Questions before consult

[julie f]

Hey all, I need some help! Here's a little background: (I promise there is a point to this and a question at the end [;)].)

I have a meeting with my OB on the 16th to discuss trying again sometime after January and, I want to ask her these questions but, would like to get some info from yall first. She will be my primary provider during a future pregnancy but it will be comanaged with a peri. Both her and the peri delivered my son in July. In September, she sent me for a consult with the peri to discuss future pregnancies and to be tested for all of the various possible predispositions. He tested me for everything, except Factor V, and all came back normal. He said that the Factor V test was not necessary. My doctor also referred me to a peri at a large teaching hospital to see if I might be able to get any more info from a 2nd opinion. The 2nd peri reviewed my records and said all looks well, I should have a full-termer next time... (While I appreciate her optimisim, I was a little thrown off by her casualness...) I asked her about the Factor V test, should it be performed? She said no, that all my other test results were fine so, she would not expect that the Factor V test would be any different.

Ok, here's my questions -
1. Should I insist that the Factor V test be performed?
2. Both peris recommended taking 81mg of aspirin each day when pg. However, one recommended that I start taking it immediately upon conception, the other (the one who will be comanaging my care) recommended that I start taking it AFTER the heartbeat has been established. From all I've read, it seems most beneficial to start taking it early but, I wanted to see what everyone else's doctors have done.

Thanks so much for any experience you can share with me.

Julie
Zachary James, 7/22/03-7/27/03, born at 26 weeks due to severe pe

[catherine]

Both seem eminently reasonable questions to me Julie. The trick might be to follow up on the answers. If not, why not. Ask about the "science" of the answer. I do think that it is very valuable to have a "non pregnant" baseline so you are ahead of the game there. I didn't get the broader panel of screens done until I was already 13 weeks pregnant with Chloe. I was essentially normal but with one borderline low. Problem is that values alter with pregnancy. I wasn't sure whether to respond to it or not, I would consider the non-pregnant values more significant. So, it wasn't until that point that baby asprin came up for discussion.

We had an unplanned pregnancy and I didn't even know I was pregnant. I thought that I was only 7-8 weeks along at most and had trouble getting an appointment. I had to convince the secretary at the office to get me in a) by reminding her what had happened "last time" and b) by telling her that I wasn't telling my husband until I'd seen my OB! The latter was the more successful approach. A question that I would ask would be whether they would to see you pretty early in your pregnancy especially if you start baby asprin straight away instead of 10- 12 weeks which seems to be the way things are going. To see a heartbeat at 8 weeks on U/S is such a reassuring sight. I've been there many times and when things are going well it really brings comfort. Admittedly last time around I was kind of stunned to see a head, arms and legs instead of a "bean" but there you go!!!!

Enjoy trying,

Catherine (37)
DH, Dave (40)
Finn (6)
Lucy (2)
Chloe (7/2/03)

[annegarrett]

Doctors vary about the Factor V Leiden test. Dr. Easterling says it is actually relatively common so ultimately not necessarily helpful to test for it. The PF has no opinion "officially" on that test so we can encourage or discourage you from insisting on it. I think what you want to find out is if your blood tends to be sluggish...and so asking them their rationale about the aspirin is important. Major studies are very unimpressive about aspirin and most specialists at the NASSHP do not recommend it. HOWEVER, there is a subset of women for whom it clearly makes a difference. Those women though have been screened for what is called "thrombophilias". I think it would be reasonable to say--I am unsure about using LDA therapy without being properly screened for thrombophilias. Otherwise, I personally would feel like it was a shot in the dark.

That is my two-cents and as always--"not a doctor" but as a woman who has had this disease...

Anne Garrett
Executive Director
Preeclampsia Foundation

[tahoe4]

In my opinion, it is extremely important to be tested for Factor V Leiden. I had a series of 10 blood tests taken after my first bought with eclampsia and I was found to have Factor V Leiden, but all of my other tests were normal. If you had blood clots in your placenta (and you probably did if you had pre-eclampsia)then you should find out if you have a clotting disorder. You can be put on blood thinners to help aleviate blood clots so if I were you I'd definitely insist on that test.