Amniocentesis are not standard procedure for all pregnancies, so why did I have one?
That is a reasonable question that one day I might wonder the answer to, so I figure I can go ahead and answer it here and now.
There are two main types of amniocentesis during pregnancy. They are both considered elective procedures, though they can be medically encouraged.
One is performed earlier in pregnancy, around 15-20 weeks, and can also be called an AFT (amniotic fluid test). The uterine wall tends to be thicker and further from the abdominal surface, making it more difficult to penetrate, but the baby is smaller and there is more fluid so it somewhat evens out. An amniocentesis this early is to determine genetic abnormalities such as Down Syndrome, Trisomy 13 and 18, Fragile X Syndrome, and neural tube defects such as spina bifida.
Michael and I have never opted to have this test done because of two main reasons: one, Dr. Hales is generally able to detect such abnormalities through a simple, painless, and risk-free anatomical sonogram that we have performed anyway; and two, because it carries a risk of miscarriage and pre-term labor, and since neither of us are genetically predisposed to pass on any of these fetal issues. There just never seemed to be a point, especially since Dr. Killeen assured us that Dr. Hales has yet to miss a warning sign and we trust them. It's not like it would affect our decision to keep the baby anyway, so we wouldn't want to endanger the child's life on a long shot.
Which brings us to the other type of amniocentesis--the one we actually had performed.
The other amniocentesis is to determine lung maturity; whether or not the fetus could be born without needing respiratory assistance or time in NICU. It is performed in the third trimester and can cause contractions or labor, so it is not done with every pregnancy. The uterus is generally thinned considerably by that point and very close to the abdominal surface, making the needle penetration less painful and difficult, but the fetus also takes up a great deal of room and has to be avoided and there is less fluid.
I have had this test done all three pregnancies because I am categorized as a high-risk pregnancy.
With Emerald, I had the gestational diabetes and the intrauterine growth restriction, as well as poor maternal weight gain. I was underweight to begin with and then lost a ton of weight from being so sick in the beginning. There was concerns of malnutrition, and because the fetus was having difficulty growing as well, they did want me to bump up my weight. Then the whole diabetes thing, that makes weight gain even harder to manage. When we went in for an anatomical scan and the baby's growth curve had dropped off so drastically, and she had failed most (if not all) of her non-stress tests indicating that she was unable to cope with the strain of vaginal birth, Dr. Killeen recommended an early delivery to ensure the safety of the baby.
It was not such an emergency that we wanted to take her if she was not breathing, and excess insulin inhibits lung development, which means that you have to tread extra carefully. They performed the amnio with her--we never got the results, because we were scheduled for an impromptu c-section a few days later.
With Gabriel, I had all the same problems almost word for word as I did with Emerald but with the added difficulty of uncertain due date and elective repeat cesarean (ERCS). Medical practice dictates that with the ERCS, an amnio be done to determine the fetus's viability just in case. It was precautionary, which turned out to be good since Gabriel was indeed not quite ripe enough to be plucked.
Final pregnancy, we still had the gestational diabetes, the uncertain due date, but not the IUGR; this time we traded it for maternal anemia and idiopathic/immune thrombocytopenic purprua (ITP), poor weight gain, low amniotic fluid levels....you get the idea. Basically, my tired out old body doesn't want to do this any more and is putting up a protest.
So, now you (and I) know. That's why we opted for the procedure. Strictly necessary? Nah. I could have waited all three times until I went into labor, but there is no guarantee that they would have gone well. I think the c-sections were good choices. Dr. Killeen strongly recommended them, and I trust him.
Time to go--my Mike made me Chinese food!!
--Andie!--
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