Wednesday, July 1, 2009
Vasa previa - next steps
Well, its official. I certainly do have vasa previa. We went to see the obs today and he gave me the ultrasound report confirming it.
LH came along as well so he could hear what the doctor had to say. He said the next step is to have another ultrasound at 28 weeks to see how things are looking. He said it is possible things will have moved around but we just have to wait and see.
He didn't want to commit to a management plan at the moment, but said an elective caesarian was definitely on the cards. He said this might be possible at 37 weeks or maybe earlier if there are other complications such as bleeding. He also said monitoring in hospital beforehand might happen dependiong on how things look.
He said that in 25 years of practicing obstetrics, it was the earliest diagnosis he had seen of vasa previa. I guess most are found when bleeding happens or worse, during labour. So I am one of the lucky ones.
He also reassured me that the vasa previa won't affect the babies' development in the uterus and it doesn't cause an increase in premature birth.
Apparently premature birth happens in 7% of cases, so it could happen to me, but at the moment, there's no reason to expect it.
My instructions from now until week 28 are no sexual intercourse and to go straight to the labour ward at the nearest hospital if there is any sign at all of red, fresh bleeding.
Since the baby isn't viable out of the womb yet, we don't have to think about going into labour so we are good to go away on our holiday at 24 weeks.
He did say that after 28 weeks, we need to be near a hospital but not to get too obsessive about this. He also said don't go away on holidays to central Aust or somewhere that there are no hospitals around. We weren't planning on it, so that's ok.
So its back to taking things one day at a time. I figure I may as well try to relax as much as I can during the next month since there isn't anything we can do, whatever happens. We will just take things as they come after that.
I feel reassured having talked to the obs about it. He knows exactly what the condition is and how to manage it. I think seeing how things go with the ultrasounds is a good plan.
Lovely husband didn't feel so reassured though. He was looking for a finalised plan of action, statistics of the likelihood of different things happening and so on. I said this isn't how doctors work. They like to have test results before they make plans and I am ok with that.
I am feeling more positive and we still both believe that E3 will survive and be fine. My main concern is managing the anxiety between now and then without driving myself over the edge with worry as time goes on.
LH came along as well so he could hear what the doctor had to say. He said the next step is to have another ultrasound at 28 weeks to see how things are looking. He said it is possible things will have moved around but we just have to wait and see.
He didn't want to commit to a management plan at the moment, but said an elective caesarian was definitely on the cards. He said this might be possible at 37 weeks or maybe earlier if there are other complications such as bleeding. He also said monitoring in hospital beforehand might happen dependiong on how things look.
He said that in 25 years of practicing obstetrics, it was the earliest diagnosis he had seen of vasa previa. I guess most are found when bleeding happens or worse, during labour. So I am one of the lucky ones.
He also reassured me that the vasa previa won't affect the babies' development in the uterus and it doesn't cause an increase in premature birth.
Apparently premature birth happens in 7% of cases, so it could happen to me, but at the moment, there's no reason to expect it.
My instructions from now until week 28 are no sexual intercourse and to go straight to the labour ward at the nearest hospital if there is any sign at all of red, fresh bleeding.
Since the baby isn't viable out of the womb yet, we don't have to think about going into labour so we are good to go away on our holiday at 24 weeks.
He did say that after 28 weeks, we need to be near a hospital but not to get too obsessive about this. He also said don't go away on holidays to central Aust or somewhere that there are no hospitals around. We weren't planning on it, so that's ok.
So its back to taking things one day at a time. I figure I may as well try to relax as much as I can during the next month since there isn't anything we can do, whatever happens. We will just take things as they come after that.
I feel reassured having talked to the obs about it. He knows exactly what the condition is and how to manage it. I think seeing how things go with the ultrasounds is a good plan.
Lovely husband didn't feel so reassured though. He was looking for a finalised plan of action, statistics of the likelihood of different things happening and so on. I said this isn't how doctors work. They like to have test results before they make plans and I am ok with that.
I am feeling more positive and we still both believe that E3 will survive and be fine. My main concern is managing the anxiety between now and then without driving myself over the edge with worry as time goes on.
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1 comment:
Dear "That Girl"
My name is Natasha Donnolley and I think Jennifer from the IVPF might have mentioned me in a previous comment to your blog. I live in Oz (used to live in Sydney now at Port Stephens) and I am a Director of the IVPF.
The posts from the IVPF aren't meant to scare you, but we do have the most up-to-date information and management recommendations on Vasa Previa available. Unfortunately many obstetricians are not aware of the latest info, some even treat it like placenta praevia and babies die. VP rarely resolves and if the vessels supposedly have moved in later scans it is usually because the initial diagnosis was incorrect. Depending on which type of VP you have (velamentous insertion or bilobed placenta) it is extremely unlikely that the vessels will clear the cervix and it won't just be possible that you will have a CS but it is definite. Not only that, there IS a higher rate of premature rupture of membranes with VP (not necessarily premature labour) and if this happens, it doesn't matter how close you are to the hospital, if you are not actually in the hospital at the time of rupture your baby will almost certainly die. Sorry to be so blunt, but it takes only minutes for a baby to lose its full blood load and those exposed vessels are extremely fragile. We are only aware of a handful of cases where the membranes have ruptured without the vessels tearing as well. We also have cases where the vessels have ruptured internally without the membranes having ruptured and the baby has slowly bled to death inutero. Sorry for the scary info, but you have been given a huge gift by being diagnosed - many women are not. As hard as it is to believe, your doctor may not know everything he needs to about VP. I have personally battled with several obstetricians in Aus and NZ to fight for women to be managed according to the IVPF recommendations (backed by the world's leading experts on VP). As a result, their babies were born alive and healthy. It is only under very rare circumstances that outpatient management is recommended. Otherwise you should be hospitalised from 30-31 weeks and a CS at 35-36 weeks at the latest. These dates are based on the largest study of VP undertaken (authored by Dr Yinka Oyelese) and are based on balancing the risk of premature rupture and prematurity issues. If you would like to email me or call me please do. tash@donnolley.com. I am happy to help in any way I can.
Regards
Natasha Donnolley
Director
International Vasa Previa Foundation
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