Monday, August 08, 2005

To clarify

I was apparently not very coherent in my middle-of-the-night ramblings about sleeplessness and the prospect of no babies in my future. So I will take this opportunity to clarify a couple things...

It's not that I fear infertility. I've never had a problem GETTING pregnant (four months is not what I classify as a problem...though there was a time when I probably would have). I simply have NO IDEA about anything having to do with my own reproductive health.

My OB lied to me about Alex's cause of death. She told me he most likely died from an intracranial hemorrhage, "But we still don't know what caused the hemorrhage." I had to read about bacteremia and chorioamnionitis in his autopsy report...where it clearly says, "In summary, the cause of death appears to be bacteremia related to chorioamnionitis. However, examination of the brain revealed significant intracranial hemorrhage. Because of advanced autolysis, the etiology of hemorrhage could not be determined."

What does this mean? Does this mean that my uterus is infected and will kill off any babies who dare dwell there? Does this mean that I could grow another perfectly healthy baby to 35 weeks and have him die quietly in his/her sleep? What does this mean? I HAVE NO IDEA! My OB can't or won't be straight with me. So I'm left asking all these questions to myself (and you dear readers). I'm ceratinly hoping the perinatologist can give me some answers tomorrow...Come On Tuesday!

But the question that really bothers me is this...if there is even a chance that this could happen I really want to even try? Do I have what it takes to take a gamble and risk losing the odds game again?

So while I'm not infertile...I'm afraid there will be no babies just the same.

Now...a brief lesson in chorioamnionitis for those that wonder...especially those that see it in their medical records (hopefully before something horrible happens to them...but especially for those who see it after something horrible happens to them)...

Chorioamnionitis is an infection of the membranes (placental tissues) and amniotic fluid. It occurs in about 1 to 2 percent of all pregnancies, but is much more common in preterm births. Chorioamnionitis can cause bacteremia (blood infection) in the mother and may lead to preterm birth and serious infection in the newborn baby. Other terms for chorioamnionitis include intra-amniotic infection and amnionitis.

The organisms usually responsible for chorioamnionitis are those that are normally present in the vagina, including Escherichia coli (E. coli). Group B streptococcus may also cause the infection. Chorioamnionitis can develop when the membranes (amniotic sac) are ruptured (broken) for an extended period. This allows the vaginal organisms to move upward into the uterus.

What are the symptoms of chorioamnionitis?
The following are the most common symptoms of chorioamnionitis. However, each woman may experience symptoms differently. Symptoms may include:
-increased heart rate in mother and fetus.
-tender or painful uterus.
-a foul odor of the amniotic fluid.

The symptoms of chorioamnionitis may resemble other conditions or medical problems. Always consult your physician for a diagnosis. (ha!)

How is chorioamnionitis diagnosed?
In addition to a complete medical history and physical examination, chorioamnionitis is diagnosed by symptoms and by laboratory tests for infection. Testing of the amniotic fluid by amniocentesis (withdrawing fluid with a needle) may be needed.

Treatment for chorioamnionitis:
Specific treatment for chorioamnionitis will be determined by your physician based on:
-your overall health and medical history.
-extent of the condition.
-your tolerance for specific medications, procedures or therapies.
-expectations for the course of the condition.
-your opinion or preference.

Antibiotics are used to treat chorioamnionitis as soon as the infection is diagnosed. Antibiotics are usually continued after delivery as well. Delivery is often necessary to prevent complications in the mother, or if the fetus is in danger.

It usually occurs when your water breaks and you are in labor for a longer time than you should. It's a result of frequent cervix checks and the lack of protection provided by the amniotic sac. Bacteria are "stirred up" and travel upwards to the uterus (which is apparently a home away from home for some of these things). This is why they will normally only let you labor for 24 hours after your water breaks. After 24 hours, the risk of infection skyrockets. In my case, I had this usual case during my delivery with Sam. No infection prior to my water breaking...but it jumped on board some time during the 22 1/2 hours of labor I had...necessitating a c-section. The thing is...I didn't KNOW I had an infection. Nobody ever told me. In fact, they told me the shivers and the vomitting I had were "normal at certain stages of labor." Upon receiving my medical records, I found that my amniotic fluid smelled and there was acute chorioamnionitis that evidenced a need for antibiotics (again, something that nobody saw fit to share with me).

There is also another kind of chorioamnionitis that is rarely studied. This is the kind I had with Alex. The kind that somehow crosses the intact amniotic barrier and infects the uterus, placenta, and fetus DURING pregnancy. It's one of those things that gets glossed over in books and such. You that reference to "resulting in...and rarely stillbirth?" My favorite line is..."There have been cases of..." and then there is nothing of substance on point.

There are theories of microscopic tears in the amniotic sac that provide access for the bacteria. There are also theories that the bacteria somehow gets into the mother's bloodstream and crosses through the amniotic barrier via the placenta. Nobody knows for sure. The only reason I know about it is because Alex had aggressive bacteremia...infection in the blood and multiple organs/tissues in his body...most notably in his lungs and heart. The only way for that infection to get into those tissues is while they are functioning and the bacteria circulates through the body. I have found that chorioamnionitis is dangerous for the mother and can lead to vascular collapse. There are many tales out there of women who "stroke out" or something similar during childbirth. It is theorized that this is one of the main causes (though again, not studied). I hypothesize that rather than happening to me...this is what happened to Alex. His body couldn't take the strain of the infection, and the blood vessels in his brain just gave out. (Hell...everyone has a theory...I don't see why I should be any different.) In a way, I suppose I owe Alex a great debt. If he hadn't died, I may have walked around for a few more days with this infection until it got so serious that it eventually cost me some physical damage. Though I have to tell you...if he could have lived, I would gladly have given my life.

Anyway...two weeks after Alex was stillborn, I complained to my OB about a UTI. (At this point, she hadn't yet lied to me.) I did a urinalysis and I had an overcolonization of E coli. I now wonder if that isn't the bacteria responsible for Alex's bacteremia, which led to the vascular collapse and intracranial hemorrhage. And given my OBs subsequent failure to tell the truth about Alex's cause of death, I wonder if she doesn't suspect the same thing and KNOW she dropped the ball? Did you see that part about diagnosing it based on your complete medical history? Well...even I didn't know I'd had it during my previous delivery (and my OB never bothered to request my medical records from my previous pregnancy) exactly HOW this was going to happen is impossible to tell. Oh, who am I kidding? It didn't happen...they thought I was being a hysterical pregnant woman and told me to take some Sudafed and Tylenol.

Regardless...I don't know anything. I can only guess until I have a doctor willing to talk straight with me. And Lord only knows if there is such a creature on this planet anymore.

1 comment:

buffi said...

Doctors are known to cover their own asses. Even at a patients expense. I could share my stories with you, but they pale miserably in comparison to your tragedy. Mine resulted in "could have beens," not anything as horrific as your experience. I hope you get the answers you want and need tomorrow. I'll be thinking of you.