Question for Dr. Fett

[Kimberly Sidden]

Hi! Dr. Fett,

I just came from my perinatologist appointment, with Dr. Elizabeth Wickstrom, from Kansas City, MO. I believe Dr. Wickstrom has met you at the Hospital in Haiti, she and a neonatologist from KC have a birthing center there. She may have even emailed with you recently.

Anyway, I am 26 weeks pregnant with my post ppcm baby and 40 years old
:-). I am scheduled to have an echo this Thursday and have requested to have another ech in April, as I am due May 7th. Should an echo in April show signs of PPCM, what would you recommend that we do differently for delivery.
I am planning on a scheduled c-section, (as my previous delivery was c-section), I am also planning on a consult with the anesthesiologist group prior to delivery. Any other recommendations? While still on the table after my last c-section, my pulse dropped to 32 and they had to give me ephedrine to boost me back up. Do you think this was due to the ppcm? I also had severe swelling last time starting about 26 weeks and continuing through delivery, with borderline blood pressure. Would I necessarily see the same symptoms this time?

It sounds hypocritical to say that I am trusting God, when I'm asking all of these questions. I know that God has a plan for me and that "all things work together for good for those that love the Lord and are called according to His purpose". I just would like to know in advance what His plan is .:)

Do you recognize my Dr.'s name? Thank you so much for your insight,wisdom, willingness, prayers and support! You are a tremendous blessing to all of us!

Kimberly

[JAMESFETT]

Yes, I do remember meeting Dr. Wickstrom, with a work team from Kansas in Haiti. Small world.... You are doing very well, it's fine to ask questions, God understands. I don't anticipate that your current echo nor your April echo will show significant deterioration. Are you having periodic blood BNP level determination? That could give you a clue of problems before clinical symptoms develop. Although still a research tool, the blood high sensitivity C-Reactive protein may be an indicator of an inflammatory process in the heart, a level less than 10 mg/L at term/early postpartum is reassuring. But remember, that's a research tool, don't know for sure if those hs-CRP findings are going to hold up as an important indicator. It has been helpful in all 30 PPCM patients tested in Haiti, and has been elevated in 2 USA PPCM patients at diagnosis. In the subsequent pregnancy the clinical pattern can be totally different, and statistically it is extremely likely to be different and better. So take one day, one week, one month at a time. Without question the C-section is the way to go, and depend upon your doctors to know the best time. Prayers and best wishes,

James

[grrrangel]

I am also curious about the pulse dropping during your c-section and possibly being ppcm related. I also had a c-section and I had so many problems with not being able to breathe during it and my blood pressure dropped to 50/20 so they gave me ephedrine, too.