Maternal Fetal Medicine Consult

Since Dr. S recommended I meet with Maternal Fetal Medicine (MFM) before conceiving, I decided to get an appointment at McKay-Dee as soon as I could in case there was something he recommended I be doing before getting pregnant.  I didn't think there was much more he could tell me that my specialists hadn't already.  I was pretty much right.  Hopefully my bill isn't too high!  I should get paid for asking better questions and being more prepared than the average patient!  haha.

I waited in the waiting room with 3 other very pregnant women, which is always kind of depressing.  Then I was taken to a consult room with another comfy couch and soft lighting.  This was nice, but in the next room I could hear the quick beating whoosh of a baby's heart beat on ultrasound.  I wished I could've been at the MFM office for that reason.

Dr. A came in, explained he was going to look over some of my test results and clinical notes since he briefly looked over everything and realized I have a lot going on.  He came back about 10 minutes later and asked me to explain all about my lupus and hypertension.  He is a very personable guy, and I think I will like him.

We talked a little about hypertension, and how he wouldn't be terribly worried if my BP was 140/100 if I wasn't having any other symptoms of preeclampsia (increased protein in urine, edema, etc.).  He said I probably already have some microvascular damage, so having a gradually higher BP during pregnancy wasn't going to cause me to have a stroke right then.  If it was a sudden spike up, he would be worried.  But he said if it was much higher than that, I should be in the hospital just like anyone else with a BP that high, pregnant or not.  I didn't tell him it had gotten up to 188/135 last summer!  He echoed my nephrologist in saying that your BP doesn't start to rise until about week 20 of pregnancy.  I was very happy to hear that info repeated because that's almost to the age of viability.

With lupus, there is a higher rate of miscarriage, early and late.  I asked him how early I would see him and if we could prevent an early loss.  He said I would see him first at 20 weeks (yay for not having to spend more money on doctors visits until then!), and there's really nothing anyone can do to prevent an early loss.  He said there is plenty we can do to prevent a late loss, and usually these mothers aren't taking care of their lupus very well or they were having a lupus flare when they conceived.  He said I'm his third patient this summer who was diagnosed as a teenager, almost died from my kidneys being affected so severely, and had barely any problems since then!  I would love to meet these other women!  Darn HIPAA. He also said I could have low-dose steroid treatment if I needed it for lupus, and that it wouldn't cause lasting harm to the baby.

He discussed some labs (APS, anti-SSA, anti-SSB), which indicated my chance of getting a blood clot and having a miscarriage, and if my baby might have congenital heart defects.  If it is found on ultrasound that my baby will have heart issues and their HR is low because they aren't getting enough blood and oxygen, I would deliver by C-section so they can constantly monitor the baby, and I would likely deliver at the University hospital so the baby could go directly to Primary Children's and be on telemetry.  He recommended I take a baby aspirin, just like everyone else has suggested. 

All in all, I knew about a lot of this.  I've done plenty of research, and my nephrologist started telling me a lot of this as soon as I told him we were thinking of starting a family back in 2011.  But it was a relief to get his blessing that pregnancy with lupus and hypertension isn't the worst idea in the world.  Again, if you're reading this, keep us in your prayers!