyhood quickly escaping my grasp. Last weekend I bawled through my niece's two hour dance recital. This was her third year and since I don't see her dance in between, comparing it to her first recital at age 5 and even last year's was unavoidable. How did she ever get to be seven?? There have been some unsettling family events lately that have me appreciating how nice my life is right now, while nervously awaiting the fallout and how it will affect us. As when Piper was first born, I find myself wishing I could just freeze time and keep everything just as it is. I keep thinking of a line that stuck in my head when I read The World According to Garp as a teenager - I can't shake the ominous feeling that the "undertoad" is lurking.