Wednesday, May 11, 2011

Post-Op Questions (???)

It's been a week since my post-op appointment.  I brought with me a list of questions to ask Dr. Bachus.  I will now list the answers.

1. Endometriosis is a condition in which the tissue that behaves like the cells lining the uterus (endometrium) grows in other areas of the body, causing pain, irregular bleeding, and possible infertility.  The tissue growth (implant) typically occurs in the pelvic area, outside of the uterus, on the ovaries, bowel, rectum, bladder, and the delicate lining of the pelvis.

My Ovary - Pre-Endometriosis Removal
2. There is really no way to keep an eye on it.  It could grow back in 6 months, 10 years, or never.

3. Our Reproductive Endocrinologist, Dr. Bachus, will follow us during the first trimester of my next pregnancy to make sure that things are moving smoothly.  At that point, we will then move back over to our regular OBGYN.

4. The Septate Uterus answers why we miscarried at 6 weeks and 19 weeks because the embryo and baby did not have enough blood supply to help them grow.

5. The septum was more than 50% down the center of my uterus.

The bottom right photo is the best picture they could get of the Septum. 

6. I can start running again 2 weeks after the surgery! :) (More on this later.)

7. The endometriosis was removed by laser destruction (or diathermy).

8. We have an 85% - 95% chance of having a normal pregnancy on our next try.

9. I will need to take a Baby Aspirin every day during my next pregnancy as a way to prevent blood clotting.

10. I have as much of a chance as any "normal" pregnant woman to have a full-term vaginal delivery when the time comes.  And at this point in my life, it really doesn't matter how Baby arrives, just as long as Baby is healthy and crying loudly upon arrival.

11. A picture to prove that I was diagnosed with a Bicornuate Uterus and reminder that second and third opinions are so important to be able to finally reach a peace of mind.

12. A picture of my original HSG, which never would have been able to give us our true diagnosis of the Septate Uterus.  I'm so happy we had the laparoscopy/hysteroscopy! 

The End.

Monday, May 2, 2011

April 29, 2011

Mom & I Before I was Wheeled Into the Operating Room
Amongst all that is going on in the world from Bin Laden to the new Duke and Duchess... Joey and I finally have our own "new beginning."

On Friday, April 29th at 2:30pm, I went into the Surgery Center of Fort Collins and got ready for the biggest moment of my life, thus far.  I signed the necessary papers, put on my surgery gown, had the IV inserted into my hand and laid down on the hospital bed.  (After the IV was put in, the worst was over for me!)  Then my mom and Joey came to my bedside and sat with me while we waited for my surgeon to give me the okay to head back.

Our Surgeon/Reproductive Endocrinologist, Dr. Bachus, came to my bedside and explained that he would be performing the laparoscopy and from there he would decide what the best plan of action would be.  If he found a normal uterus or a bicornuate uterus, I would be in and out within 10 minutes because the procedure would only be diagnostic.  However, if he found a septum, he would then go ahead and remove it.  At this point, all we could do was just wait and see...

Around 5:30pm, I heard my name being called by the post-op nurse and realized I wasn't at work.  (I had previously been dreaming about case managing one of my clients.)  I looked around and realized that I had been under anesthesia for over 2 hours.  The nurse told me to take deep breaths and I laid there taking the best deep breaths that I could.  Thirty minutes later I was able to stand up, get dressed and go meet my Mom and Joey in the recovery room.  I began to sit down on the big comfy chair in the recovery room, when they walked in with sh*t eating grins from ear to ear.

"Did you hear the news?"
I had no clue.

"The doctor found a septum halfway down your uterus AND endometriosis.  He was able to get rid of it all.  You are as clean as a whistle inside!"

It would end up taking me another 24 hours to really let it sink in, but those were the best words I had ever heard.  I called it my "Christmas in April".  The surgery was over, the septum was identified and removed AND endometriosis was identified and removed before it caused me any more problems later on.

From here, I need to heal for 3 months, have one more MRI to make sure that my uterus healed properly, and then it is all in our hands.

It can really play with your mind when you go from a zero understanding of why you continue to miscarry and if you will ever be able to have a "normal" pregnancy, to having the world open up in front of you and the doctor telling you that you are healthy and good to go.  I'm still processing the whole situation in my head, and probably will be for a little while.  Luckily Joey and I start counseling next week with the same LCSW that helped us through the grief and loss of Baby.

Our journey to a family continues with cautious excitement and unexplainable relief.  I just can't thank the doctors, family and friends enough that have supported us to get to this point.

Our Answer! A Septate Uterus

The septate uterus is the most common müllerian anomaly, accounting for 3% of detected anomalies. It consists of a single uterus divided by a largely fibrous midline septum. If the septum extends to the internal opening (os) of the cervix or even further downward, it is considered a complete septum. If it does not, the uterus has a partial septum and is "subseptate." In addition, a septum may be broken up longitudinally, or segmented. The outside contour of the uterine dome (fundus) may or may not be indented, but the groove does not exceed 1.5 centimeters in depth.

In the female embryo, uterine development is usually complete by 22 weeks' gestation, with the two müllerian ducts fusing together to form a single uterus. In one of the final events of uterine formation, the wall where the ducts fused dissolves, forming a single endometrial cavity. It is the failure of this last process that produces a septate uterus with two endometrial canals, reflecting either a partial or complete failure of the duct walls to dissolve, depending on the extent of the septum. Although there is some evidence of a weak genetic factor at work, researchers still do not know the exact cause of the failure of a septum to resorb.

While a septum is not thought to decrease fertility, it does seem to affect the course of a pregnancy, either through miscarriage or pregnancy complications. Early miscarriage is common within the septate uterus, because the blood-starved median septum is covered by a poorer grade of endometrium than that of the blood-rich sidewalls. An embryo implanting in the septum frequently fails to thrive because of lack of nourishment, and an early miscarriage is the result. Late miscarriage is also common, and its likelihood increases along with the extent of the septum. Some studies suggest that in a completely septate uterus, the prognosis of a live birth is as low as 10%. In a late miscarriage, the pregnancy outgrows available space and the cervix may give way, typically midway in the pregnancy, before the fetus is mature enough to survive. Other complications include premature labor, premature birth, intrauterine growth retardation, and fetal malpresentation at birth. One caveat to keep in mind is that women diagnosed with uterine septa tend to be the ones with the most problems conceiving or carrying to term; cases of septa that do not affect reproduction are probably under-reported.

Unless the woman has a vaginal septum or double cervix, the septate uterus is usually not diagnosed until a woman has had some pregnancy failure. Typically, after failure to conceive or repeated miscarriage, hysterosalpingogram (HSG), in which dye is injected into the uterus and x-rays taken, reveals some degree of septation. Other tests which may reveal a septum are: magnetic resonance imaging (MRI), ultrasound, and hysteroscopy.

Each test has its own advantages and disadvantages. For instance HSG, which shows the inner contours of theuterine cavity and fallopian tubes, can not tell the difference between a septate uterus and a bicornuate uterus because it does not reveal the outer contour of the uterus. A spetate uterus looks normal or nearly normal on the outside, while a bicornuate uterus has some degree of outer division. Although some medical texts state that the angle between the horns may reveal the type of uterus, with an angle less than 75 degrees indicating a septate uterus, this is not reliable; some septa are very broad. MRI, on the other hand is increasingly thought to be more reliable, although sometimes it is difficult to see the uterus in the proper plane. While ultrasound may sometimes reveal the outer shape of the uterus, it is best used as an adjunct to a more definitive test. Hysteroscopy can frequently determine whether the septum is fibrous or muscular, and when used simultaneously with laparoscopy, can provide a very accurate diagnosis. Although a simultaneous hysteroscopy and laparoscopy is invasive, it can be done at the same time as a hysteroscopic metroplasty, if the latter is indicated to reduce a uterine septum.

One of the heartening aspects of having a septate uterus is that it can be repaired through a relatively simple surgery, giving the woman near-normal odds of carrying a subsequent pregnancy to term. Whether or not she needs a metroplasty depends on the extent of the septum, or whether or not she has lost previous pregnancies. Until the mid-1980s, surgery to reduce a septum, called a metroplasty, was done through an abdominal incision. Recent development of the hysteroscopic metroplasty (also known as "septoplasty") has rendered the former technique almost obsolete.

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