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-   -   Is my doctor wrong? (http://www.justmommies.com/forums/f106-high-risk-pregnancy/2615524-my-doctor-wrong.html)

jdsm514 January 16th, 2013 04:07 PM

Is my doctor wrong?
 
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?

bcogoli January 16th, 2013 04:44 PM

Re: Is my doctor wrong?
 
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.

jdsm514 January 16th, 2013 04:56 PM

Re: Is my doctor wrong?
 
Quote:

Originally Posted by bcogoli (Post 26981319)
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!

chickadee January 16th, 2013 05:29 PM

Re: Is my doctor wrong?
 
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!!

jdsm514 January 17th, 2013 08:39 AM

Re: Is my doctor wrong?
 
Quote:

Originally Posted by chickadee (Post 26981486)
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...

Wee3monkeys January 18th, 2013 12:05 PM

Re: Is my doctor wrong?
 
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!

preetianm March 20th, 2013 03:58 AM

Re: Is my doctor wrong?
 
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

bevyvuska May 9th, 2013 01:44 PM

Re: Is my doctor wrong?
 
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.

Krisnina May 11th, 2013 07:18 PM

Re: Is my doctor wrong?
 
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.


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