Tuesday, February 20, 2007

Baby Drama Tuesday, Back on Schedule

Goddammit. When trusty assistant called first thing this morning, I asked, “Are we gonna do this the easy way or the hard way?” Naturally, we’re going the hard way.

The Fetal Fibronectin Test (fFN) results came back positive. What does that mean, you ask? Good question. Here is what I have learned. Don’t quote me on any of this.

A negative result means a 1% chance of going into labor in the next two weeks. Negative would’ve been good.

Positive is much less clear. There is a 40-60% chance that I’ll go into labor in the next two weeks. There are lots of false positives. False positives come from having sex, a vaginal u/s, or a manual exam prior to doing the fFn swab. I did none of those things. False positives are also sometimes inexplicable.

The fFN test measures a protein that is present in the cervicovaginal secretions when labor is imminent. The protein “reflects mechanical or inflammatory damage to the membranes or the placenta.”

There are four situations that can cause the damage:

-activation of labor through the hypothalamus-pituitary-adrenal axis, which is brought on by stress; good thing I’m not stressed out by this whole situation
-a problem with the uterus
-a problem with the placenta such as abruption
-my least favorite, infection.

I was not happy to see infection on that list because as you well know, infection is what ended LC’s life at 23 weeks. The cerclage is a breeding ground for infection, being a foreign body and all. My understanding of an infection is that by the time I would have symptoms, it’ll be too late to save the baby.

I wish I’d been having regular urine and even blood cultures done to monitor any signs of an infection brewing. I have an appt. tomorrow and will certainly be asking for cultures to be done. Maybe we can discover an infection before it gets into the placenta where it is untreatable.

The other problem with the cerclage is that it puts me at risk for pre-term labor, as does incompetent cervix and a prior LEEP procedure. The fFN test is more predictive of labor with women who are high-risk and are symptomatic.

Am I symptomatic? The contractions are certainly a concern. I don’t know why I am having them although I know I had them, albeit less frequently and later on, in prior pregnancies. They could be doing damage to the placenta that is causing the protein to show up.

Another reason that fFN shows up is a problem with the placenta. This reminds me that about my elevated hCG level that was 3x normal. Elevated hCG is associated with placental problems. Fancy doc wasn’t concerned about that, naturally, but it makes sense to me that a placental problem could be showing up now via detection of fFN.

The placental problem disaster scenario reminds me that I haven’t had an u/s since early January for the amnio. Things could be happening in there. I have an u/s scheduled for tomorrow. I am most eager to see what’s going on in there. I love the idea that I can actually have a look in there instead of just wondering.

So far the list of things that’ll keep me up tonight:

-positive fFn, as high as 60% chance of labor in the next two weeks
-cerclage breeding infection, infection causing fFn to show up, infection kills baby
-damage to the cerclage from contractions, causing fFn to show up
-elevated hCG coming back to haunt me in the form of a placental problem
-I haven’t had an u/s since early January
-I haven’t had a urine or blood culture since I can’t remember when
-the pinchy, ouchy pressure that I’ve been feeling could be… something, I don’t know what

So fancy doc, once again, is not concerned. Sometimes I wonder what it will take to raise an eyebrow on this guy. Is he just trying to keep me calm? As if. Tomorrow I want to ask him, “If this thing goes south, will there be anything that you regret not doing?” In other words, “Are we doing everything we can to make this happen?”

During the course of my morning’s research, I came across the ACOG practice bulletin’s flowchart for pre-term labor issues. Basically, regarding bedrest, it says something like don’t prescribe it routinely because it doesn’t work. That really discouraged me because resting feels like the only thing that I can do. I feel safer when I am resting. I imagine that I can keep my baby safer if I rest. Bottom line I think is that I can’t. I can’t keep my baby safe. If this is going to happen soon there is nothing that I can do about it. That, my friends, is depressing.


Blogger Bri said...

Crap. Hm. Well, I am very glad you are having a look and some more time for questions - please get good and pushy on his ass because I worry about you and his strange, lax ways. I will be thinking of you. Keep us posted. And I say keep resting. I can't believe it doesn't help.

3:42 PM  
Anonymous amy said...

that is depressing. i'll be holding my breath until you post again. sending you all the best in the meantime...

4:02 PM  
Blogger AJ said...

Thinking of you. Lots.

5:28 PM  
Anonymous j said...

fuckety fuck. Agreeing with Bri. Press this guy for some serious answers. We want this kid, in you, for way longer than two more weeks. For serious. Thoughts with you.

5:57 PM  
Blogger charlotte said...

I was thinking after we talked today that Fancy Doc really needs to spend some SERIOUS time with you tomorrow, and you really should press him for a consultation with another doc.

6:03 PM  
Blogger bleu said...

Hi, I am so sorry you are dealing with this. While I am not familiar with this I am wondering if they could also, along with doing the damn u/s and cultures, put you on a round of ABX. I am the last person to suggest ABX usually, but since you won't have symptoms til too late wouldn't it make sense?
Just my line of thinking of things to possibly try to avoid possible yucky things.

6:55 PM  
Anonymous kari said...

you would really think fancy doc would take everything more seriously after the horror of last time. i'm pissed at him for ignoring your concerns abt the contractions. and really, why wouldn't they be checking for infection all the damn time? but anyway, positives on those tests don't necessarily mean anything bad. and that's what i choose to believe is going on. nothing bad. thinking of you.

8:03 PM  
Blogger BethGo said...

Oh Honey. This just sucks. I don't even know what to say.
I've experienced my own pain with this having babies stuff but I don't have any advice for you that will help and not sound like assvice.
There is so much about this situation that you can't control right now. That must be so hard.
Just breathe I guess. I don't know.

I'm thinking of you

11:15 PM  
Blogger Tamsin said...

Wow. That is a lot to worry about, and with good reason.

I so hope that none of it comes to pass though.

1:06 AM  
Blogger Truck Driver Wife said...


Saying extra prayers for you and that baby tonight.

6:16 AM  
Blogger Elizabeth said...

My fFN came back positive with both of my pregnancies. My first baby was born the next day (born at 26 weeks, 6 days), my second son held on for almost 3 more weeks (born at 35 weeks, 4 days). (I had a cerclage with #2.)

6:03 AM  

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