Friday, May 29, 2009

Postpartum visit and test results.

Well, today was my postpartum appt. I attempted to record it so I wouldn't forget anything but, just my luck, the batteries died shortly after I started taping. So I may miss something but this was the gist:

First of all the test results were in. There wasn't alot they could tell during the autopsy due to extensive maceration (breakdown of tissues due to extended exposure to moisture), autolysis (essentially self-digestion), and liquification of tissues (I know its rather graphic, sorry). The genetic testing came back normal. However, chromosomal testing could not be done due to "the sample" being compromised and failing to produce metaphase cells (a stage of mitosis- contains condensed chromosomes containing genetic information) for analysis. I knew this was possible since I read something that said there was a window after death that the cells need to be collected and grown, and we missed the window. Riley's placenta and membranes were inflamed but the doctor says its most likely due to the window of time between death and delivery. The only result I can't figure out, and didn't get to ask the doctor about is the result of my parvovirus b19 test which had a rather high level (0.0-0.8 is the norm, my result was 5.7)... but I don't have ANY symptoms and I would think in the last month SOMETHING would have shown.

Now that I have the test results out of the way, I asked alot of questions. He said that he can't say 100% that Riley had anencephaly given his gestational age but that the signs fit so he is going to treat me as if he did. I mentioned the appearance on most anencephaly babies and how they differed from Riley's and he said that the difference is most likely due to gestational age as well. I asked what the extent of Riley's Anen was. He said it was pretty extensive and that all he had was a brain stem. I mentioned that I had found online that anencephaly can be caused by excess androgens and that I was concerned that it was caused by me having PCOS, but he said that women with PCOS very rarely, if ever, have androgens high enough to cause something like this and that I had nothing to worry about. I asked what the minimum time we needed to wait to try again and he said that he generally recommends that couples wait until after the first postpartum period and I said well "that could be a year or two for me! *laughs*" so if I haven't had a postpartum period withing the next 8 weeks I am supposed to come in to get something to induce AF. I asked how my next pregnancy would differ from Riley's, care wise and he said that it wouldn't differ all that much. He said other than taking the higher 4mg dose of folic acid that they would probably do an ultrasound at 16 weeks next time instead of waiting for the 20 week one and then doing the 20 week as well. He said that between the 16 week and 20 week ultrasound, if there is a problem that it should be recognizable by then and if nothing is seen by the 20 week ultrasound that he believes we would be in the clear as far as neural tube defects. I can already say that is going to be the longest 20 weeks of my life! I also asked about the testing I had read about online called 'alpha-fetoprotien' (AFP) and he said that they take it a step further and order a similar blood test that measures not only AFP but also 4 other markers that test for chomosomal abnormaities like downs syndrome. I said I deffinitely wanted to get that test next time, if only to give me a heads-up. This time I was blindsided and I don't want to be again. I asked if, given Riley's condition, the risk of an amniocentesis would be warranted and he said no. He did my exam and said that everything was exactly where and how it should be then we continued talking. I said that I understood that many Anen babies died inutero but that I was wondering why his heart was beating so strong one week and literally the next he was gone. He said that there are varying degrees of Anen and the extensive nature of Riley's Anen lead him to believe that there was most likely a heart problem as well and that may have been "the final nail" as they say. However, the autopsy report says "examination of the heart is not possible due to extensive maceration" so I guess we will never know for sure.

Again, I may have asked more questions but I can't remember anymore. BUT there is some humor in all this. If you remember from my post about Riley's delivery I mentioned that the on-call doc (my docs partner) who delivered Riley kept "praising", for lack of a better word, how well I was pushing and my focus and whatnot and he had said he was going to tell my doctor how well I did. Honestly, I didn't expect him to. I mean they have soooo many patients and DH and I were just one couple. I honestly didn't expect him to remember. However, after my exam my doctor backs his seat up and says "by the way, Dr. B talked to me and he really had quite a bit to say on how well you did on pushing, and that he believes you would make an excellent candidate to VBAC again in the future. So, we will definitely have to talk about that again in the future." I couldn't help but blush and giggle. Partially because its nice to be told I CAN do it when my previous doc only ever told me I couldn't so its kinda like a "I told you so" moment, partially because I tend to get embarrassed when people 'praise', again for a lack of better word, me, but more so because I was kinda surprised at the way he really was gung-ho about making sure my doctor knew how well I did.

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