Preg or TTC with an EF less than 55%????

[jmonte]

Is anyone out there with a less than "normal" EF that is pregnant or working on becoming pregnant?

[SusanD]

TTC knowingly if their EF was <55%...especially given the data that they don't do as well as those whose EF is recovered.

Obviously if someone is already pg and their EF is not recovered then it's a matter of gathering up your healthcare team and and proceeding cautiously and optimistically into the pg.

[jmonte]

Well, I was diagnosed with mild DCM- Muga and Mri's show my EF in the 50% range and echos in the 45% range. My docs (and I've seen a lot) all agree that I've probably been at this EF for a long time. The etiology is unknown but they don't think it was necessarily PPCM since my pregnancy was unremarkable and without incident. They only found the lower EF after 7 mos when they did a baseline echo postpartum due to my VSD which I was born with. I saw a Congenital Heart Spclist and he said my numbers were pretty good and he would not try to talk me out of my plans for a baby. My Cardio says I am about a 2-3% risk of serious problems. The high risk OB says I'm only mod risk. So all this makes me feel fairly comfortable to try. The only thing is, it is unknown what my EF was from the time Vincent was born to 7 mos old. Maybe it was worse and got better- we'll never know since I was asymptomatic and not tested until 7 mos past. Do you think I'm crazy for trying? Does this info still make you think it is too risky? I appreciate your opinion- thanks Susan. Julie

[SusanD]

Hmm, Julie....you have some interesting points and sounds like your health care team is really considering all of them.

I admittedly am *not* an expert on PPCM and further pregnancies. I have, in the past, been quite vocal about women with PPCM not attempting further pregancies. However, we have had more than a few women go on to be fine with post PPCM pregnancies, so I've altered my stance a little bit and am not so flamingly against it...if all that makes sense.

My standard advice for women considering further pg's is this:

-get second and third opinions from both cardios and perinatologists (not just a regular obgyn)
-ask yourself about the very real possible outcomes and how equipped you and your family are to deal with them i.e. deciding between mom and baby, preemie births, NICU stays. This not only includes the emotional aspect but the financial aspect as well....do you have *excellent* disability and in-hospital coverage ? enough savings in the bank to pay your deductible and out of pocket premiums ?
-do you have everything legal lined up (living willl, advanced directives,etc.)
-do you have family or friends to be there for you for all possible scenarios ? Of course the most WANTED scenario is a normal, happy healthy delivery....but you need to know and have a plan for who will be there in case it is not how you expected
-could your Dh take extended leave ?
-if you had to go on bedrest, what would be your plan ?

I make this list *not* to be a negative person, but to put a bit of objectivity and planning into what is surely a difficult decision.

We are fortunate enough that having another baby (via me at least !) was not really an option....DD was an in vitro baby (i.e. cost upwards of $20,000.00 dollars) and we could not repeat that expense and there were many other health problems I would not care to repeat. The reason I say fortunate is it would have been a MUCH more agonizing decision had I been able to readily get pregnant without all the other considerations.

I applaud your planning and preparation and TOTALLY wish I had better answers for you. My *expertise* such as it is, is more in dealing with CHF and the care aspects of PPCM....I do not encounter that many PPCM women as they consider further pregnancies. The list above is what I myself would use if I were planning.

Keep us updated...you are so "on the cusp"...not perfectly normal EF but still within a reach...and I would think it would make the decision that much harder.

[jmonte]

Thank you so much Susan- you have given me a lot more to think about. I am tortured by this decision. If I were a little bit better or a little bit worse, or had symptoms the decision would be easier. But I am right on that line , so to speak. It stinks. I ran a marathon in 1999 and if my baseline is really in the mid 40's than I did alright with that. We just don't know. I found an old echo from 10 yrs ago and it showed slight enlargement but otherwise pretty normal. I also used to party a lot- college and post college- so maybe too many quarter beer nights hurt me too. I wish I knew- now I'm the healthiest I've ever been but have this going on. Ick. But thanks for your input. Julie

[tabs]

Well, I tried to post earlier and it was lost in cyberworld so here is to another try.

Julie, I spent my entire third pg with an ef in the low 40's. It was discovered at 12 weeks gestation. My family doctor put me on sick leave by 20 weeks because I was not being medicated and I had a possible blood clot in my heart. By 24 weeks I was having symptomatic palps. A holter revealed a heart rate that would jump as high as 200 beats per minute. My cardiologist then put me on bed rest. I delivered my baby at least 3 weeks early ( I say at least because they kept changing dates on me and she was a characteristic premee at birth). Six days later I was readmitted with an ef of 7%.

I am lucky because I live in Canada so most medical expenses were covered. I had a great job that paid me full pay while on sick leave allowing us to keep our 2 children in daycare while my husband worked. My parents were wonderful and lived with us on and off from end of March till after Christmas. My husband was able to take parental leave. We were also able to receive many free benefits (childcare and housekeeping) from our employers.

You do need to develop plans for all possiblilities if you decide to get pregnant again. I did make it, but I had many complications. One thing we did not do that I would reccomend is to be put on a beta blocker when it is safe during the pregnancy. We did not do this as we were not sure if my ef was pregnancy related or just "normal" for me.

On a brighter note, my second pregnancy was probably my easiest pg with very few symptoms.

This is a decision that you and your husband need to make with all the relevant info that you can find. On a personal note I am almost 5 years out from my lowest ef and my current ef is still in the 40's. I do not know if I would try again for another child, but then I already have three.

Twilah

[WVMommy]

i am currently 15 weeks and have and echo that read 45-50% a week ago. I think my health care is horrible !!!Is there so one out there that can advise me of high risk clinics in other states!

[naturalmama1012]

My EF by MUGA is 59%... but by echo generally has been consistently read at about 45%.

I am in a similar situation to you, except that my docs opted to go for the PPCM diagnosis rather than DCM, although I was asymptomatic and had an incident-free pg the first time around as well. I personally feel that I probably had this pre-pg with #1, and it is DCM. The thing is, we only know what my heart was doing after the delivery of my son, and not prior to that... they found it after an abnormal EKG during labor prompted them to look closer, otherwise we would have never known.

The biggest thing for me was acknowledging the risks... and accepting that if something happened early in the pg, I would have to make a decision between myself and the baby. At this point (32 weeks), it is more of an issue of my own health... which has been absolutely fine so far. I know there is a possibility of further heart damage... which I accepted because

a) it is a big enough deal to me to have more kids, that I could never live wondering "what if" I could have been just fine but never had more and

b) there was not enough concrete evidence of PPCM or that I would actually have a high risk of further damage.

I also know that if this is PPCM and I do have a reoccurance I could potentially face a life-threatening situation, but I could face a life-threatening situation getting in my car to go to work tomorrow too. I suppose to some that might sound sort of flippant, and like I don't take it seriously... I do... I guess what I am trying to say is, you have to make whatever choice is right for you, that you can be comfortable with.

It's a tough decision!

[tinabowen]

My EF was 55% in Feb a month before I found out I was pregnant(was not trying)..I have a team of Dr's Perinatolgist,Cardiologist and OB.
Right now at 13 wks I see my OB every three weeks, starting at 20 wks that will go to every two weeks and then at 33 wks(when I started showing signs of problems in my last pregnancy) I go twice a wk..I will see my Peri every four weeks starting at 24 wks and at 33 wks once a week for Bio-Physical Profiles of the baby..
I will see my Cardiologist on July 21 then every 4 wks after that.

If I have any signs of Heart failure they will deliver wether it's time or not.

In my last pregnancy by this stage I could wear shoes and the fact I can now is GREAT..

It really broke my heart when the OB said I could not have another child.I went through 9 years of Miscarriage and infertilty to have my son and there they were telling me he was it..The Cardiologist after my 3 month Echo EF50% told me I could have another baby since my heart was healing but wanted me to wait a year or more, that didn't work a higher power had other plans..I am thankful for the team of Dr's I have..


Tina
mom to Miracle Nicholas(8-13-04)
Mom to be to "SPUD" due (11-30-05)