Don't forget to see the previous post for part one.
23.) What is the diameter of the TAC around the OS? I am under the belief that it is supposed to be under 2 cm, preferably 1.6 cm. What is your take on this?
a. I cannot give you a diameter, because that would entail actually measuring around the cervix after the TAC is placed which is difficult to do. I can tell you that it is placed quite tightly, but not too tightly to stop your menses. Every woman is different, some have a thick cervix, and some have really thin cervix. To give you a diameter would be misleading, because every cervix is different.
24.) How long is the incision? 4 inches?
a. We don't deal with inches usually, but the incision is approximately 6-7 cm.
25.) Is there even a remote possibility that I will get to 37 weeks, if no other complications are present?
a. Yes there is a strong possibility that you will get to 37 weeks. However, I do not think that far ahead. I think in terms of milestones. Lets get you to 24 weeks, then 28 weeks, then 30 weeks, then 34 weeks, then 36 weeks, then 37 weeks.
26.) Is there a possibility that the TAC might hinder me from getting pregnant? I know one of the possible problems might be secondary infertility.
a. No. There has been no documented proof that the TAC causes second infertility. But it seems to me that you guys get pregnant quite easily, so I don't think there should be a problem.
27.) If done pre-pregnancy how long should we wait before trying to conceive?
a. 4 - 6 weeks. I cannot imagine any woman wanting to engage in intercourse 2 weeks after major abdominal surgery, but if after 2 weeks you feel up to it go ahead. i would suggest that you wait until you heal though.
28.) What is the physical recovery after placement?
a. Difficulty walking afterwards, getting around slowly the first week, possible constipation.
29.) How is my physical recovery impacted if I get pregnant right away?
a. It should not impact you that greatly. The stretching of the uterus might make you feel pain where the incision site is, but that is minimal.
30.) What physical changes are in store for my body?
a. Just a scar, possible numbness of the incision site.
31.) What is your professional stance in regards to pelvic rest? Bed rest? (I do not want bedrest unless complications arise)
a. Absolutely no intercourse. I will suggest bedrest during the 2nd trimester, especially during your critical weeks. I want to do whatever it takes to get the baby to term. I do not want you to feel any regret if something happens that could have been helped with bedrest.
I let her know that my OB and MFM will say "take it one week at a time", because they know some women have to work. This is where we came to a compromise. I will work and do modified bed rest (on my butt as soon as I get home) and during the critical periods be seen more often and if changes start to occur, then I will be taken off work completely. It is important that I sit as much as possible. I let her know though that I have faith, and I will be putting that faith in God and in the TAC.
I guess another intern is in store for me.
32.) How often should my CL be measured?
a. every 3 - 4 weeks translabially.
Frankly, this is too wide of a gap for me. Especially between 16 - 24 weeks. I WANT to be seen weekly, even if I have to pay for the ultrasounds myself.
33.) Which weeks do you view as critical?
a. Every woman is different, but I can tell based on your history that your critical weeks start between 16 and 20.
34.) How often should I be seen during those critical weeks?
a. Depends on how everything is going, but about every 2 weeks.
Thats much better. Anyone know where I can buy a used US machine? Lol.
35.) How am I monitored after placement?
a. I will be considered high risk so an MFM should be part of the team.
36.) What is your view on 17p shots or prometrium?
a. Prefer 17p -it is administered through the muscle. The prometrium is inserted vaginally, and we want to reduce going near that area.
37.) What about Fetal Fibronectin Tests (FFN)?
a. Only if labor symptoms occur, such as contractions, increased discharge, leaking of fluid, etc.
38.) Should Betamethasone shots be given to mature the babies lungs? At what point?
a. No. not unless labor is imminent. The shots only last for 2 weeks (?) and can only be given twice throughout the entire pregnancy.
39.) What kind of contact will you have with my OB/MFM?
a. We will consult as needed.
40.) During pregnancy, can I call if i have any questions or concerns?
41.) What is your opinion concerning working during pregnancy, if there are not other complications? Is it possible to go back to work after the surgery and through the pregnancy?
a. I already know her stance on bedrest. Keeping in mind that she does not monitor her patients during their pregnancies, she just does the procedure. My OB has a few TAC patients and they are not on bedrest, nor does he prescribe bedrest unless complications occur.
42.) Which hospital do you work out of?
43.) If interested, how soon can I book the procedure?
a. As soon as possible. She does not believe in using people as guinea pigs (haven't I said these words before- not wanting to be a guinea pig? Confirmation again), so she will not be doing the surgery alone. Dr. Richards (someone who does the procedures often) will be doing the surgery with her.
44.) Prior to having the TAC done, what are some tests that you suggest I do? I have already been checked for blood clotting disorders.
a. Nothing. I checked your records, and nothing indicates that any other factors played a part. If we find something else during the surgery, we will address them then.
45.) Have you ever heard of Drs. Davis or Haney?
a. No. (WHAT????!!!!)
46.) "A properly placed TAC defines the internal OS. In other words, the TAC is placed at the level of the internal opening of the cervix. What is confusing is that early in pregnancy, the lower uterine segment is also contracted and many sonographers and physicians measure this contracted area as being part of the cervix. IT IS NOT!! So... when the lower uterine segment develops and opens up, the gestational sac settles down to just above the TAC and many, who do not understand the normal physiology, begin to worry. If you have a true IC, and if you have a good TAC, this opening of the lower uterine segment, and loss of the closed area above the TAC, is going to happen. It is not a matter of "if", its a matter of "when". If everything opens up to just above the TAC, the only thing it means is that you needed the TAC. As long as there is no funneling of the membranes through or below the TAC, you are in great shape! I do not recommend any restriction of activity for my patients whose scans demonstrate this finding." - Dr. Dav.is
Are you of the same opinion?
a. She agrees, but reiterates her personal preference for some sort of bedrest. Again, she wants to do everything it takes to help me bring a baby to term, even if it means an additional vaginal stitch as well.
Those are all the questions I had to ask her. Again, I feel comfortable doing this procedure with her and Dr. Rich.ards (now I have another Dr. to research). She welcomed the questions, encouraged us to ask more, and is willing to assist and do all that she can to help us bring a live baby home.
As of now the surgery is not scheduled. She asked us how soon we wanted to do the surgery, any dates we prefer and so on. We really don't have a preference, all we know is we want it done as soon as possible. She is going to check Dr. Richar.ds' schedule and let us know of a date and time by the end of the week.
Thanks for the prayers ladies, they helped to keep me calm. Of course, I will keep you updated as this progresses, but now that we have a plan of action, I am scared out of my mind! Not that the stitch will fail. but that our dreams are about to become reality with God's help and the help of these two Dr.'s. Now the questions that are plaguing me include; "am I really ready again? Will I make a great mom? How will I survive bedrest a second time around if needed (trusting God that I won't)?, am I ready for the emotional aspect that comes with being pregnant after two losses?
Despite all these fears, I am once again putting my faith, hope and trust in God, and comfort myself with the fact that this is the year of promises fulfilled.
Awaiting my expected end.