amnion chorion separation

27 weeks and counting!

We have hit the 27 week mark and celebrated the last week of the second trimester with a big appointment at the OB office, complete with a follow-up ultrasound.  I have spent the last week in frequent contact with my OB office and on frequent bed rest due to a headache that wouldn’t go away, blurred vision, and high blood pressures.  All of these are unfortunately signs of preeclampsia.  Preeclampsia is a dangerous condition that can affect 5-8% of pregnancies, but that typically starts later in the third trimester (Preeclampsia Foundation).  For me to be having signs of this condition this early into the pregnancy was scary to say the least.  Thankfully my blood pressure has been staying down with bed rest.  Unfortunately Tylenol has not been effective for the headaches or blurred vision for me and I stopped taking it after a few days due to the ineffectiveness and some right upper quadrant abdominal pain (which can indicate liver problems).    So I ventured into this appointment with my Mom at my side (my husband was unable to take the day off of work) with a bit of trepidation.

First up was the ultrasound.  Catriona is a bit of a mover and a shaker so it created a challenge for picture-taking, but everything look great.  The fluid levels were good, the placenta is healthy, her head is down and she is ready to roll and the best news of all is that the membranes fused!  Although there are still some (slight) risks for early delivery that go along with a late fusion we are now talking a week or two early as opposed to months early which technically means we have an excellent chance for a full term (after 37 weeks) healthy and happy baby.  Now lets just hope that she doesn’t come on Liam’s birthday!  Thank you everyone for your thoughts and prayers for the last few months that we would get our miracle, they certainly helped to get us through this stressful time.  We feel so lucky to have this great news to share and to see how healthy our little girl is now that my body has decided to behave properly!

Next up was the visit with the nurse midwife and the OB.  It was a tag team visit due to the high blood pressures today, that ended up with a trip to the hospital.  While we have an excellent health care system up here in the Northeast, and some of the best prenatal care in the country, it is still very concerning to have more than a week of high blood pressures and headaches, so it was off to the hospital for me to test for preeclampsia ( a set of tests that includes a urine collection, liver function panel, creatinine, and CBC), and calling out of work for at least the next week until my next OB visit.  The midwife and OB were hopeful that the headaches, blurred vision, and high blood pressures (because they were not critically high and were only pre-hypertensive) could be due to a migraine headache caused by increased estrogen levels rather than preeclampsia because it was so early in the pregnancy.  After a couple of hours in the hospital, and a couple of blood draws we had our second round of good news for the day, no preeclampsia!  I am now on migraine medication and monitoring side effects, but my blood pressure is almost back to normal and right now I am pain free for the first time in 8 days (though a bit foggy and tired from the medication).

 

 

For me the best part of the day was being able to make it home in time to tuck my little guy into bed.  He loved seeing the new pictures of his sister and was so happy to get some extra Momma snuggles tonight!

Conan and I are thrilled with the news, and are very hopeful that after the next week life will get back to as close to normal as we can!  Thank you again to everyone for the thoughts and prayers!  Lets hope the remainder of the pregnancy is now stress free!

 

*****Preeclampsia is a pretty scary and potentially life threatening condition that affects 5-8% of pregnancies in the United States and accounts for approximately 18% of maternal deaths in this country.  To educate yourself more on this condition please visit preeclampsia.org which provides excellent resources in learning the signs and symptoms of preeclampsia.  Also keep in mind that while giving birth does solve the problems caused by preeclampsia for your infant it does not always solve the problems caused by it for mothers.  Be aware and educate yourself on the potential post birth problems that can occur for mothers who experience this condition.*****

Preeclampsia Foundation. (n.d.). Preeclampsia Foundation. Retrieved February 19, 2015, from Preeclampsia Fact Sheet : http://www.preeclampsia.org/pdf/Preeclampsia%20Fact%20sheet%20v2.pdf

 

Congratulations, It’s a Girl, but wait…. (Learning about Amnion-Chorion Separation)

I have been absent from the world of blogging for a few months.  Some of it is just simply from a lack of time due to the holidays and work becoming busier than ever.  The last few weeks have been purposeful though as I have been (and continue to at this time) sorting through the emotions that have ensued since our 19 week ultrasound.

That is right, we had an ultrasound that showed number two is officially a little girl!  Liam is going to have a little sister to torture 🙂

The day of the ultrasound my husband, Liam, and I met my parents at the doctor’s office.  My parents stayed long enough to hear that they were going to have a granddaughter, and then headed back out to the waiting room play area while the little girl continued her second photo shoot (we had a dating ultrasound at 9 weeks).  She was being quite active at that point in time and I figured that was causing things to take longer than they had with Liam.  Now I suspect something different.  As the sonographer finished up she made one quick comment about the membranes not being fused and then handed us our pictures and showed us to our room for the checkup I had scheduled after the ultrasound.  There we waited…. and waited….. and kept ourselves busy looking over the pictures and discussing what we thought life would be like with a little girl…. and waited some more.  I suggested that maybe an emergency had occurred and that is why they were running late.  I never suspected that the reason they were running late was the quick comment at the end of the ultrasound, though it had apparently crossed my husbands mind as he asked what it meant, to which I replied that I had no clue, membranes not fusing was not something I could recall being discussed in nursing school.

Thirty minutes later our nurse midwife walked into the room apologizing for being late.  The reason, she explained was because she had to make a phone call to the high risk pregnancy specialist in the area regarding the ultrasound.  Inside the uterus there are two membranes, the amnion and chorion, that typically fuse by week 17, mine have not at week 19.  It is extremely rare for this to happen. So rare that no one (including the high risk specialist) have ever seen it. Unfortunately with rarity and lack of study comes a lack of answers. My nurse practitioner was unable to provide me with much to go on other than to:

1. Not stress out about it too much.
2. Take it as easy as I could
3. Prepare for a follow-up ultrasound at 27 or 28 weeks and then frequent trips to the high risk specialist after that.

Being the person that I am I (of course) could not tolerate the lack of answers as to what exactly the prognosis was for my daughter and myself, and so I have spent the last few weeks scouring medical journals searching for answers. I consider myself to be fairly adept at research having spent over a decade fine tuning my research skills while obtaining various college degrees. For the first time ever my searches were leading to mostly dead ends. After several weeks I found a grand total of one research study that focused on this condition in a medical journal. One single study to supply me with a prognosis and potential recommendations.

The prognosis itself isn’t great, though it could certainly be worse  If our little girl can make it through the next few weeks thing will look a little brighter, but it seems the major danger with the membranes not fusing is that they can get tangled around the umbilical cord cutting off the babies oxygen supply.  The lifting restriction and directions to stop and rest every couple of hours when at work are so very important for me to follow, and are constantly on my mind.  Drinking enough water to keep my fluid levels up is also extremely important.  I breathe a sigh of relief every time she kicks.  After 28 weeks the trips to the high risk specialist will be to make sure she is still living in an environment where she can thrive and grow.  There is a risk of IUGR (intrauterine growth restriction) which can result in developmental delays, and she will almost certainly be a smaller baby.  It seems that every person that has been through this (the handful I could find across the country) has been put on bed rest or modified bed rest by 35 weeks…. so I am mentally preparing myself for that as well.

My husband and I are focused on staying positive.  At the same time we are preparing a room and sorting clothes for a baby who might not make it home.  I am keeping myself as busy as I can to continue to help distract myself from the reality of the situation while trying to enjoy every single moment I have with our little girl.  She is already a feisty little one who kicks much harder than her brother did at 23 weeks, especially when her puppy brothers start barking!  We have decided to name her Catriona Dawn…. Liam can’t quite get that out, but calls her “Ona” for short and frequently gives her “kisses” through Momma’s belly.  Catriona is already loved immensely and we truly hope that with precautions and my general state of healthfulness (otherwise) we will beat the 50/50 odds and enjoy a happy healthy little girl.

Without further ado…. the star of the show 🙂

 

19 weeks, posing at her second official photoshoot

19 weeks, posing at her second official photo shoot

 

And a picture of the bump at 20 weeks 🙂

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20 weeks, halfway there!

Are you interested in learning more about Amnion-Chorion separation?  The most helpful website that I was able to find with recommendations was from a San Diego practitioner and can be found here.

Do you enjoy reading research papers as much as I do?  You too can enjoy the only research I was able to find on the subject here.  You will note that I did not mention the increased chance for Trisomy 21 during my discussion.  I do not feel that the risk is all that much higher than it would have been without the amnion chorion separation as our scan was normal and the other testing we have had done has not (yet) come back abnormal.  Keep in mind that I am not an expert in this field, the area of medicine that I practice in is geriatrics.

It seems that diagnosis of Amnion-Chorion separation is increasing thanks to improvements in ultrasound technology, hopefully the odds for successful outcomes will increase with the increase in diagnosis.  My hope for the future for women who receive this diagnosis is that the recommendations for Mom during the pregnancy can be fine tuned and more concrete 🙂