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I developed severe hyperemesis gravidarum, lost a lot
of weight in my early pregnancy, and ended up on a Zofran subcutaneous pump in
order to function day to day without vomiting constantly. At least it enabled
me to still work as a physician in a busy hospital. Because of my twin
pregnancy and history of prior surgery for a uterine anomaly, I was fortunate to
undergo high-level ultrasounds weekly from almost the very beginning of my
pregnancy.
At 18 weeks along, I was told that it appeared that the placenta
previa they'd been watching was not going to move out of the way, as they
sometimes do as the uterus enlarges. I was told to keep my activity light, and
to report any bleeding. At 20 weeks, they discovered that my previa had become
a partial previa (only partly covering the cervix), but with fetal vessels
coming off the edge of the placenta traversing the cervix-- a very dangerous
kind of vasa previa that they had not seen previously on my other scans. They
were also worried that I may have a placenta accreta, where the placenta grows
into the wall of the uterus, which often leads to a hysterectomy at the time of
delivery due to bleeding; we wouldn't know for sure about the accreta until
delivery, but the vasa previa and partial placenta previa were for sure.
A few
days later, while I was working on labor and delivery supervising other
residents and teaching medical students, I began having painless bleeding. I
was taken to the hospital across town, and admitted and treated with magnesium
to stop the contractions that the bleeding had stirred up. This was a
controversial treatment given that my babies were pre-viable at the time. The
treatment worked, and after being there for more than a week, I was allowed to
go home on strict bedrest and medicines to prevent contractions. I was also
getting IV iron infusions and Procrit (injections to make my body produce blood
cells) because of severe anemia from all the blood loss and malnutrition.
After being home for just a few days, I had another episode of spontaneous
bleeding, about 600 ml, at home while just lying on the couch. I called the
emergency squad and was taken back to the hospital in the middle of an ice
storm, just praying that my vulnerable little Twin A wasn't bleeding to death
every second of the trip. Fortunately, the bleeding had all been maternal (from
the placenta previa, not the fetal vessels), and high doses of magnesium were
able to get the contractions and bleeding to stop. I received antenatal
steroids to help the babies' lungs mature. I was 23 weeks 6 days when I was
re-admitted; my babies would barely be able to have a chance at life at that
gestation. One week later, still on magnesium, they let me get up and take a
shower. I hemorrhaged in the shower, losing almost a liter of blood, and ended
up in the OR for a C-section at 24 weeks 6 days. I remember being prepped for
surgery and grabbing the collar of a pediatrics resident as I was about to be
put under, telling her the names of my babies, as I didn't want them to die
without names.
And suddenly, the bleeding stopped. I asked them to wait a little longer--
don't cut, the bleeding stopped, I think!-- and after spending an hour in the
OR, we were able to avoid delivery and I went back to my room on very high doses
of magnesium. I received a lot of blood transfusions. I hemorrhaged again 3
days later in the middle of the night, and was returned to the OR, but again we
waited it out and were able to avoid delivery. Thank God the babies were
tolerating all of this! All the bleeding was coming from my placenta and not
their tiny little blood vessels. I bled again at 28 weeks, but it was more
minor. I was in the hospital on magnesium for 79 days, and my wonderful husband
Fred spent every night there with me; my mom took a leave of absence from her
job and spent the days with me too. I would have gone crazy if it weren't for
them keeping me going. Every day, as miserable as it was for me, I knew was a
gift for my babies.
Finally, at 31 weeks, I began contracting again for no reason, and even
increasing the magnesium wasn't stopping the contractions. My doctors decided
that the best course of action was to proceed with cesarean delivery safely,
under controlled circumstances, before I began to bleed-- which would've been a
much higher chance of fetal bleeding at that gestation if it happened. I was
sectioned that night at 31 weeks 4 days, and had Jakob (3 lb 14.5 oz) and Mia (3
lb 15.8 oz) who needed to be on a ventilator for a couple days only. They spent
about a month in the NICU just growing and learning to eat, and they are healthy
31 month old toddlers now. They have had no problems associated with
prematurity, and are quite smart and precocious for their age if I can brag on
them a bit! At my delivery, the placenta was quite the subject of academic
interest! There was a velamentous cord insertion of twin A, leading to his
fetal vessels coursing through the membranes like a spider web. I was
transfused 15 units of blood to make up for all the blood loss.
I am used to being the doctor treating patients with problems in their
pregnancies. Being on the other side as a patient was the hardest thing I have
ever done. I feel like the luckiest woman in the world to have had all those
complications early on in pregnancy, because that led to my vasa previa being
diagnosed and managed appropriately-- and my twins are alive today because I had
the benefit of knowing ahead of time.
Below are some of the photos of my placenta and the ultrasound or the doppler
flow highlighting the fetal vessels coursing over the cervix. I bet a lot of
people have never seen what it really looks like. The doctor in me just had to
look at it and hold the placenta in my own hands and know what it was that
caused all of this drama for us!
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