Thursday, January 9, 2014

A new stroke theory

I had an ultrasound for the new baby today and what was supposed to be our first meeting with our new high-risk OB.  (I'm considered high-risk because of Allie's stroke and will be followed by both the high-risk and my regular OB throughout this pregnancy.)  When we got into the ultrasound room the technician apologized that the doctor would not be able to meet with us today because four of his patients were admitted to the hospital last night and he's there with them.

The ultrasound went great and all of the results from the baby's genetic testing were good.  So far, the new baby is in good health and it was fun to watch him/her squirm around trying to get away from the prodding ultrasound wand.  I remember watching Allie doing the same!

A couple hours after the appointment, the doctor called to apologize for not being there in person and to talk a little about Allie.  His first point of discussion was Allie's cord knot.  He was shocked that Allie survived it.  He said that they only see those types of the knots in cases of "fetal demise" and said it was "miraculous" that Allie was born alive.  (See a description of the cord knot here and and our regular OB's shock at the cord knot here.)

Next, we moved on to the stroke.  He said that he looked through Allie's ultrasounds from when she was in utero and there was no indication that anything happened.  He also looked through all of my blood work and noted that all the clotting disorder tests looked fine.  We knew all this but its always nice to get another opinion.
Cerebral arterial supply to the brain 

He said that he has a suspicion that the stroke and the cord knot are related.  I asked how this could be since her stoke looks like it was from a clot because the damage is localized around the middle cerebral artery as as opposed to a lack of oxygen that usually does uniform damage to the whole brain.  I had read about cord knots resulting in oxygen deprivation but never anything localized.

He said it could be that Allie had a structural vascular abnormality in her brain that made it difficult to get blood through or around her middle cerebral artery and increased pressure from the cord knot exacerbated it.  He compared it to hitting a big pot hole in your car when you have a tire with low air pressure.  Neither one would cause huge damage on their own but when you put them together, the result can be catastrophic.

This is all just a theory but it is very different from anything we've heard before.

In terms of the new baby:

  • I'm on an 81mg aspirin until I'm 6 weeks postpartum (I've been taking this since we decided to try for another baby, so nothing new here);
  • I will be followed closely by the high-risk OB throughout the whole pregnancy (there was some question about if the high-risk doctor would just piggy back on the regular OB who would do all the visits and ultrasounds);
  • The high-risk OB will do all of my ultrasounds to make sure nothing looks fishy; and
  • I will be induced for a C-section at 39 weeks pregnant (he said risks for complications increase exponentially beyond 40 weeks... Allie was born at 41).    

I have another ultrasound and meeting with the high-risk OB next month, where we will get a better look at the growing baby and find out if its a boy or girl.  I'm excited to tell Allie if she'll have a brother or sister.  She's holding strong to her Peter name choice, so we shall see.

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