There's just no easy way to ask what is wrong with a person and why they have preemies. So, for everyone who wants to ask, but can't figure out how, here is your answer...
First of all, you shoud know I am the queen of "this is rare" and "this isn't common, but it isn't uncommon." Caleb inherited that little trait from me.
I have a bicornuate uterus. Basically that means my uterus is shaped like a heart. The top of the heart is called a horn. The longer the horn, the more complications. With a bicornuate uterus, there is a very high rate first and second trimester miscarriages and premature births. There is only about a 50-60% chance of fetal survival. I have been very fortunate with both of my pregnancies!
Many people with this condition have multiple miscarriages before they find out about it (like 5 or 6 miscarriages). I found out about it 2 years ago. Just after we got married, my period started a week early and didn't end for 22 days. When we got back from our honeymoon, I called my doctor. They did an ultrasound and diagnosed me with a septate uterus. They upped the hormones in my pill and told me that when we decided to get pregnant, they would watch and see how things went. The doctor told me that if I had a miscarriage, we would talk. Cary and I weren’t ready to have kids yet, so I didn’t think about it anymore. Then, my body started rejecting the pill. I had every side effect possible, including depression (who knew the pill could cause depression). So, I had to stop taking the pill. Cary and I decided that I would stay off the pill for a few months to let my body adjust, and then I would talk to my doctor about other options. I was starting to feel like myself again, so I decided I would call my doctor after my next cycle. Oops! I never had a next cycle! This is where Caleb comes in the picture…
So, I called my doctor and told her I was pregnant. They scheduled me for an ultrasound within a week to see if the egg had implanted in the correct spot. If the egg implanted close to the horn, I would be at a higher risk of miscarriage. The ultrasound showed little Caleb was in the perfect spot.
At 16 weeks I went to the perinatalogist for the first time. They did an ultrasound and said I more then likely had a bicornuate uterus, but they couldn't tell for sure because Caleb was already taken up so much room. The doctor diagramed out a bunch of different types of uterine anomalies. He pointed to each one - this one has a high rate of twins; this one doesn't cause too many problems; this one can cause some problems; and this one is the worst one to have, it causes the most problems and this is the one you have. Everything looked great at that point, so they scheduled me to come back in 4 weeks. At my 20 week appointment, everything still looked great, so they told me to come back in 6 weeks. At my 26 weeks and 2 days appointment, my cervix was down to .75 centimeters (2.5 centimeters is the average). They sent me directly to the hospital and I found out I was having contractions and I was in preterm labor. They started me on magnesium sulfate to stop the labor and steroid shots to speed up the development of Caleb's lungs. 4 days later, I went into labor again. This time there was no stopping it. The rest is history...
Now that I'm pregnant again, they have told me a little more of what to expect. This baby will probably be breech and delivered by C-section (I was fortunate with Caleb, he was head down and I was able to have a vaginal deliver). Now, my cervix length is checked every 2 weeks. So far, so good. If it starts to get shorter, I will start going to the perinatalogist more. I had a preventative cerclage at 13 weeks. (By the time they found out about my incompetent cervix with Caleb, there wasn't enough cervix left for a cerclage.) This condition (deformity, freakness, whatever you what to call it) can also cause IUGR. Caleb and monster #2 have both measured perfect with no signs of IUGR.
With Caleb, I also had a placental rupture just before he was delivered. This may have been caused by the bicornuate uterus. There is nothing that can be done to prevent a placental rupture. In my case, if the placental attaches to the very top of the uterus, away for the horn, everything should be ok. If it attaches any where else, there is a possibility it can rupture again. There’s no way to determine where the placental will attach. Again, so far, so good.
So, that's what's wrong with me and what makes me high risk and why Caleb came so early.
We are doing everything we can to prevent from having another preemie. I go the perinatalogist every 2 weeks, I go the OB once a month, I get weekly p17 shots, I try to stay off my feet (that was Caleb's doctor's advice), and I get a lot of rest.
Here are the big high risk milestones:
24 weeks - point of viability. Babies born before 24 weeks have such a low chance of survival that most hospitals will not resuscitate them.
28 weeks - babies born at 28 weeks have about an 85% chance of survival and they are at a lower risk for some of the stuff Caleb had and (I think) they are no longer considered micro-preemies.
35 weeks - at this point the lungs are fully developed, the baby is no longer considered premature, and if there are no other health issues the baby should be able to go home from the hospital with us.
36 weeks - the cerclage will be removed (unless I have already gone into labor or if they decide to schedule a c-section.)
37 weeks - term
40 weeks - huge belly full-term.
Look what I just found in my computer! It's Caleb at 20 weeks, 2 days. The ultrasound is from August 26, 2005.