Perinatal Visit

Today was my appointment with the Perinatal Specialist - Dr. Dickson. He's a doctor that specializes in high risk pregnancies - which I am. As if the gastric bypass surgery, the back surgery, the back pain medications, the second stomach surgery weren't enough, my body added in the incompetent cervix with Christopher. So I'm one fun risk after another now.


(This is "Squish" at 5 weeks, 6 days. This is my uterus. The white "V" is pointing down to the white spot that is his heartbeat. The round up in the upper right hand side is the amniotic sac - it sort of makes up that whole upper right area.)

The good news is that there is in fact only one baby in there. I asked the ultrasound tech to make sure because my mother-in-law had a dream that we were having twins. The tech looked around and said there was only one baby in there. I was also right in that squish is only measuring at 6 weeks, not 7. I spent enough years trying to get pregnant that I know how to find out when you ovulate. Most women ovulate on the 14th day of their cycle, I ovulated on day 22 - so I'm measuring a week behind based on the first day of my last period, which is what they normally go by. Right now squish is due around the 26th of June - I was told to expect to deliver early.

Dr. Dickson did say that our loss of Christopher was a pretty 'classic' case of incompetent cervix. Except for the fact that I caught the issue before the baby was born. Dr. Dickson did tell me that had he been my doctor at the time he would have probably forced the issue on delivering Christopher as soon as they saw the sac outside of my cervix and the liquid level in the amniotic sac. At the same time, he said that not many people would have been willing to do all that I did to try to save Christopher. That is one thing I have a lot of trouble accepting, it's hard for me to imagine that people wouldn't be willing to do whatever it took to possibly save their baby, but Dr. Dickson made it sound like most women wouldn't risk it.

The plan right now is that I see Dr. Leeds (my second OB at Sun Life) a week from Monday. She will probably schedule a visit a month from then to see me. I'll see Dr. Dickson in six weeks. At the six week visit - 12 weeks gestation - they will do a test called the "NT" test - Nuclotransulency test. (Around the first or second week in December). The test is one they do to check for birth defects and things like Downs Syndrome. They will do a thorough ultrasound at that point, checking my cervix then, and will schedule me for my cerclage.

I was told the cerclage would be done between 12 and 14 weeks gestation, right around Christmastime. What the cerclage is basically the doctor going in surgically and putting a purse string on my cervix. They pull the string tight to make sure that the cervix doesn't open. Kind of like the pull ties on a trash bag.

When they perform the surgery they normally do an epidural block to keep the patient from feeling what is going on down there while they perform the surgery. Dr. Dickson said that for me they would not do it that way. There is just too much damage already done to my spine to risk it. So they will do general anesthesia for me instead.

The risks with the cerclage are infection and miscarriage. Infection is an issue any time any part of you is exposed to outside elements. They normally put you on antibiotics at the hospital to prevent infection, and keep it in check in the off chance it happens. Miscarriage is another risk, when they go in to do the cerclage they use a needle, which can poke the amniotic sac and cause it to leak, which could cause a miscarriage. Also all that activity and them messing with your cervix could cause you to have contractions - the contractions if they get bad enough could cause the baby to be born, or even rip the area the ceclage is stitched too. Dr. Dickson said he's never had a case where that happened.

Once the cerclage is in place I'll have ultrasounds done every two weeks to check my cervical length, and look for funneling. What happens with incompetent cervix is that the weight of the baby puts so much pressure on your cervix that it starts opening up the top, as the top widens, the length of the cervix shortens forming a cone. The ceclage's job is to make sure that your cervix cannot funnel past that point.

IF my cervix starts showing signs of funneling or shortening I'll be put on serious bed rest, or hospitalized depending on how bad it is. If they are worried about the stitch holding they may go in and place another cerclage but that is highly unlikely from what Dr. Dickson said.

I was told right now to take it easy, and start getting used to making sure to get in some time each day with my feet up. Dr. Dickson said to expect some sort of bed rest, probably about 4 hours each day of laying horizontal with no pressure on my cervix. I was told to start working at not staying on my feet for long lengths of time, because once the cerclage is in place he won't want me on my feet for more than two hours at any given point. I was told get all my walking done prior to the cerclage placement.

At around 14 weeks I'll start getting steroid shots to help the babies body mature a little more quickly. This was in case squish is born early he'll have a better chance of survival. I was told that the risks of the shot are minimal compared to the chance of squish not making it if he's born too early.

For now I guess that's it. Most everything else is a "we'll cross that bridge if and when we get there". To just take it easy, not out do things, more rules will get put in place when the cerclage is put in, and depending on what my cervix does. Dr. Dickson did agree that avoiding surgeries and house fires during the pregnancy would probably be a good idea. Both of us are hoping for a boring pregnancy other than the frequent check ups.

My goals right now are:
Get pregnant. (CHECK)
Get to see the baby in there. (CHECK)
Get to see Squishes heart beat on the monitor. (CHECK)
Get to the second trimester. (When the chance of miscarriage goes way down.)
Have the cerclage put in place.
Get to the point I can have the shots done.
Find out what we are having, a boy or girl.
Pick a name.
22 weeks - the point when we lost our Christopher.
Hit 24 weeks - the point where if Squish is born early there is a chance he'll live.
Hit the third trimester - most babies born in the third trimester make it.
Hit 34 weeks - the point where hospital stays are minimum and the baby is mostly developed.
35 weeks - the point where they will go in and take the cerclage out.
After that it's keep the baby in as long as possible.
Bring our baby home, and not lose our sanity (okay, what passes for sanity in my world).