Log In Sign Up

Is my doctor wrong?


Forum: High Risk Pregnancy

Notices

Welcome to the JustMommies Message Boards.

We pride ourselves on having the friendliest and most welcoming forums for moms and moms to be! Please take a moment and register for free so you can be a part of our growing community of mothers. If you have any problems registering please drop an email to boards@justmommies.com.

Our community is moderated by our moderation team so you won't see spam or offensive messages posted on our forums. Each of our message boards is hosted by JustMommies hosts, whose names are listed at the top each board. We hope you find our message boards friendly, helpful, and fun to be on!

Reply Post New Topic
  Subscribe To High Risk Pregnancy LinkBack Topic Tools Search this Topic Display Modes
  #1  
January 16th, 2013, 04:07 PM
Newbie
Join Date: Jan 2013
Posts: 3
I am 28 years old and 14 weeks pregnant with my second. My first child is a healthy 20 month old and my pregnancy with her was uncomplicated. For this pregnancy, my first trimester screen results were:

NT: 2.9mm (otherwise baby looked perfectly normal)

PAPP-A: 0.81 MoM (40 percentile)

Free Beta HCG: 1.33 MoM (70 percentile)

I am awaiting the results of the MaterniT21 test. I am praying the results come back soon and baby is normal chromosomally.

However, today at my doctor's appointment, my doctor told me that even if baby is normal chromosomally, I will be considered high risk. She specifically said that my low PAPP-A and high free HCG are associated with preeclampsia, IUGR, low birth weight, etc. So she wants me to get one NST and one BPP every week from week 32 through delivery to check on baby!

I am fine with extra monitoring if it is warranted, but all the studies I've come across mention the 5th percentile (or maybe even the 10th percentile) as the cut-off value for low PAPP-A and the 95th percentile for free HCG. I couldn't find any studies that demonstrate that percentiles of 40 and 70 are any indication for alarm. Even for values that do meet the cut-off levels, the predictive value of poor pregnancy outcome is still weak.

So what do you think? Do you have any experience with this? Is my doctor being extra, extra conservative? Or is she off the mark and not praciticing evidence-based medicine?
Reply With Quote
  #2  
January 16th, 2013, 04:44 PM
Mega Super Mommy
Join Date: Sep 2012
Posts: 2,259
Im so sorry you have to deal with this. I know that there are general guidlines for things but some doctors have their own stricter guidlines based on experience. So i think your doctor is just being extra carefull. I would use your discretion and comfort level when deciding what to do. The NST and BPP checks are non invasive so i would just do that part since it wont hurt anything. With that said i would also not worry to much about the possible complications that your tests may or may not indicate. Just take care of yourself and trust that everything will be fine. Im praying for you.
Reply With Quote
  #3  
January 16th, 2013, 04:56 PM
Newbie
Join Date: Jan 2013
Posts: 3
Quote:
Originally Posted by bcogoli View Post
Im so sorry you have to deal with this. I know that there are general guidlines for things but some doctors have their own stricter guidlines based on experience. So i think your doctor is just being extra carefull. I would use your discretion and comfort level when deciding what to do. The NST and BPP checks are non invasive so i would just do that part since it wont hurt anything. With that said i would also not worry to much about the possible complications that your tests may or may not indicate. Just take care of yourself and trust that everything will be fine. Im praying for you.
This put a smile on my face. Thanks so much for your kind words!
Reply With Quote
  #4  
January 16th, 2013, 05:29 PM
Mega Super Mommy
Join Date: Dec 2011
Posts: 1,154
I had only one issue come up in my first-trimester screening (low free beta hCG), but was put on notice that I'd have the same monitoring plan beginning at 32 weeks. I was told by the genetic counselor that the predictive value of the hCG result for placental insufficiency (possibly leading to IUGR in later pregnancy) was very low (1%), and so I really put it out of my mind and didn't worry about it. I'm still sure that was the right way to think of it.

As it turned out, though, we did begin detecting slowed growth at 31 weeks. At that u/s the baby's growth was only 75% of what we would have expected since the last u/s at 27 weeks. I freaked out for about a week, very concerned that they'd need to deliver the baby very premature and that he would be tiny and underdeveloped. But the weekly NSTs and twice weekly BPPs I've had since then have reassured me that the baby continues to be healthy despite his slowed growth, and the increased protein my perinatologist recommended (I'm drinking an Ensure every day and eating a high-protein diet) seems to have helped to keep the baby's growth at the same rate (they've been doing growth ultrasounds every 2 weeks, and he's stayed at 75% of the expected rate). He doesn't yet meet the IUGR deifinition, so I've been able to keep him in and growing. He'll be small when he's delivered at 39 weeks, but full term and healthy.

The extra monitoring after 32 weeks won't hurt anything, and if you DO run into any issues it may help to provide some peace of mind. My OB told me that the BPPs are actually a far better indicator of fetal health than something like monitoring kick counts; kick counts tell you something about how the baby is doing at that moment, but apparently a good BPP has a predictive value of nearly 100% that the baby will be fine over the following week. That's been huge for me - when they do the BPP and the baby looks fine, I can be pretty sure he will continue to be fine over the next week even if I think I'm feeling him move a little less one morning or something. That kind of thing might not help as much for someone else, but for a worrier like me (and someone who's had multiple losses prior to this pregnancy, which will result in my first baby) it's been great.

Just my experience and two cents. I hope everything goes very smoothly with your pregnancy and that the extra monitoring turns out to not be needed at all. Good luck!!
__________________


Reply With Quote
  #5  
January 17th, 2013, 08:39 AM
Newbie
Join Date: Jan 2013
Posts: 3
Quote:
Originally Posted by chickadee View Post
I had only one issue come up in my first-trimester screening (low free beta hCG), but was put on notice that I'd have the same monitoring plan beginning at 32 weeks. I was told by the genetic counselor that the predictive value of the hCG result for placental insufficiency (possibly leading to IUGR in later pregnancy) was very low (1%), and so I really put it out of my mind and didn't worry about it. I'm still sure that was the right way to think of it.

As it turned out, though, we did begin detecting slowed growth at 31 weeks. At that u/s the baby's growth was only 75% of what we would have expected since the last u/s at 27 weeks. I freaked out for about a week, very concerned that they'd need to deliver the baby very premature and that he would be tiny and underdeveloped. But the weekly NSTs and twice weekly BPPs I've had since then have reassured me that the baby continues to be healthy despite his slowed growth, and the increased protein my perinatologist recommended (I'm drinking an Ensure every day and eating a high-protein diet) seems to have helped to keep the baby's growth at the same rate (they've been doing growth ultrasounds every 2 weeks, and he's stayed at 75% of the expected rate). He doesn't yet meet the IUGR deifinition, so I've been able to keep him in and growing. He'll be small when he's delivered at 39 weeks, but full term and healthy.

The extra monitoring after 32 weeks won't hurt anything, and if you DO run into any issues it may help to provide some peace of mind. My OB told me that the BPPs are actually a far better indicator of fetal health than something like monitoring kick counts; kick counts tell you something about how the baby is doing at that moment, but apparently a good BPP has a predictive value of nearly 100% that the baby will be fine over the following week. That's been huge for me - when they do the BPP and the baby looks fine, I can be pretty sure he will continue to be fine over the next week even if I think I'm feeling him move a little less one morning or something. That kind of thing might not help as much for someone else, but for a worrier like me (and someone who's had multiple losses prior to this pregnancy, which will result in my first baby) it's been great.

Just my experience and two cents. I hope everything goes very smoothly with your pregnancy and that the extra monitoring turns out to not be needed at all. Good luck!!
Thank you for your feedback! It's very interesting to hear that the BPPs are fairly reliable at predicting a baby's health for a week or so. Oh, and I'm a worrier too, so I guess the extra monitoring could be reassuring...
Reply With Quote
  #6  
January 18th, 2013, 12:05 PM
Wee3monkeys's Avatar Mega Super Mommy
Join Date: Mar 2008
Location: Nebraska
Posts: 3,352
Hmmm, very interesting information from everyone! I always decline the screenings, so I have zero experience to help, but I find it all very interesting. Good luck!
__________________





Reply With Quote
  #7  
March 20th, 2013, 03:58 AM
Member
Join Date: Sep 2012
Posts: 11
hey sometimes doctors are may be extra carefull they have their experience with them so they wanted to treat you like them.hope he will treat you right as his own experience.gud luck
__________________
Pregnancy Tips
Reply With Quote
  #8  
May 9th, 2013, 01:44 PM
bevyvuska's Avatar Mega Super Mommy
Join Date: Oct 2006
Location: San Jose, CA
Posts: 1,321
Send a message via MSN to bevyvuska
I personally would rather have a doctor that is on the more cautious side of the coin, than the more flippant, it's fine side.
With my son, my doctor put me on weekly NSTs & BP checks after my cousin, who was due within a month of me, had an eclamptic seisure that came on in just a few days. My BP that always ran low, even in pregnancy, (100/60) went up to around "normal" 120/80 for a bit, so he didn't want to take any chances. All went well, but being that none of it's invasive, there is no harm in the monitoring.
__________________



Reply With Quote
  #9  
May 11th, 2013, 07:18 PM
Krisnina's Avatar Mega Super Mommy
Join Date: Mar 2012
Location: Los Angeles, Ca
Posts: 1,076
My papp-a levels were .2 something, which is super low. So far they haven't found anything wrong with the baby, but they (my perinatologist and my ob) have been monitoring me and baby growth. I will tell you that I have been on modified bedrest since 26 weeks because I was having contractions ( on the NST ) none that really bothered me. I am on medication to stop contractions, and at first I was seen every week but for the past month, I have been switched to every two weeks. When I was having the weekly appointments although they seemed to be a bit much, it really put my mind at ease, just in case. I think it is a good thing that the doctors want to closely monitor you, no matter what. Overly protective is better than ignoring a possible problem.
__________________




Reply With Quote
Reply

Topic Tools Search this Topic
Search this Topic:

Advanced Search
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off



All times are GMT -7. The time now is 04:31 AM.



Powered by vBulletin® Version 3.8.7
Copyright ©2000 - 2014, vBulletin Solutions, Inc.
Search Engine Optimization by vBSEO 3.6.0