Wednesday, May 4, 2011

More on HCG

I finally heard back from my midwife today! Talking with her made me feel a lot better.

First, she explained to me about the fetus's risk for chromosomal abnormalities. She told me that the risk for Down Syndrome baby in a woman my age is normally 1 in 620. After my screen, it went way down to 1 in 3500. She then discussed the risk for Trisomy 18. She said the likelihood of a woman my age giving birth to a baby with Trisomy 18 is 1 in 2200. After my screen, my risk dropped to 1 in 10,000. She told me that the results from my screen are very reassuring, and my risk is very, very low.

She then went on to talk about the HCG. She explained that HCG is very important for at-risk women in the first trimester. It can indicate if a pregnancy is progressing well, if a woman at-risk for a miscarriage might miscarry (in the case of low HCG). She said it can indicate a molar pregnancy (in the case of high HCG). She then went on to say that I'm in the second trimester (well, almost), and she said that monitoring HCG is not really important any more. Kate said she doesn't know the exact statistic, but she'd estimate that about 10-20% of women have elevated HCG. Basically, she said, it's not a rare condition that causes a lot of alarm.

At this point, she said, we're not really worried about what caused the HCG, and the cause is unknown. She said we're now worried about the potential side effects from the high HCG. She told me that the place I went to for my screen, Obsentrix, deals with high-risk women all the time. She said they handle women who are pregnant with triplets and quadruplets, and she said they really know their stuff. She didn't call them experts exactly, but it seemed implied. Kate said she would never tell anyone to ignore their advice. She added that baby aspirin poses little risk to a pregnant woman, and they want me to take it to reduce my risk for high blood pressure. She said that research has shown that women who have pre-eclampsia often have high HCG in their second-trimester screen. She said they want to reduce my risk for hypertension later in the pregnancy and during delivery. She went on to say that the research is mostly on women who start the baby aspirin early in the first trimester. Apparently, women who are at-risk for the condition (based on past pregnancies) are often put on baby aspirin from the moment they know they're pregnant. Kate told me that there's not a lot of information out there on women who start baby aspirin during the second trimester, but she said she'd try to find an article on the subject for me.

I told Kate I was reluctant to take baby aspirin to reduce my risk for hypertension because aspirin can be so dangerous to the fetus and placenta. It's true that my blood pressure rose during my last pregnancy (my systolic went from under 100 to close to 140 during the second trimester but then dropped off again during the third), but I have very low, stable blood pressure right now and have a fairly healthy diet and lifestyle. I made a mental note at that moment to sign up for prenatal yoga classes, too. She told me that I am an adult and should be able to make that decision myself. She told me it's her job to arm me with information and then let me choose what is best for me. She said if this was absolutely vital for my health, she would tell me so. She said this isn't one of those recommendations that is an absolute must.

I'm so glad she said that. Sometimes, I feel like doctors give you their medical opinion and then treat it as the only option. In those situations, it's frustrating to not be able to have an opinion or a voice in the decision-making. I feel good to know that the baby aspirin is recommended to me as a preventative measure to help ensure my good health, but it isn't absolutely vital. There's a chance I'll kick myself later if I develop high blood pressure, but at least I'll know it was my choice.

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