Thanks to a power outage, I'm rewriting this blog...so I'll try to remember to the best of my pregger brain ability! Yesterday, February 4, 2010, I had my 12 week prenatal appointment with my OB. It was the first time I've gotten to see her with this pregnancy, as it is Kaiser's policy to meet with a nurse practicioner for the first visit. I was looking forward to this appointment, because I had prepared many questions for Dr. Moore and I really like her personality.
I was seen very quickly after I arrived, I was taken back by the nurse to be weighed, have my temp taken and check my bp. I was pleased with the results, I've only gained a pound, my temp was normal and my bp was average, 112/60. I was brought back to my room to wait for Dr. Moore.
When Dr. Moore walked in, she smiled and said, "Well, no preconception visit for you!" I laughed, as I had emailed her days before my positive pregnancy test about having a preconception appointment since my last pregnancy ended with serious complications. I said, "Apparently I'm fertile!" She asked how my symptoms were treating me, which have been relatively mild compared to when I was pregnant with Lily. Then we started in with the conversation surrounding my complications with the last pregnancy, HELLP Syndrome and sever preeclampsia, which lead to the premature delivery of Lily at 36 weeks gestation. I told her, "I'm a giant dork, so I've done tons of research & have some questions written down." She was happy that I was informed and I started my questions:
Q1.) The Preeclampsia Foundation recommends being co-monitored or have consultation services by a MFM Specailist. How does Kaiser approach this & how can we set that up?
A1.) I'll write a referal today for a visit with our perinatologist at the Rock Creek facility. Your 20 week appointment will be with him, rather than with radiology. The perinatologist will perform the ultrasound, reveal the gender of the baby and consult with you regarding your risks & care for HELLP Syndrome & preeclampsia.
Q2.) My research indicates the average reoccurance rate of HELLP is 5-20% & 40-60% for preeclampsia. Due to these risks, expert srecommend close monitoring. What is your definition of close & how will my prenatal schedule look?
A2.) At your 16 week appointment we'll be running baseline preeclampsia labs, in addition to your AFP bloodscreen for Down's, and send you home with a 24-hour urine kit. Your 20 week appointment (as mentioned above) will be with the perinatologist. We'll see you every four weeks until 32 weeks when we'll start seeing you every other week. Unless your bp starts to climb or you experience anyother symptoms of preeclampsia, in which case we'd have you come in immediately.
Q3.) "If she develops severe disease at 28-36 weeks, reoccurance is about 40%; 1/3 will be at the same gestational age." Will this effect the scheduling of my c-section?
A3.) We'll schedule your c-section for 39 weeks & hope you make it to term. We will deliver early if you go into labor naturally, break your bag of waters OR develop HELLP or preeclampsia.
Q4.) When should I begin monitoring my bp at home?
A4.) You can start monitoring anytime, but around 28 weeks you can keep record of your bp. Make sure you rest for 30 minutes prior. If your pressure reads 140/90 or above, it's time to call us or go to L&D.
Q5.) I try to keep hydrated, but I'm not urinating as much with this pregnancy as I did with my first. Could this be because breastfeeding hormones are similar to pregnancy hormones?
A5.) Your body may be used to pregnancy & not as effected as it was with the initial pregnancy. The other reason could be that when we preform a c-section the bladder is disected from the uterus. Therefore, your bladder and uterus may not be touching as they used to & the sensitivity is lessened. Just pay attention to the color of your urine, if it's a clear to pale yellow, you're getting enough fluids.
After our Q&A session, Dr. Moore pulled out the doppler and found the baby's heartbeat! She found it with ease, which surprised me since Lily was hiding & she had to do an u/s. Although it would've been nice to see this baby, I remember how frightened I was when she couldn't find Lily's and the minutes it took her to get the mobile u/s machine felt like an eternity. I pulled out my phone and recorded the baby's heartbeat to play back later for Mike & Lily. I was concentrating so hard on recording the heartbeat, I forgot to ask what the bpm were....oh well! Anyway, it was a relief to hear the heartbeat, but it still doesnt' seem quite real yet. I can't wait to start feeling the baby so it will really sink in!
I was seen very quickly after I arrived, I was taken back by the nurse to be weighed, have my temp taken and check my bp. I was pleased with the results, I've only gained a pound, my temp was normal and my bp was average, 112/60. I was brought back to my room to wait for Dr. Moore.
When Dr. Moore walked in, she smiled and said, "Well, no preconception visit for you!" I laughed, as I had emailed her days before my positive pregnancy test about having a preconception appointment since my last pregnancy ended with serious complications. I said, "Apparently I'm fertile!" She asked how my symptoms were treating me, which have been relatively mild compared to when I was pregnant with Lily. Then we started in with the conversation surrounding my complications with the last pregnancy, HELLP Syndrome and sever preeclampsia, which lead to the premature delivery of Lily at 36 weeks gestation. I told her, "I'm a giant dork, so I've done tons of research & have some questions written down." She was happy that I was informed and I started my questions:
Q1.) The Preeclampsia Foundation recommends being co-monitored or have consultation services by a MFM Specailist. How does Kaiser approach this & how can we set that up?
A1.) I'll write a referal today for a visit with our perinatologist at the Rock Creek facility. Your 20 week appointment will be with him, rather than with radiology. The perinatologist will perform the ultrasound, reveal the gender of the baby and consult with you regarding your risks & care for HELLP Syndrome & preeclampsia.
Q2.) My research indicates the average reoccurance rate of HELLP is 5-20% & 40-60% for preeclampsia. Due to these risks, expert srecommend close monitoring. What is your definition of close & how will my prenatal schedule look?
A2.) At your 16 week appointment we'll be running baseline preeclampsia labs, in addition to your AFP bloodscreen for Down's, and send you home with a 24-hour urine kit. Your 20 week appointment (as mentioned above) will be with the perinatologist. We'll see you every four weeks until 32 weeks when we'll start seeing you every other week. Unless your bp starts to climb or you experience anyother symptoms of preeclampsia, in which case we'd have you come in immediately.
Q3.) "If she develops severe disease at 28-36 weeks, reoccurance is about 40%; 1/3 will be at the same gestational age." Will this effect the scheduling of my c-section?
A3.) We'll schedule your c-section for 39 weeks & hope you make it to term. We will deliver early if you go into labor naturally, break your bag of waters OR develop HELLP or preeclampsia.
Q4.) When should I begin monitoring my bp at home?
A4.) You can start monitoring anytime, but around 28 weeks you can keep record of your bp. Make sure you rest for 30 minutes prior. If your pressure reads 140/90 or above, it's time to call us or go to L&D.
Q5.) I try to keep hydrated, but I'm not urinating as much with this pregnancy as I did with my first. Could this be because breastfeeding hormones are similar to pregnancy hormones?
A5.) Your body may be used to pregnancy & not as effected as it was with the initial pregnancy. The other reason could be that when we preform a c-section the bladder is disected from the uterus. Therefore, your bladder and uterus may not be touching as they used to & the sensitivity is lessened. Just pay attention to the color of your urine, if it's a clear to pale yellow, you're getting enough fluids.
After our Q&A session, Dr. Moore pulled out the doppler and found the baby's heartbeat! She found it with ease, which surprised me since Lily was hiding & she had to do an u/s. Although it would've been nice to see this baby, I remember how frightened I was when she couldn't find Lily's and the minutes it took her to get the mobile u/s machine felt like an eternity. I pulled out my phone and recorded the baby's heartbeat to play back later for Mike & Lily. I was concentrating so hard on recording the heartbeat, I forgot to ask what the bpm were....oh well! Anyway, it was a relief to hear the heartbeat, but it still doesnt' seem quite real yet. I can't wait to start feeling the baby so it will really sink in!
