Can we discuss this birth situation?

[kimberlylibby]

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[kimberlylibby]

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[Quirky]

Just bumping for you....you might want to pm pamamidwife, lorijds, and Momto6 (or is it Mom2six?? ) . I hope your sister does OK and keeps that baby in longer.....26 weeks is waaaaay too young.

[cottonwood]

Nobody seems to know! I wish I had some useful info to give you, but it sounds like your sister is really not well, and I just don't know much about appropriate medical care for truly problematic pregnancies.

[doctorjen]

I'll take a shot, but keep in mind I don't know specifics, really, about the woman in question.
Atrial fibrillation is a heart arrhythmia in which the atria (upper chamber of the heart) just flutter irregularly instead of contracting regularly. Instead of transmitting a nice, steady contraction rhythm to the ventricles (bottom chambers of the heart) an irregular pacing signal gets through, so the ventricles also tend to beat irregularly and too fast. The treatment is usually medication to slow the heart rate (some of which can't be given in pregnancy) and anti-coagulation, to prevent clots from developing in the fluttering atria. More worrisome is why she might have developed this. Usually it is seen in older folks who have had high blood pressure for years, causing the atria to become enlarged from coping with higher pressures, and eventually disrupting the conducting system of the atria. It can also be caused by heart failure - and peripartum cardiomyopathy is one possible very serious cause of heart failure in pregnancy. Hyperthyroidism can also cause it. On the other hand, occasionally it can develop out of the blue for no specific reason, and then may not be as concerning (but still would require treatment, close observation, and cardiology evaluation.)
By itself, a. fib. would probably not be a reason for a cesarean, I would think, but heart failure might be. Labor causes both a lot of physican exertion type stress on the heart, and fluid shifts that effect the heart. She'd want to get good opinions about this, though, because surgery is also a huge stress on the heart, and in fact in folks with a. fib. there is a significant risk of clots developing in the the fluttering atria, and then causing stroke peri-operatively. Moms with peripartum cardiomyopathy due have a risk of heart attack. These folks would be outside my scope of practice, so I don't know exactly what the risk is, but I don't think it's negligible. Sounds like this is a bad situation all the way around, and she should have very tight monitoring by a perinatologist and a good cardiologist.
Edited to fix bad typos from NAK!

[bunny's mama]

Originally Posted by kimberlylibby

She's even gone so far as to talk about how "cute the baby will be in the NICU". (that's another issue in itself).

bless you doctorjen, what a great response. and i even understood it!

kimberlylibby, i just wanted to say WOW to your sister's attitude about having such a young preemie. obviously she hasn't seen just how tiny a babe born at 26 weeks (or close to it) really is. i do know someonw who delivered her dd at 27 weeks and the child (at 5 y.o. today) has serious vision and lung problems. so it's more than just a size problem.

yikes. i'll think good thoughts for your sis and the babe.

[mamallama]

It does sound like your sister has some serious health issues. We all want birth to be "normal," all of the time--and sometimes we want to blame it on medical mismanagement when it's not--but the truth is, some moms and some babies do need extreme intervention to come out alive on the other side.

I am not a doctor, and I cannot evaluate the likelihood of your sister having a heart attack in labor. I will say though (but I'm sure you know this,) that the length of labor does not directly correlate with its intensity. Sometimes its the quickest ones that are hardest on the mom.

When the stakes are high (as they are right now), I think it is always wise to seek a second opinion from a qualified and experienced care provider. Getting a second opinion does not have to involve a confrontation. My experience in dealing with healthcare providers regarding serious matters has been that they understand the gravity of the situation, and they're very concerned about the patient/consumer being satisfied.

I'm sure your sister is scared, whether or not she is communicating that to you, or even admitting it to herself. I'm willing to bet that it was her defense mechanisms talking when she made the comment about the baby looking cute in the NICU.

[Foobar]

Honestly, it sounds like a c-section might be the right way to go in her case.

I would also suggest she get a second opinion. The terb is DEFINATELY out. The elevation to your heartrate is nasty.

I tend to agree that she is going on her defense mechanisms on the NICU statement. It's one way to ignore the realities of the situation.

This is a sacry situation. I send out hugs to you and your sister

[kimberlylibby]

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[doctorjen]

Heparin would be absolutely appropriate. Folks with a. fib. need to be anti-coagulated to prevent clots from forming in the fluttering atria which can then be thrown off and cause stroke. Coumadin (warfarin) is used in non-pregnant folks, but can't be used in pregnancy, while heparin can.
The ineffective contractions of the heart thing sounds like maybe she does have some heart failure, or systolic dysfunction, which is where the heart does not contract as well as it should.
Does her doc not want her to see a perinatologist? Heart patients usually scare general OB docs quite a bit and usually they are anxious to have the patient seen by a specialist.

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