Preeclampsia?

[Guest]

Dr Cusick,

After suffering from infertility for several years, my husband and I conceived on our first try with IVF/ICSI. Other than hypothyroidism, I was a healthy 33 year old (turned 34 the day before beta). My hypothyroidism had been controlled for 4 years with levothyroxine. After the positive beta, I continued progesterone supplementation until approximately 10 or 11 weeks and low dose baby aspirin until +/-21 weeks when my OB told me to stop because there were risks to the fetus in the 3rd trimester.







1.

2. Would you recommend treatment with heparin in a subsequent pregnancy? If so, when would you recommend starting injections? Day of transfer? Positive beta? Day cardiac activity is confirmed?

3. Is it possible for someone to test negative for autoimmune & blood clotting disorders to develop them only when pregnant?

4. Is the one gene mutation of MTHFR considered a clotting disorder? (Homocystien levels were normal.)

5. What are your thoughts on recurrence of preeclampsia?

I want to thank you in advance for you help.
Becky

[Bill Cusick MD]

Becky

Sorry for your loss- there is little you/we can do for women who develop severe preeclampsia as early as you did- although controversial in some eyes, baby ASA started early in a pregnancy may delay or slow the development of preeclampsia- stopping it at 21 weeks would not have had any impact. in fact the benefits of baby ASA are best realized when the med is started early in pregnancy (does not help when started in the mid-trimester)

Recurrence risk with a singleton pregnancy is 66%, with a 1/3 of these cases occuring in the 2nd trimester

There is an association between the blood clotting issue and wome with severe, early preeclampsia- had one been found, the standard recommendation would be to add Heparin to the treatement plan. Other women who might consider Heparin, despite lack of proven value, would be those who have failed baby ASA alone in prior pregnancy or those with a negative work-up but a placenta showing major clotting abnormailities.

Hope this helps-

wc

[lvazquez]

Hi Becky-

I lost my 3rd baby 7 months ago. I have two other boys who were born prematurely at 32 and another at 34 weeks. This last baby was stillborn at 30 weeks exactly. I saw a perinatologist for 2 visits in mid-Dec. and in early Jan. I too had a MTHFR gene and also factor V Leiden. I guess both spell not so great news. It was recommended that I go on a Heparin pump (full blown heparinzation!) at 21 weeks. I was really scared about doing that. I wish that my doc would've had the decency to at least talk with me over the phone when I had questions the next day, but he refused. No one in AZ will talk to you for free over the phone. In CA, it seems like people will bend over backwards (blue state) Just an observation as I've met with a few IVF clinics, surrogacy agencies, and attorneys w/ surrogacy law over the past few months.

I did a tubal ligation, and I guess I can't reverse it? I'm too high risk to get pregnant again really and the fact that I can't even carry a baby past 34 weeks isn't great. I honestly don't know what I would do. I was on baby aspirin with all (3) pregnancies. With my first, about half way through because I started to enter that pre-eclampsia stage. I took it with my 2nd and 3rd pregnancies right after my first prenatal appointment. I too was told that pre-eclampsia wouldn't necessarily reoccur in the 2nd pregnancy and if it did, perhaps later on in the 3rd trimester.

Baby aspirin is enough for most folks, but other need Heparin whether it's twice daily injections or the pump. I didn't do it. I ended up with a bloodclot. Did the abruption kill the baby or did i get the clot first and then that caused the abruption? I'll never know. We refused an autopsy. It was such a hard decision to make at the time.

All I know, is that nurses and docs need to LISTEN to their patients. The nurses should've called that guy and woke him up! I don't care if it's in the middle of the night, do your job, and look after your pregnant patients, that's your job! Went in to the medical field to help people, so let's do that. These people make A LOT of money (more than teachers anyway) and at least they can pick up the phone and call the appropriate people.

Sorry to vent, but it's been one of those horrible days. I applaud you for trying again. You are a strong and brave woman. I wish you the best of luck with everything. You sound like you know what you're doing. Keep asking those questions, push for answers, and demand the best of service. We are the only advocates for our children. Moms do know what's best

Hugs,

Lindsay

[Everchildless]

Preeclampsia

I have to say that I did get some flashbacks from your story. I do recall having been told that I had infarcts in (one or more of) my planceta(s). I suffer from PE and (borderline) HELLP.I am trying to find my way. I hear that ther is something that probably floats in our blood that essentially constricts the flow to the planceta when the fetus is recognized (simple explanaion). Supposidely there is research going on on how to divert those chemicals. I am not sure that I can mention othe programs or locations so I will stop here or aviod too much sharing, until I know it is ok to do so. Odly enough, I am not supposed to fit the category of on who gets hellp syndrom (based upon the HELLP Syndrome Society--yet I do; I digress). Good luck. You are still young. I am 43 (and suffering in my own way, yet cannot give up, because I will continue to try until i cannot conceive or I have tried all possible alternatives). I send much.