26 Weeks ... and now the countdown's on ...

So the past couple of weeks have been a bit hectic with Thanksgiving and whatnot ... I've been so busy with my other kids, trying to finish college applications with my 17-year old, dealing with a snotty, sick and cranky 4-year old, and all the rest in between.  On the pregnancy front, it's been trying to say the least.  

I saw Dr. G Monday for my regular visit and finally got the results back from the MRI last Tuesday.  I must say, I went into the MRI with such trepidation that the actual event was ... rather anticlimatic.  After dealing with insurance issues -- the freaking company denied my claim of all things, saying the MRI was "not medically necessary" -- for an hour and a half, I finally went in for the procedure.  For anyone who's pregnant and unlucky enough to warrant an MRI and is worried about the ill effects on the baby, be cautious, but don't panic.  I had what's called a "visceral pelvis without IV contrast" MRI, which means I didn't have to ingest any of that nasty tracer agent.  I laid down on the table, had a couple of shield placed over my abdomen, requested my favorite radio station on the headphones, and stayed still as the technician slid me into the tube.  Half an hour later I was done.  

The good news is that Dr. G gave me a copy of MRI report so I don't have to rely on my faulty pregnancy brain to recount our conversation.  It could have been better.  The report impression reads: 

"Abnormal appearance of the anterior inferior placenta-myometrial interface with bulging, lobulated margins, dark intraplacental bands and irregularity at the border of the posterior bladder/uterine margin.  Findings are most compatible with a placenta increta.  Focal percreta at the left lateral superior bladder wall cannot be excluded (possible.)"

Placenta increta -- Irregular interface (lobulated) between the placenta and adjacent myometrium. Enlarged vessels extend through the placenta to the serosa surface.

An irregular interface between posterior aspect of the bladder and adjacent uterus.

Placenta previa

Basically, what this means is that a placenta increta has been confirmed and it's still "suspicious" for a placenta percreta in the left corner of my bladder.  They don't know for sure if it's definitely breached the bladder but they believe it's gone through the serosa, the outer membrane of the uterus.  Results from an earlier color doppler ultrasound found that there were placental vessel imprints on the outside wall of the bladder.  As my darling husband likes to put it, "It's like someone's knocking on the door but no one's opened it yet."  Yup.  That pretty much describes it.  Again, I'm told there's a caveat:  no one knows for sure what is really in there until they cut me open.

I'm partial to previa ;-)  ... just a joke to lighten the mood.

I was also given Dr. R's MFM consultation write up on me.  I'm chuckling a bit over my "active problem list": -- placenta accreta/increta/percreta; history of preterm labor; partial placenta previa; uterine fibroid in pregnancy, and here's the best part ... AMA (advanced maternal age).  She made the recommendation that I'd have a repeat ultrasound at 30 weeks with Dr. T, keep up with the cervical length ultrasounds every two weeks, and if my cervix does, indeed, shorten, or if I have regular contractions (6+ an hour), or if I start bleeding, then I should get the steroids immediately.  However, if I don't have any of these things, then the steroids would be administered at 33-1/2 weeks with a scheduled cesarean hysterectomy at 34 weeks.  (This means we've got exactly seven weekends to get everything ready before the baby gets here and I'm incapacitated for a while.)

I'm a little annoyed at both Dr. R and Dr. G.  It would appear that both expected the other to refer me to a gynecological oncologist but neither did.  So now I have to wait for Dr. G to decide who he wants to work with and make the appointment myself.  It's got to be made in the next week or two.  I think I'm burying the lead, but the contractions are becoming more and more frequent and pronounced -- sometimes 4 or 5 an hour-- and on Sunday I started spotting (today's Wednesday).  The stabbing pain is so much more and have migrated toward the left side of my lower abdomen.  Now that I know the MRI results, it all makes sense, right?  Dr. G thinks that I'm basically a walking time bomb.  According to him, there's no knowing when I'll start bleeding but he thinks I probably will if I've already begun to spot.  I could go into labor prematurely -- thank you positive fFN -- any time between now and the scheduled delivery.  

Dr. G and I discussed bed rest at length.  I told him that my contractions occur regardless if I'm lying down or standing.  Yes, they absolutely do get more frequent and painful when I'm active, but we've agreed that I'll take it as easy as I can.  That means no exercise, no walking for more than a few minutes at a time, and plenty of chair breaks.  Having been through this before, I know the drill.  I lie down on my left side when I have too many contractions, drink a lot of water, and sometimes they'll go away, sometimes not.  There's not much else I can do.  Luckily, I've managed to hold off on going to the hospital again for preterm labor.  At 26 weeks+4 days, that's a record for me.  I usually have my L&D frequent customer card punched a few times by now.

Wayne and I have been trying to put on a brave face for the kids but Sunday and then Monday after my visit with Dr. G were hard.  Something inside me broke and I spent the better part of both days crying. I couldn't help it.  The boys all saw me, but only my little one said something as only four-year olds can do.  I feel myself withdrawing, pulling back from friends and family outside of Wayne and the kids.  I just want to envelope myself into them and not deal with anything else.  They are my priority.  

One of the reasons, I know, of why I'm retreating has a lot to do with not wanting to hear other people's comments.  I've gotten a few from folks who are essentially clueless about this, despite what I've already told them.  People who tell me to stay away from the internet, to stop reading about the condition because they think it's making me crazy.  But that's not it.  A journalist before I had kids, I was and still am an amazing researcher.  It's in my nature to till information forwards and backwards until I understand the scope of a matter.  I really took offense at those comments and found them patronizing.  I know I'm sensitive now, but people telling me that everything's going to be alright, to not read anything, to keep up positive spirits ... well, first of all, they don't know that for sure. Plus, I just want to turn it around and ask them, if this were you, what would you do?  I dare anyone who's been diagnosed with a serious condition to not read as much as they can on it.  Can you imagine telling a cancer victim not to research their prognosis?  Why, then, is it so galling to some of my "friends" that I should do the same?  Does it make me feel any better to know that maternal morbidity has been reported to occur in up to 60% and maternal mortality in 7-10% of cases with placenta accreta?  No, but at least I have my facts and I'm prepared.  It's always easy to talk when the discussion isn't about yourself. 

Also, I've found that most don't people understand the whole concept of a preemie baby.  I've gotten some comments in the vein of, "Well, at least you won't have to go through the last trimester and be uncomfortable."  Others seem to think that a preemie baby is just a small baby and all they need to do is "feed and grow."  Ah, to be clueless.  Never mind the fears of NEC, open PDA, ROP, brain bleeds, lumbar punctures, high jet vents, desats, and bradys, and so on and so on.  Wayne and I have been through them all. Again, some of the comments have been pretty ridiculous and infuriating. So I'm barricading myself for the time being because if I leave myself open then I'll say something I'll regret.

Another thing that I'm bugged about ... I had thought that Dr. R was was going to be in charge of the operation since she's the MFM.  Nope ... turns out that Dr. G will be handling the C-section and the oncologists would do the hysterectomy.  I love Dr. G. I've been with him for the past 15 years, but what's niggling at me is that he didn't catch the increta initially.  The sonographer at the hospital where I was taken into the ER found it.  Once he knew about it to look for it, he easily found it.  So that begs the question, if I meet all the risk factors for placenta accreta, then why wasn't it ever discussed?  The women I've spoken to with this condition certainly had never heard of it before their diagnoses.