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Tuesday, November 17, 2009

To switch or not to switch, that is the question (LONG)

So even before I became pregnant, I knew I would have to find a new ob, bc mine decided to up and move to Georgia, a couple months after the twins were born. I had two different groups I was recommended from two different hospitals.

Group 1 (4 person practice) from Hospital A: This hospital has the best of the best around in regards to all care. They also have the only NICU in the area. Their maternity wing of their hospital has several floors and is massive (I get lost every time I go to visit someone in there). There is a whole c-section floor, just for patients with c-sections (which I am not sure how much I would like to be actually segragated.) There are two beds to each c-section room and you are told you might have to share depending on how many c-section patients there are at the time. Their perinatology department is located on underneath all the maternity floors, at the bottom and is pretty big.

Group 2 (4 person practice) from Hospital B: This is the 2nd largest hospital in this area. They are a Catholic hospital. Their maternity area is small and quaint, with about 18 rooms, including 2 c-section rooms (although when those are filled up, you get a regular labor and delivery room). They have a perinatology department located off the maternity area-MUCH smaller then the other hospital. They have an underground passage that leads you to the main hospital, which has a lot of the bells and whistles of the other hospital-not all but certainly many.

I have delivered ALL my babies so far at Hospital B. I have LOVED Hospital B and I would much prefer to be there. With my twins' pregnancy, I had a complete placenta previa with one of my twins and I was carefully watched by their perinatology for any signs of acreta. At delivery, I hemmorhaged a lot after the fact (we aren't sure of why, bc my placentas came out allright, but it was concluded that one reason might be bc my uterus was SUPER overextended with 15 lbs of baby). I ended up with 4 units of blood that afternoon and a trip through that underground passage for some procedure to help stop the bleeding, plus a night's stay in ICU. My babies stayed in the little nursery they have overnight. All in all, early the next day I was deemed healthy and I traveled back underground back to maternity to be with my babies by 7:30 am for the next 4 days. I trust them a lot bc of that situation. But then i worry about my potential risks NOW.

When getting pregnant, I hoped and prayed that baby would stay away from my scars so that I could have an uneventful pregnancy this time. I now have two scars, bc when I had the complete placenta previa, they didn't want to cut through my placenta and have me bleed too fast when they had two babies to deliver, plus they weren't sure of how "sticky" my placenta might be to scar. My scars are a couple inches away from each other. Gavin-baby A- couldn't resist the urge to be down there and alas another baby seems to have gotten the invitiation that near my scars was just way too inviting and that is where he/she is now. I am pretty much guaranteed placenta previa (which I had last time and it didn't really cause me many problems-even with cervix is pretty good about staying tightly closed-hence one reason why I had c-sections). The problems lies in IF that low lying placenta attaches itself into my scar or can find its way through my scar and out of my uterus. This is called placenta acreta, increta, percreta (varying levels of it).

Placenta Accreta occurs when the placenta attaches too deep in the uterine wall but it does not penetrate the uterine muscle. Placenta accreta is the most common accounting for approximately 75% of all cases.

Placenta Increta occurs when the placenta attaches even deeper into the uterine wall and does penetrate into the uterine muscle. Placenta increta accounts for approximately 15% of all cases.

Placenta Percreta occurs when the placenta penetrates through the entire uterine wall and attaches to another organ such as the bladder. Placenta percreta is the least common of the three conditions accounting for approximately 5% of all cases.

What causes placenta accreta?

The specific cause of placenta accreta is unknown, but it can be related to placenta previa and previous cesarean deliveries. Placenta accreta is present in 5% to 10% of women with placenta previa.

A cesarean delivery increases the possibility of a future placenta accreta, and the more cesareans, the greater the increase. Multiple cesareans were present in over 60% of placenta accreta cases.
I was carefully watched for placenta acreta with my last pregnancy, and the hospital took a LOT of precautions for my c-section just in case there was some they didn't catch (I got an epidural and a spinal, I got 3 ivs instead of 1, they had tons of my blood type on hand). I trust that this hospital, although smaller, does know what its doing. Placenta acreta (the most common) would probably most likely lead to a hysteroctomy, which I am sure they could handle as well. But if it was the worst of the worst, percreta (which is the most rare form of this), I don't know if they would be willing to deal with it, or send me off elsewhere?
I am worried though about my risks, bc I have two scars now. I am not so worried about my first scar (the lower one) bc we went through this already and it held up pretty well. But I do worry about the integrity of my second scar. Its just an unknown. My pregnancy could go really well, it could go just okay or it could go horrible. Time will tell what happens.

So do I pick the hospital (Hospital B) that I am comfortable with and that I love, and hope for the best or even the mediocre...and if things do go REALLY bad, hopefully they would transfer me to the bigger hospital for my care. Or do I continue my care with the best hospital (Hospital A), and committ myself there, no matter what may play out in this pregnancy, even if its not really where I [I]want[/I] to go.

Right now I am going to practice involved with Hospital A. I kind of freaked out with the bleeding and just called the first available number I had. I am NOT loving this ob I have been seeing (she told me she would have made me tie my tubes after the fourth pregnancy, she also said she would have delivered my twins at 36 weeks with placenta previa and never let me go as far as they let me-38.5 weeks). These two statements leave a bad taste in my mouth. Plus the whole "it looks like its near/on your scar-you have to terminate and here are all the ways you can do that right now" peptalk we got at our first meeting, as well as the "its just a bad one" in regards to pregnancy. There are 3 other doctors in her practice, do I try another one and hope for the best?

I wonder if the practice affiliated with Hospital B would be a little less critical of me, especially when they are a Catholic hospital. I know if I went to this dr for my last pregnancy, she would have given me a hysteroctomy for sure...whereas the other hospital did what they did to save my uterus, even with me having 5 kids. And how do you switch to a totally different practice after all I have been through already. Just call up as a new patient, or explain this whole last 3 weeks, or what? I told you this was going to be LONG!!! So I don't know what to do, but I want to figure it out soon. My heart wants to go with hospital B, but is that the smartest choice? I don't know.  I would love ANY feedback anyone has at all! After my ultrasound, I called up twice and waited TWO days to hear back from the practice I am currently at, only to hear that Dr. doesn't want to see me again until almost 11 weeks. So I figure I have til then to figure out what I am doing. Anyways, thanks for reading all this and thanks for any feedback any of you might have-I appreciate it!

1 comment:

  1. You know I love hospital B! I love reading your stories! I wish you the very best of luck and can't wait to see more ultrasound pictures of the new baby boy/girl. I think your family needs another girl! ((hugs))-C