Consult with Dr. Carpenter

I said this deserved its own post-- I hope I can remember/piece together from my notes enough details to make it worth it.

The first thing Dr. C discussed with us was risk of loss of the entire pregnancy, between 10-24 weeks.  For singletons, the risk is 2.5%, for twins 7-8%, and for triplets 15%.  The risk of losing a single fetus remains constant over all pregnancies-- each fetus has a 2.5% chance of dying between 10-24 weeks.

The next thing we discussed was prematurity, which is defined as being born between 20.1 weeks and 36.6 weeks.  For a singleton, the rate is 7-8%, for twins 45-50%, for triplets 80-85%.

Next, we talked about the most critical issue in our minds-- delivery between 24-28 weeks.  Here the rates are: 1-1.5% for a singleton, 5% for twins, 7-8% for triplets.  M and I had read the earlier materials to say the risk was 15% for triplets, so this lower risk was a big relief.

We talked specifically about the major risks of delivery in that timeframe.  Babies born between 24 and 26 weeks have a 9% incidence of cerebal palsy, as compared to .1% at 40 weeks.  Other complications of prematurity are:

1. Lung disease (varying degrees, most is resolved by age 7-8)
2. Head bleeds (grade 1-2 usually resolve without consequence; higher grades do have lasting developmental effects)
3. NEC
4. Infection (to any and all organs-- worst is meningitis, next septicemia)

Every one of those complications is scary, but the good news is, in terms of long-term health outcomes, premature babies have pretty good odds, and there are advances all the time.

We talked briefly about the risks of reduction, including the risk of regret and delayed grief.  He said 1% of people who reduce experience great regret.  He also told us about two former patients of his who had reduced triplets and, much later when their twins were born and healthy, had basically psychotic reations to the grief and had to be hospitalized.  Yikes.

He said the timeframe to reduce, if you were going to do it, is ideally 10.5 -14 weeks.

We talked about genetic testing.  He believes the risk of CVS is approximately equal to the risk of amnio, which is minimal.  He said there was a study comparing 34,000 women who received no amnio to 14,000 who underwent amnio, and the increased rate of loss for the amnio group was 1 in 750.  It still makes me nervous.

If we do CVS (and it does look like that's the plan), he said to make sure they do array CGH or CMA testing, which includes molecular testing.  That's a little over my head, but I'm transcribing from my notes.

I asked specifically about the possibility of increased risk related to my taking Lovenox.  He said he would recommend skipping the dose before the test, and restarting 8 hours after the test.  He said he had one patient experience bleeding under those conditions (though I think the pregnancy was unaffected).

Other than that, he said his mantra is "Decrease stress, Increase rest."  He said say it every day and live by it.  He says there's no clinical support for bedrest (unless something goes wrong) and that I should continue to be moderately active-- walking in the pool is a good way to get no-impact exercise this summer.  And, like I mentioned before, he gave us some provider recommendations, which is how I teamed up with Dr. Uribe and Dr. Haeri here in Austin.

So overall, the conversation was really helpful.  We feel secure in our shared decision to continue on with the triplet pregnancy.  If there is anything wrong with any of the babies, we may need to reevaluate that-- knowing that one baby could jeopardize the whole pregnancy.  But for now, we have no indication that anything's wrong and we're all predicting sunny skies and fat, healthy babies at the end of this adventure.