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Pre-conception appt. with MFM - need advice

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Pre-conception appt. with MFM - need advice

Postby Aidensmommy212 » Sun Jun 26, 2011 04:24 pm

by Aidensmommy212 (14 Posts), Sun Jun 26, 2011 04:24 pm

Hi Everyone,
I went to the hospital on Tuesday to have my appointment with the MFM that I saw during some of my hospital stay. Going back to see that doctor, in that hospital, on that floor was incredibly tough but I braved through it because I needed questions answered and to hear her opinion on what happened with me. It was called a "pre-conception visit" although we are not ready to try quite yet (it has only been 4 months and is still pretty fresh for both of us).
Anyways, I brought a list of questions and concerns with me that I compiled from these boards and then just sat and listened to what she had to say. Some of what she said was not surprising but some of it left me shocked and not sure what to make of it. Here's what was covered:

- She said that I would not need to have any blood tests done before conceiving again because they were all done while I was in the hospital and they all came back negative. The only blood test I would need would be as soon as I got pregnant again to use as a baseline for my liver enzymes and platelet numbers.
- Having discussed my case with her, she disagreed with some of her collegues and said that I absolutely DID NOT have HELLP Syndrome. I had been questioning that all along, I just wasn't sure what to make of it (I never had the "H" show up). She really insisted that you need all of the letters to classify as having HELLP.
- She called my case "Severe Pre-eclampsia" even though my blood pressure only hit 140/90 twice and I never had any protein show up in my urine.
- When I asked about how long to wait to try again after having a Classical C-Section, she told me 18 months! Seems like a very long time to me...and also, my OB told me that I should wait about 8 months. That's a HUGE difference.
- I asked what my care would look like the next time I got pregnant and she was very...laid back....about it I guess. She basically told me that I could go on LDA "if I wanted to" because Aiden had IUGR. Other than that, nothing would really change. She would see me along with my OB "if I wanted her to" but she said no bed rest, no taking my blood pressure at home, and that she would let me go full term if I made it that far. This probably shocked me the most about the visit.

I want to be as proactive about my health as possible next time so I feel like I need a 2nd opinion. I know that other drugs are not guaranteed to work (ie. Lovenox), but I feel like it would honestly make me feel better to be doing SOMETHING. I am looking into going to see a different MFM soon and see what he has to say. I feel like if he tells me something different, I won't even know what to do with ANOTHER opinion (whose word do you take on what?). Anyways, any advice/experience that you might have would be really appreciated! Thanks so much!
Last edited by Aidensmommy212 on Sun Jun 26, 2011 07:16 am, edited 1 time in total.
Nikki (28) & hubby Blaine (40)
Mommy to Aiden Blaine - 15 oz./10.5 in. w/ IUGR
Born 2/12/11 @ 24+1 weeks due to Severe PE & HELLP
Lived 10 days, loved and missed more than words can say
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Re: Pre-conception appt. with MFM - need advice

Postby flori » Sun Jun 26, 2011 06:14 pm

by flori (225 Posts), Sun Jun 26, 2011 06:14 pm

Hi Nikki, I re-read your first post about Aiden's birth and it brought me to tears again.

While I am still very early in my grieving, as you are, I have also begun to take steps to try again- one of them being reaching out to different MFMs. Good for you for wanting a second opinion on everything.

I think the first thing that I would seek an answer to is why this MFM doesn't want you to have your blood work redone. At my pp appointment (which I had with my MFM, not the delivering OB) he said that I should wait about 4-6 months before having any preconception blood work done, just to make sure my body had gone back to its pre-pregnancy state.

I also did not have all the symptoms of HELLP (no H, like you) but my MFM still classified it as HELLP because of my liver and platelets. My blood pressure was normal the hours before delivery, but I was told that was still a symptom of pre-eclampsia because it skyrocketed over 140/90 several times when I was having URQ pain. My MFM also said that IUGR was another symptom. I also never had any swelling or weight gain.

I've read on the forums that the longer wait times quoted are usually a way to cover bases, but that 3-6 is enough time to heal. My MFM said one year, but I will probably only wait closer to 8 or 9. I would love to try sooner, but with all the research pointing towards weight loss being a good way to help subsequent pregnancies- I've decided to focus on that.

I am also curious about her approach to lda. I know it's sort of become a staple in IUGR pregnancies, I wonder if your MFM has a reason for her lackadaisical approach to it. I'm going to follow this thread closely because you have the same questions/concerns that I do. Good luck!
Flori, 30
Mommy to Gracie- born at 25 weeks 03/15/11, 11 inches, 1.1lbs, and absolutely beautiful. Became my sweet angel the next day.
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Re: Pre-conception appt. with MFM - need advice

Postby riehlism » Mon Jun 27, 2011 00:58 am

by riehlism (655 Posts), Mon Jun 27, 2011 00:58 am

There are a couple of things I wanted to comment on, but I'm probably going to forget some as I type.

-You are considered severe because you had preeclampsia prior to 32 to weeks (or was it prior to the 3rd trimester...one of thsoe).
-Blood tests. It's pretty odd that she won't repeat it. I saw my OB, more than one MFM, and my hematologist who said it should be done some time after the postpartum period. Tests while you are going through it is not as precise. Again, that's from the various providers I have seen over the course of the last year.
-No bed rest. There is no evidence that shows bed rest actually helps anything. So many docs are on the fence about this.
-Not taking pressures at home. Odd. That seems pretty shocking to me too. Was her reasoning to not alarm you when you take it at home? Or...is it to have another occasion to charge you for a visit? Hmmmmm....

Here's what I went through:
I had tests done in the hospital, and redone a couple of months (?) postpartum. Tests were negative. At the preconception appointment, my MFM said baby aspirin, definitely. Lovenox maybe. Depending on what he sees during the development, he may even add some prednisone, but it is rare to need that.

I started LDA while TTC (it helps with implantation). I started Lovenox at 13 weeks (because that's the earliest I could get to my MFM). I am currently 21.5 with no problems. At this point in my last pregnancy I was getting pressures of 150/104 and had severe PE with HELLP and delivering just 3 weeks later. I checked my BP yesterday and it was 114/72. So far so good.

I share the same questions you have about that MFM appointment. Maybe another MFM may raise fewer questions for you.
Jasmin: Severe PE/HELLP and delivered at 24+6 & PCOS (29) Hubby Bubby, Frank (29)
Baby Blue stopped in to say hello and goodbye on 6/3/10
Baby Lucas was born on 10/13/11, PE and HELLP-free! Thank you baby aspirin and Lovenox
http://www.ehd.org/pregnancy-calendar.php?id=18192
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Re: Pre-conception appt. with MFM - need advice

Postby rwpokluda » Mon Jun 27, 2011 10:28 pm

by rwpokluda (26 Posts), Mon Jun 27, 2011 10:28 pm

Hi Nikki, I was 25 weeks and had both Severe Pre-e and Severe HELLP with my son. I just went through the entire process with two Peris that were fabulous and know a ton about Pre-e and HELLP. I was given the largest round of blood tests I have ever been through to narrow down and mak sure that I had no clotting issues or any thing else that could have caused my problems. They were all neg. If one had been pos I would have been put on a blood thinner. However they did say that no matter what women with our history should take a LDA as a precautionary. Won't hurt and can only help. Also I was put on a very high dose of Folic acid to build up my system. Grandted my son is now 3 so my body has "recovered" but I still have sparatic bp issues. I also have PCOS so I have to take progesterone and metformin to pretreat. But my suggestion is deff get a second opion. If many docs are in dissagreament with your one doctor something isn't right. There is no "laid back" approach when it comes to women with our kind of delivery history. That is one thing I know for certain. My OB who is also one of the MFM specialists made it quite clear that when someone has a history like ours, their pregnancy care is taken quite seriously. I will be having growth scans every 4 weeks and blood and urine checks every 2. With your history you should be considered high risk and there should never be a "if you feel like it" type of attitude. Let me know if you would like the names of my doc and I would be happy to send them to you. Good luck and I am so sorry for your loss. My heart breaks for you. All the best and God bless.
Janna
[color=#FF00BF]Janna
Mommy to Blake born April 26, 2008 at 25 wks 1 lb. 4 oz, 11 in., due to severe Pre-E and severe HELLP, healthy 3 year old boy now![/color]
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Re: Pre-conception appt. with MFM - need advice

Postby rwpokluda » Mon Jun 27, 2011 10:40 pm

by rwpokluda (26 Posts), Mon Jun 27, 2011 10:40 pm

Oh one more thing I forgot when looking back. With a classical c-section scar they will automatically deliver you early due to that incision. I was told by several docs the same thing. I was told that due to my classical c-section scar from my first delivery, yes you have to have that way again you can not have natural, two you will delivery early (this is what they told me) IF I make it to 36/37 weeks I WILL HAVE to deliver then because with that type of scar there is a high risk for that area to rupture if I continue longer. I know sounds scary, but these docs deal with high risk women every day and they don't play around and take it lightly. It is very serious to them when someone comes to them with a history and they take the time to sit and listen and really go through things with you. I don't like the fact that your doc said those things to you. Makes me feel like she just kind of blew you off and that is not cool at all.
[color=#FF00BF]Janna
Mommy to Blake born April 26, 2008 at 25 wks 1 lb. 4 oz, 11 in., due to severe Pre-E and severe HELLP, healthy 3 year old boy now![/color]
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Re: Pre-conception appt. with MFM - need advice

Postby miamibunnie » Tue Jun 28, 2011 02:17 am

by miamibunnie (510 Posts), Tue Jun 28, 2011 02:17 am

Well first of I would definitly schedule for another MFM, to get another opinion. I tell you before I got pregnant this time around I saw 3 drs, the first one told me dont try again because I would not make it this time around since I delivered so early at 24 and 23 wks...today I am almost 34 weeks. The 2nd rejected my care because he did not want to risk...but the third...she was so positive with ne and told me I was going to be put on a strict diet and would be on lovenox although I have no clotting disorder. By the way the 2nd dr rejected me because he was partners with the 1st dr...


So the best thing is to find a dr that will work with u and be honest...my dr from the start told me u r my priority if it happened again before 25 wks she would rescue me....I tell u I am very satisfied with my care.
Lisette 37 Hubby 37
Lisette 36 / Luis 36
1996 25 weeker due to Eclampsia with seizures daughter alive today 15 yrs old " Julyzah Caridad"
2010 23 weeker due to severe preeclampsia my angel left us

2011/27/July we beat preeclampsia and made it to 36.5 weeks 6lbs 1oz baby girl "Kendall Lauren " pe-free just bp started acting up.
Thanks to God, my doctor, Lovenox and Lda.
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Re: Pre-conception appt. with MFM - need advice

Postby Aidensmommy212 » Sun Jul 03, 2011 06:36 pm

by Aidensmommy212 (14 Posts), Sun Jul 03, 2011 06:36 pm

Thank you so much for all of your comments and advice! I feel much better knowing that I have all of you to go to for advice and support when I have any questions or concerns.
After having read all of your comments, I decided to go ahead and make an appointment with a different MFM on 7/21 for a 2nd opinion. This guy is rated in the "100 top docs" in my area and seems to have pretty good patient ratings, so hopefully this one will go better than the last one. Part of me expects to go in and have him tell me the exact opposite of everything I was told at the other appointment. I'm also a little paranoid that I'm going to be told that my care was not handled correctly during my hospital stay (something that I'm sure the other doctor would never admit to seeing that she was in charge of my care). On the up side, it's good to have an opinion that is completely unbiased, this doctor was not connected at all with my case last time so it will be fresh eyes looking at what happened for the first time with no pre-conceived opinions formed already.
Wish me luck! I hope all you ladies out there are doing well! Thanks again.
Nikki (28) & hubby Blaine (40)
Mommy to Aiden Blaine - 15 oz./10.5 in. w/ IUGR
Born 2/12/11 @ 24+1 weeks due to Severe PE & HELLP
Lived 10 days, loved and missed more than words can say
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Re: Pre-conception appt. with MFM - need advice

Postby princesspurr » Fri Jul 15, 2011 08:30 am

by princesspurr (39 Posts), Fri Jul 15, 2011 08:30 am

I would go to a different doc. My docs re-ran my blood tests a few times and they came out different as my body healed and 5 years later a gene mutation finally showed up in the results. If I do get pregnant again I want to be at a different hospital because although they did a good job with me, I feel like my daughter would have made it if she would have been else where. I also had a classic c-section on the inside, my outside was a bikini cut. I was told I would always have to have a c-section, they told me to wait 6 months to at least a year to give me time to heal, both physically and emotionally from the experience. It has been almost 7 years for me, and I have a new hubby so I'm just a ton of variables right now!
I wanted to wish you good luck, and it does get easier and better. I still have days where I will cry over my daughter, but for the most part I just love and miss my angel, but it isn't that pain that it was the first year. The first year was the worst.
Val (32) & Carlos (30)
Married: April 29th 2011
Veronica Rosina, 11/25/2004-11/27/2004
Born at 26.5 weeks because of severe preeclampsia (doc says I was on my way to HELLP but not there yet)
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Re: Pre-conception appt. with MFM - need advice

Postby angieb » Fri Jul 15, 2011 10:21 am

by angieb (1192 Posts), Fri Jul 15, 2011 10:21 am

Definitely see a different MFM, I'm not too impressed with what you've said of that MFM.

Your bloodwork should definitely, ABSOLUTELY, be redone.

18 months is a ridiculous timeframe. We waited 3 months but it took 11 months. I had a healthy second pregnancy and while my OB was doing my second c-section, she said my first incision/scar looked fantastic, she wouldn't have known it was there if she hadn't done it. (BTW, they do a regular low transverse c-section in the future, if they can, usually...they don't like to reopen those classical incisions unless they have to.)

And it doesn't sound like she's planning to be very proactive, which I personally really wouldn't like

My plan was LDA with a + test, lovenox after confirming heartbeat (no underlying conditions but I got sick so early they decided the potential benefits outweighed the risks), monitoring blood pressure at home 2x a day at least, monthly appointments in the first tri, every 2 weeks around the time I got sick, every week in the third trimester. Monthly growth ultrasounds from the beginning and 2x weekly NST's starting at 28 weeks.
Me (29) DH (30)
#1-Olivia Caetlyn-9-28-09-9-28-09, 23+2 wks, emergency classic c-section, class I HELLP, IUGR
#2- Lucas Oliver (rainbow baby)- April 2011, 36+2 wks, HELLP and pre-e free! (lovenox and LDA pregnancy)
#3-Matthew, late October 2012...mostly normal, 37 wks, (lovenox and LDA again)
My blog: http://www.butterflies-and-rainbows.blogspot.com/
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Re: Pre-conception appt. with MFM - need advice

Postby blythe » Mon Jul 18, 2011 01:33 am

by blythe (3060 Posts), Mon Jul 18, 2011 01:33 am

I just wanted to add an alternate experience about c-section scars. Catherine (our Director of Research and one of our moderators) had HELLP and a c-section in her second pregnancy. I'm not sure how long it was between her second and third pregnancy but I am almost positive it was over 18 months. During her repeat section her doctors found that her scar was extremely weak. She attributes the weak scar to complications from her HELLP.
viewtopic.php?f=12&t=38969&p=52463&hilit=tubes#p52463

As for the HELLP vs Severe PE diagnosis, it's my understanding that our experts are comfortable diagnosing "partial HELLP" but I suppose if someone wanted to be a stickler you didn't meet the full research/diagnostic criteria. Family Practice Notebook (read about them here: http://www.fpnotebook.com/about.htm ) says that the diagnostic criteria for severe PE only needs *one* criteria - "One of the following must be present (Hypertension, Proteinuria or Other Criteria)". The "other criteria" listed include fetal growth restriction and thrombocytopenia (low platelets).

So your doctor may not have been wrong, but... that being said, *I* wouldn't be comfortable with the first MFM you described. I just like more monitoring and more collaborative treatment. I hope the next doctor you talk to is a better "fit" for you!
Heather, mom to
#1 7-18-03 - 5#8oz 37 weeks PE/PIH
#2 8-11-06 - 6#14oz 37 weeks PE/PIH
#3 9-10-09 - 5#10oz 37 weeks PE/PIH
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