Thursday, 27 March 2014

Pip Story - Twin pregnancy, with cpp and percerta.

My First hold of the twins together. 

On New Years Eve 2007, aged 37, I did a home pregnancy test which came up positive. I had 4 children, 3 from previous and 1 with my 2nd husband. I was nervous but at the same time excited as my youngest was quite a bit younger than my other children and this meant he would get a sibling close in age to him, he was only 1 at the time. As I was over 35 I went for a 12 week nuchal scan to make sure everything was ok. As soon as the ultra sound began up on the screen appeared 2 babies. Congratulations the lady doing the scan said, it’s twins. I was shocked, I never expected twins.
A week after the scan I had a bleed, confused by this I asked the midwives at the hospital during my booking in appointment what this might mean. She said it was probably implantation bleeding and said this often happens with twins, so I didn’t give it another thought. The bleeds kept happening and I was sent for another scan. During the 2nd scan I was told I had a placenta previa but she said the placenta can often lie low at the beginning of a pregnancy and it should move up as my uterus grew. Happy with that I proceeded with my normal routine.

I had a couple more bleeds but nothing too huge over the next few weeks, I really didn’t worry about it too much. At my 18 week scan my placenta was still low and was graded as a complete previa. I was also told the twins weren’t growing at a normal rate and were small for their gestation, particularly baby b. I had a hospital appointment a couple of days later and the doctor didn’t like the look of the ultra sound report and wanted me to start having ultra sounds fortnightly in Sydney, a 2 hour drive from home. The doctor advised me that as the placenta was lying so low it wasn’t getting the same blood flow as a placenta up the top of the uterus, so it wasn’t feeding the babies properly. I was also told to have pelvic rest and if I had any bleeds to get straight to my local hospital. Of course I had another few bleeds and a few hospital trips.

Around this time I had also started having quite bad pain at the site of my previous c-section. My 1st 3 children had been natural births, no pain killers, nothing. They had all been fast labours with no major complications but with my 4th baby I had to have an emergency c-section, he had turned into breech position but also had his feet above his head, Frank Breech, he was trying to come out bottom 1st. So I was whisked away to have my baby via c-section, which I might add was horrible. I had never had major surgery I was terrified and really just wanted another natural birth.

I had quite a bad bleed at 22 weeks and the local hospital was considering transferring me to Sydney. Luckily that bleed stopped and after several hours they released me. At 24 weeks I had another scan in Sydney and the babies really hadn’t grown much again, I was told they had severe IUGR, they explained again that the blood flow wasn’t good as the placenta was lying so low. Saddened I drove home and tried my best to do nothing, trying in vain to increase the blood supply to the twins. At 26 weeks I went to Sydney again for another scan, this time they said, you can’t go home today, we are going to admit you. The babies weren’t growing properly and baby b was not getting enough blood flow, they decided complete bed rest would be the best thing for the babies. I was admitted and given my 1st steroid injection to help their lungs develop, this is when I started to get really frightened. This is the moment things became real, my babies might come early, not just early but they were really small for their gestation, their chances of being born healthy weren’t all that good. I received my 2nd steroid injection within 24 hrs of the 1st one and I had neonatologists come and visit me in my room. I was given brochures about preemie babies and their outcomes. However the obstetrician reassured me they would do their best to keep the babies inside me till 36 weeks.

I had scans every 2nd day and each time I hoped and prayed they had grown. Unfortunately they weren’t growing well. They also discovered the pain I had been complaining about on the inside of my c-section scar was actually an accreta. I had never heard of it before. All of a sudden I had so much interest in me by all sorts of different specialists. My head was a whirl with this new information I was being given. I clearly remember being so angry that I had to have a c-section previously. I even confronted the obstetrician, asking why they let so many women have elective c-sections if this sort of thing can happen. It didn’t make sense. I was mad with my cousins that I had considered to posh to push, both had lined up for elective c-sections. 1 had 2 c-sections the other was due to have her 3rd c-section. I couldn’t understand how they paid to go to private hospital and paid to have elective c-sections and their obstetricians allowed this. I was angry, frightened and feeling completely miserable, I was stuck in hospital, unable to see my husband or children until weekends as we lived 2 hours drive away and my husband had to work and somehow juggle the 4 children we had at home, cook dinners, prepare school lunches, make sure homework was completed and find someone daily to help with our 1 year old. The twins prognosis wasn’t very good and now my life was also at risk. Could things go more wrong?

I continued to have scans every 2nd day. The babies weren’t really growing and the accreta was looking worse, they decided it might be turning into a percreta. They were worried about my bladder. I had the neonatologist come to visit me in my room to see if I had any questions for him considering I should have read the brochures. He advised that I do a tour of the NICU, so I knew what my babies might be in for. I agreed and it was set up for the next day. Being wheeled through there, being shown the equipment, how it worked and what it was for and then being shown a baby that they estimated was a similar size to my twins at that time was awful. But I had hope that I would carry them another 8 weeks and deliver them at 36 weeks and surely they would be bigger and more robust.

I got to 29 weeks and the situation wasn’t looking good. The accreta definitely looked like a percreta and the babies weren’t growing. They decided to start getting organised for imminent surgery. I was wheeled off for bloods, visited by an anaesthetist, a gynaecological oncologist, interventional radiology, urologists and so on. They all came more than once explaining things and asking if I had questions, it was surreal in a really bad way. The NICU had 2 beds ready and everyone was on standby.
At 29 weeks and 5 days they told me tomorrow will be delivery day, baby b wasn’t going to survive the next 36 hours, the blood flow was so poor. I was fasted from 12am and wheeled to the interventional radiology rooms the next morning to have balloons inserted into my femoral arteries, so they could prevent blood loss should I haemorrhage and central lines put into my neck, all while being awake. Then I was wheeled off to see the anaesthetist to have cannulas inserted. Not long after I kissed my husband and was wheeled into a massive operating room. There were 30 people in there, I was shocked to see so many, All the different doctors went through what their role was and they all had interns there to watch and learn.

The operation goal was to get the twins out, repair damage done by the accreta/percreta and stitch me back up. Things didn’t go to plan, I began haemorrhaging as soon as they opened me up, the femoral artery balloons were inflated, I had a lot of blood and blood products administered, they had no hope of saving my uterus, and they were racing just to keep me alive. All I really know is the surgery lasted 7 hours and I woke momentarily up in ICU. The next thing I knew was I was in High Dependency, it was the next day and my husband was right next to me, although I could only just make him out as I couldn’t see properly. I asked him how the twins were, he said the boys are ok but very small, he tried to show me a photo of them but my eyes couldn’t focus, I was frustrated I couldn’t see what they looked like. I wanted to see them in the NICU but the nurses said I wasn’t well enough to be moved yet. The next couple of days are a blur of nurses, machines beeping, tubes hanging out of me, bags blowing up constantly on my legs and oxygen. I wasn’t allowed to move, I was completely stuck lying on my back as the balloons in my arteries were still there and they wouldn’t remove them yet in case I had to have more surgery, they were unsure if I had damage done to my bowel. The nurses came in every hour to check me and I remember them saying push the button, the morphine button, but I was too weak to press it, either they did or my husband would. During this time I missed my sons 2nd Birthday and I still hadn’t met my twins.

                                               Recovery in High Dependency Unit.

Day 5 came and the nurses wheeled my bed into the NICU, I still couldn’t move and I couldn’t focus but they wheeled me between 2 incubators and told me these are your boys. I could see 2 very small pink blobs inside but couldn’t focus at all. I kept asking the nurses why I couldn’t see and they just said it was because of the medications. I was so frustrated, what do they look like? I was told they were tiny but considering that they were doing alright. Taj was a little over 800g and Zahn was 1.2kg. They needed to be on a ventilator for a while and they had so many machines keeping them alive it was awful. I just wanted to leave, I couldn’t see properly, it was hot in there and I started to feel ill.
The next day they took the balloons out of my femoral arteries and I had a physio come as my lungs weren’t handling the flat on back position. Day 7 I had the drain tube removed from my swollen belly and they said they would put me in Maternity the next day. Day 10 I was discharged from hospital after begging them to please let me go. I needed to be with my other children, I needed them to know I was going to be alright, I also needed to be around them for my own comfort and to let the healing begin properly. We did the long painful drive home, without our babies, I cried the entire way. I couldn’t drive for 12 weeks so I had no way of getting myself back down to Sydney, I had to rely on someone else to help me. My husband worked for contractors and they lost their contract so my husband lost his job only days after I got home. It was scary financially but a blessing at the same time as I had him to help me through all of this and to be my driver. He cooked and cleaned and was my rock, we became closer than we had already been. The twins spent 2 mths in NICU in Sydney, and then they were transferred to my local hospital. They spent another mth in there and came home weighing only 4lb and 5lb.

                                                    My first precious cuddle with Zahn.

                                                          Welcome to the world Zahn

                                                     Welcome to the world Taj

The recovery and NICU was a time in my life I would rather forget as it was so traumatic, my vision never properly came back and I now wear glasses but we are all here and we are all survivors.

                                                              All the children together :)

Sunday, 16 March 2014

Anthea’s Story - Placenta Accreta.

Celebrating My lovelies first birthday giving back. 
We had been trying for a baby for some time. I had waited a long time before we started trying. There was always something that had to be completed first. Finally in May 2012 we were pregnant with our first baby.  I remember I was at a wedding – a Greek wedding – it was a beautiful day and the Great-Grandma of the Bride said  something to me in Greek. I had no idea what she said. Later I was told that she said I was with child. Naturally that night I did the pee on a stick, I nervously waited and yelled out to my husband to tell him the news! I was roughly all of 5 weeks pregnant. 

At 6 weeks we confirmed with my GP that we were in fact pregnant. That night I had my first bleed. I remember curling up in a ball crying on the floor as my husband was on the phone to Health Direct. I thought I had lost the baby. We spent the night in the hospital being told there was nothing we could do but wait. On the following Monday it was confirmed that the pregnancy was still in fact viable but there was no guarantee that we would not have bleeding again.

At 7, 8, 10, 14 & 16 weeks we had more bleeding. Every time my heart sank a little more but I never gave up. I wrote notes to our little baby every time it happened asking this little being to just hold on. It was figured out at 8wks by my OB that there had been two babies but one obviously never developed. I will never forget how I felt once my OB told me that we had lost a twin. It was an answer to the bleeding but the sadness of what could have been never leaves me.

The remainder of my pregnancy was deemed normal. I was scanned at every appointment and everything had gone well. I was eating healthy, keeping fit and enjoying being pregnant. I had no further bleeds and the 20 week scan was all clear. Nothing unusual. Just a normal first baby. I worked until 36 weeks and enjoyed almost 6 weeks of doing as little as possible. In fact I went well past my due date to the point that I was induced.

On the 25th of Jan 2013 I had a wonderful 5 hour labour once my waters were broken. I used gas until 9cm dilated and then the Epidural had kicked in. Thank god for the Epi is all I can say. My baby had crowned and decided to not only move slightly transverse but also twist her shoulders. She was delivered via Ventouse with the help of an episiotomy. Once she was delivered (my husband had to even help push my stomach to get her out!) they immediately wanted to deliver the placenta and placed my baby on my chest. Oh that was amazing – it just took my breath away. Then things were not sounding great, although the Epi took away most of the feeling – I could feel a gushing sensation and thought there was no way I could be peeing as I had assistance there as well.

Then I could hear my OB saying the placenta was not fully coming out and that he had to manually go in and remove it. Then all of a sudden I remember hearing my OB calling for Code Blue and telling everyone to get in there. My baby was taken off of me and they were jabbing me with needles left right & centre. My husband watched the entire thing but stayed and held my hand asking me to just keep squeezing his hand. I switched off to everything else that I could and just remember trying to squeeze his hand so he knew that I was going to be OK. Code Green (I think) was also called – from what I understand this meant get the states Blood Supply on alert.

I was rushed out of the Delivery Suite with a Team of Drs fussing over me. I remember getting to a door way and they had to slam the stirrups down and hold my legs up to get the bed through. Then I remember the lights on the ceiling and feeling like everything was so fast. It was, they were rushing me straight to Theatre. They say you see the bright lights when you are close to death and I know what this means now.

It was a complete shock to everyone, there was no inclination that this was going to happen. It certainly gave my OB a massive fright. Theatre was around 3 hours I think and they did the same surgery twice after I started bleeding again. They had to basically pack & re-inflate my uterus so that my body thought I was still pregnant. I had a surgical balloon and so much packing to help everything and control the bleeding.

My OB was 5 mins away from considering a hysterectomy but the bleeding managed to slow due to Factor VIII blood product being administered to me. If a hysterectomy was what he had to do to save my life I would not have cared. I had over 8 litres of blood transfused and that does not include Plasma, Platelets and any other blood products. I was put into an Induced Coma and on the respirator in effort for my body to deal with the shock. Then I was transferred to CCU and it was just watch and see. Obviously I had no idea what had happened.

My husband was advised that I would be on the respirator for at least 5 days and that there may need to be further discussions if I was not responsive. I must have decided I was not going to wait that long to see my baby girl and by hell did I put up a fight. Just over a couple of days later I was able to breathe on my own, although I still had oxygen to help. I woke up and had every limb attached to some kind of machine, be it a monitor, drip or god knows what else – it was on me. I could not move and was very puffy from all of the fluids that were being pumped back into me. It was the ultimate detox. My husband waited until I was able to talk again. Once I could, we announced our little girl’s name – Vivienne Quorra Childs. Vivienne means lively and Quorra means heart. She is a lively heart Childs.

I did what I was told, I was patient and I was positive. I managed to only cry once, because I overheard the nurse saying they would not bring my baby down. I had to be in CCU – my family was on the edge and not coping very well. If I could prove to them that I could fight this, then they would cope with the trauma of it all better. My mum did not leave my side the entire time; she was focused on her daughter so my husband could be focused on his. I made a remarkable recovery – one they did not expect. When I asked for my baby, to try feed her, they prepared me that my milk may never come in. I didn’t care – it was my only way that I could bond with her. I thought that just the motion of skin to skin would keep me fighting. Again, I proved them wrong and I am still breast feeding my little girl now at almost 13 months old.

I was lucky - I still have my uterus intact and after further surgery in May 2013 - by OB is hopeful that another child is definitely a possibility. It is just up to us to decide if we want to go down this path again, even though it would be managed next time around.

Today, the 20th of February 2014 was the day I was allowed to give back. For the first time ever I made a Blood Donation. It is part of my road to recovery mentally. There is still a journey to go with that but I will get there.

Placenta Accreta was a very small article I read about in my baby book - I never thought it would happen to me.