Wednesday, May 13, 2009

Previa or Not Previa: That is the Question

When we last left our Mother Thing, I was in the hospital under observation after the babies and I crashed while I was lying on my back.  Checked into my room (a labor and delivery room because the Special Maternity ward was filled the other Charlotteans pregnant with twins and triplets), everything was looking good.   No contractions at all and the babies' heartbeats were looking great.

I slept for squat that night due to the leftover terbutaline, but whatever.  

The next morning, I felt fine and was ready to go home after a visit from my regular OB and my high risk OB (to check my cervix and placenta).  Then they started monitoring me and noticed I was still having contractions.  Not wanting to risk the whole terbutaline problem again, they started nifedipine/procardia, an off label use of a blood pressure medicine for pre-term contractions that has fewer side effects and is safer for the babies.  The main side effects are headaches, dizziness, a flushed appearance, shaking, and insomnia. Trust me on all of those.  And that's *better* than the side effecs ot  terbutaline! Yeeha!

About mid-morning, we got to to see the high risk OB, Dr. #3 as we call him as he is the third partner in the high risk OB clinic.  A quick check of the babies confirmed that Baby A continues to be on track at exactly the correct rate of development (she always measures whatever day of my pg that we go in for the measure) and Baby B is a giant (measuring a week + ahead of the pg).  Then the doc checked out my previa.

Now, I cannot recall if I have been talking here about visualizing my uterus growing and moving the placenta away from my cervix.  I joke with everyone about it.  So Dr. #3 took a look and had some great news.  He is convinced that not only do I not have a marginal placenta previa, the placenta ends about 2.5 cm away from my cervix and that a vaginal delivery is perfectly fine.  

Good news, eh!?  Except the nurse (Dr. #1's nurse) asked for clarification that something she saw wasn't the edge of the placenta and didn't it touch the cervix.  Nope! Dr. #3 disagreed.  That's not part of the placenta.  No problem with placenta previa and my cervical length is still strong at 44 or 42 mm.  The nurses did not look convinced about the previa and when she took us back to my room suggested that my next appt at the high risk OB, I request Dr. #1 for my ultrasound.

My first thought was the Dr. #1 and Dr. #3 need to get together and work it out because while I think that it's fully possible for my placenta to move away from my cervix, I'm not convinced it moved 2.5 cm in one week.  So is someone wrong?  I don't think so.  Dr. #3 is new to the clinic, but headed up a high risk OB research clinic previously, so no slacker there.  Is Dr. #1 reallllly conservative and happy to recommend a c-section if there's even a chance of a problem? Could be; I don't really know.

I do know this this is not a trivial discrepancy, at least to me.  I'm thinking of this in terms of Alpha/Type I error vs. Beta/Type II error, because that's the way a research psychologist thinks.   

Alpha error is that there is not a relationship, but your research says there is.  That is the possible error Dr. #1 is making:  there is no prevai, he thinks there is.  The result is that  the babies are needlessly delivered before they are ready to make their debut and I have a c-section when I don't need to have one. I want to give them the best chance in this world and let come when they and my body think it's time.  

Beta error is that there is a relationship, but your research says that there isn't.  This is the possible error that Dr. #3 is making: there is previa, but he says there isn't.  The bad outcome here is excessive bleeding and putting my life and Baby A's life in danger.  Obviously, this is bad. And one would want to avoid making a beta error in this case.  However, being too conservative and deciding that an Alpha error is better puts my babies' health at risk needlessly.  

I brought this up to my regular OB at the hospital and he refused to get involved in my discussion about the differences in diagnoses.  (What's the equivalent of the thin blue line that can be applied to doctors?)  I don't think that either doctor is "wrong" or "bad."  I know from my own experiences that data (even hard data with objective numbers) can be interpreted multiple ways.  Both high risk OBs have pointed to same gray, fuzzy parts of the pictures to prove their points.  It meant absolutely nothing to Dave and me.  I do think it shows that this is a lot more subjective analysis than people might believe.  There is no blood test with standardized numbers to compare and make a decision.  The placenta is not waving a flag and going "Over here!  Over here!" 

So am I such a Negative Nancy that I cannot accept the good news that I don't have placenta previa any more (and possibly, never did) or am I such an Objective Olivia that I want the data to add up and make sense to me?  I don't know, but we've decided to request Dr. #2 at our next visit in two weeks to see what he has to say.  He doesn't have a dog in this fight (I have seen both #1 and #3 earlier in the pg), and we might request a group meeting for them to hash this out.   

Thinking that there *might* be a problem is no reason to assuredly say that there *is* a problem.  But then again, I don't want Baby A or me to die. Thank god(dess) for my doula team to help me figure out how to go forward with this.

In the meantime, I continue to visualize my ute moving my placenta up.  And I am curious to see how the next ultrasound goes.    And I'm counting contractions to see if I need to be taking my Procardia.  I'm on the minimal dose now and things appear to be going well.

1 comment:

Carroll said...

Wowza! Somehow I missed that Tuesday post. What a roller coaster ride this has been for you, Anita.

Somehow I feel confident that all the uncertainties *will* be resolved. Your idea of requesting a group meeting sounds like a good one too. As colleagues, they really should be able to discuss/decide/reach consensus, and ultimately put your mind at ease regarding the best process for a positive outcome for you and the babies.

My favorite part of this story? The Dave and Conor Snuggle!


And your new church community full of helpers!!

And that you and the babies are OK!!!