Latest / Cry It Out Loud: Navigating Infertility, Miscarriage, Stillbirth, Infant Loss & Pregnancy After Loss / Ask a Maternal Fetal Medicine Doctor Segment

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Ask a Maternal Fetal Medicine Doctor Segment · Cry It Out Loud: Navigating Infertility, Miscarriage, Stillbirth, Infant Loss & Pregnancy After Loss

• 0:09
  Cry It Out Loud, a podcast by chasing the rainbows with your
• 0:17
  host Bernice Quisenberry. This week's podcast episode is
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  with Doctor Serena Wu, maternal fetal medicine doctor specialist
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  who also experienced her own baby loss.
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  And we just appreciate her being willing to come on here and to
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  do our Ask a Maternal Fetal Medicine Doctor segment for all
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  of our survivors out there to hear.
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  So welcome, Serena. Thank you for coming back.
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  Thank you so much for having me, Bernice.
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  It's it's a pleasure and an honor as well as a privilege to
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  be here on your podcast. I am super excited about today's
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  podcast because I think not only do we want to answer any
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  survivors questions but also have a discussion about topics
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  that you may have questions about.
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  You know whether that is you know, diabetes in pregnancy or
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  hypertension in pregnancy. You will be seeing most likely a
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  maternal fetal medicine specialist.
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  So this today's podcast, I'm excited to open that up to show
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  you what some of the things that we can and we will talk on your
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  podcast just as an example. Absolutely.
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  Well, I appreciate you sharing that Serena because it is so
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  important just to go through different topics, different
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  things that happened to us survivors, you know during the
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  whole entire process. And to have that safe space that
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  we can go to and someone to turn to that's not in a you know,
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  threatening environment. Because it was really hard for
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  me, for example, to return to my doctor's office after we went
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  through our loss and to see my physicians and things like that.
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  So just to have a place where they can go and they can ask
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  questions, you know, from an from another expert is just
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  always a great for me was always great because I always felt like
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  I couldn't get enough ears or eyes on Brooks chart and on what
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  happened during our birth story. So thank you.
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  Right now and and exactly to your point to be able to do that
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  in a safe place. Yeah, absolutely.
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  But I just want to real quick do the disclaimer here.
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  We're not trying to give out medical advice, medically
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  treating any person, diagnosing any person providing second
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  opinions. Virtual Consult consults all
• 2:35
  throughout our entire podcast for medical advice, treatment or
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  diagnosis. Please consult your primary care
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  physician or obstetrician. And like Serena and I were
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  saying this segment is just to give some peace for our
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  listeners who are struggling with some questions.
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  You know that happened during the whirlwind of events, you
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  know when we went through our traumatic losses of our babies.
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  And we just want to be able to keep and open the dialogue
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  without feeling judged or silenced around our losses.
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  So our intention is solely to help survivors process their
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  traumatic loss. So any requests that you may
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  have on different topics like Serena mentioned or anything you
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  know around your loss, please write in at
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  criedoutloudpodcast.com. Because we not want, not only
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  want to address questions that survivors have around their own
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  loss, but we also want to make sure that we're addressing, you
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  know, topics and discussions that come up too and that others
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  are probably and probably want some answers too.
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  Right. I mean, so.
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  I mean, I there there are. What makes the pregnancy high
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  risk isn't just only the pregnancy itself, which could be
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  your cervix was considered too weak by your doctor and you
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  needed a stitch to close it up. If you had twins, for example,
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  that are triplets, that makes your pregnancy high risk if
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  there's something going on with the baby.
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  So it's not just maternal conditions that can make your
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  pregnancy high risk it your pregnancy can be high risk for a
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  whole bunch of other things that you don't realize until you're
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  in the middle of it and something's going on.
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  Yeah, until you're living it. You're exactly right.
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  Yeah. I'm Serena.
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  Absolutely. And I think after losing Brooke
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  and thinking about, you know, trying to get pregnant again or,
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  you know what that kind of look like, I felt like after our
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  loss, we got a lot of unsolicited advice and then some
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  solicited advice, too, from, like, friends, colleagues, loved
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  ones, You know, that we're coming at us at all different
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  angles about, you know, what? You should ask for this or you
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  need to do this or, you know, that you should handle this
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  differently in pregnancy. And it was like, whoa, you know,
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  like pump the brakes a little bit.
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  It's a little overwhelming because, you know, we're still
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  trying to process our loss on top of considering having
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  another baby and they're two separate babies.
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  So, you know, we're still grieving one and then
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  considering going into another, you know, pregnancy where it
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  ended in the worst case scenario possible previous.
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  Right, right. I'm sure that everybody was
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  helping or thinking they're helping by giving you advice on
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  what to do next. I'm sure also that you one or
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  parents go to different like doctors or providers just to say
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  what would you do next, what should we do?
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  And you might get a lot of right advice, and depending on the
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  advice, it might be might not be the most up to date, or maybe
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  something that was done five years ago but isn't necessarily
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  done currently. Right.
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  And I think it's really important to have those open
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  discussions and to know, you know, the difference, especially
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  like things that you should talk to your maternal fetal medicine
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  doctor about. Because what's interesting is,
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  you know, not having or needing a maternal fetal medicine doctor
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  before it was like, you know, now needing one with my age and
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  and, you know all the things and then, you know, with Brooke and
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  then after Brooke and the complications with pregnancy,
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  You know, I didn't know how to go about or what I should be
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  asking or what I should be suggesting or or how do you even
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  open that dialogue? It's because, you know, you turn
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  to your doctor and you just expect them to know and you just
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  kind of go with it until a tragedy happens.
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  And then it's like, OK, now I need to advocate or I need to
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  talk more effectively with my doctor or understand things a
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  little better, I think. Right, right.
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  So I think that's a perfect segue into this article that the
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  Society of Maternal Fetal Medicine put out and it has been
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  revised multiple times and the latest revision was December of
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  2022. And the title of that article is
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  18 things physicians and patients should question.
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  So 18 things that doctors or your you know, whether it's your
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  family medicine doctor or or your internist or your OBGYN,
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  even your MFM that may that may be recommended for the next
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  pregnancy depending on what occurred in in your previous
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  pregnancy. You know, if if you had a
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  complication, A maternal complication or multiple
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  complications, these are things that they recommended that the
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  physician and the patient should question together, which I think
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  it's perfect because I think that dialogue and that
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  partnership with your doctor as you move forward with the next
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  pregnancy is so important, you know.
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  It really is. And yeah, because you do, you
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  need that partnership because you're trusting your life.
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  You're trusting your baby's life with your doctor and not that
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  they're God, they have any control over situations, but
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  just saying that, you know, I want you to deliver my baby.
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  And that means so much coming from a baby lost survivor who
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  just went through, you know, the worst case scenario.
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  So it's like, you know, when you pick your doctor, it's just it's
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  like a beautiful union between two people.
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  And I mean, they're either going to be in the delivery room with
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  you, they're going to see your baby for the first time with
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  you. Like they're going to get to
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  experience all those first with you.
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  And it's like, OK, like, you just have to feel like you can
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  have those trusted conversations and honest conversations with
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  them because they're not going to know if something might come
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  up or something's going wrong unless you tell them.
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  And you can feel comfortable doing so.
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  So I love having this open dialogue and and feeling like,
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  you know, you have this communication and and things
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  like that going back and forth. So, yeah, so let's dive into the
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  first one. I'm going to actually let you
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  take it away, Serena. Yeah.
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  Yeah. So the first, the first one that
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  they suggest is to not do an inherited thrombophilia
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  evaluation for those women who've had histories of
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  pregnancy loss babies that were growth restricted patients whose
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  pregnancies were complicated by preeclampsia and by placental
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  abruption. And I know that and This is why
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  you need you know, and I know Bernice will I'll, we'll have
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  this article for anybody who wants a copy of it.
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  We'll, we'll be happy to share it with you because yeah, there
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  are a lot of big medical words here or medical terms that
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  you're like what? And but to break it down, so
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  this is for women's who who pregnancies were complicated by
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  either recurrent pregnancy loss, which is generally speaking
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  three or more miscarriages and a miscarriage is generally
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  speaking in the United States it can be less than 20 weeks.
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  I know we typically use 13 weeks and under, but most women can't
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  wait to three. Actually.
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  We start doing testing and we start doing looking into what
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  could be the cause. Actually, after two, I know the
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  recommendation is 3, but I know doctors start looking as soon as
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  a woman has hit two growth restriction.
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  So you've gone to see your doc and they're doing an ultrasound
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  and they do a weight on the baby and they do measurements.
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  And if that combined weight is less than the 10th percentile
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  and especially if it's less than the third percentile, that's
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  when your baby you'll hear those terms growth restricted.
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  And I mean we can you know if a listener out there wants to know
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  more about growth restriction, that can be a topic of certainly
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  a topic that we talk about on a on another preeclampsia is also
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  another medical term of a condition that women only women
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  can get because you only get it in pregnancy.
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  It has to do with high blood pressure and protein in the
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  urine and unfortunately the only cure for preeclampsia is to
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  deliver the baby and you basically can get it from
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  anytime after 20 weeks to term, so by 40 weeks.
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  So it's it's I I don't want to scare anybody with this.
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  The majority of women do not get preeclampsia.
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  There are risk factors for preeclampsia, but once you have
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  it you you will know everything about it because you end up
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  diving into that world of women who've had preeclampsia.
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  And placental abruption is is just a term that the placenta
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  which is the attachment that connects the baby to you and is
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  that really is starting to be considered another organ, is the
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  thing that filters the nutrients and the oxygen from you to the
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  baby and the baby releases its its things back to the mom.
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  So it's that organ that attaches uterus and is the is the filter
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  between mom and baby. So inherited thrombophilia is
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  but blood work, and it's a bunch of laboratory evaluations for
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  something that you may have gotten from mom and dad.
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  That's what inherited means. You inherit something from mom
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  and dad, and thrombophilia is just fancy medical term for
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  something that makes you clot more, so making you for more
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  blood clots. Now pregnancy is a state that
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  you form a lot of blood. You are at higher risk to form
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  blood clots. So having an inherited condition
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  where you're more predisposed on top of being pregnant, can make
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  you more likely to form a blood clot in pregnancy.
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  So I'm, you know, Bernice as you know you.
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  Or as you might know, that's pretty scary.
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  Thing Absolutely 100%. So this first thing is actually
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  saying in all of these conditions, we actually used to
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  evaluate all women who've had recurrent pregnancy loss,
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  babies, who are extra small, women who've had preeclampsia,
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  women whose pregnancy they ended up being delivered because of a
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  placental abruption. They are saying don't do it.
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  We used to do it, but now they're saying don't do it.
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  And the reason for that is that they've actually found that that
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  doesn't lead to any of these things.
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  OK, that's good. Yeah.
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  Because I I was under the impression, you know, more
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  testing the better. Like let's let's do as much as
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  we need to. But if it's not needed or
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  warranted because it doesn't have any relevance to either
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  thing, will that makes sense then?
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  Right now there is one thrombophilia and I think you
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  know in a stillbirth evaluation this may be worthwhile is to
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  test for anti phospholipidamid body syndrome and that is an
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  inherited thrombophilia. But there are other laboratory
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  evaluations of other ones they have heard of, like MTHFR with
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  which is an acronym for Methyl Tetrahydrofolate Reductase
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  deficiency. So again, a mouthful.
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  But you know, women come to my office and they have this huge
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  work up of all of these things and in the end, depending on
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  their history, they might not need it.
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  Yeah. No, that's good to know.
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  Absolutely. Wow.
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  OK, a lot of. Information in.
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  Right. I know.
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  I've like tried to process it all, to be honest and all the
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  terminology. What I'm so grateful that you
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  broke it down too. Thanks, Serena, for explaining
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  that. Just because for someone like
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  me, you know, I need to understand and actually get a
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  better picture. So I love that you did that.
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  Yeah. So the next one says don't make
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  irreversible decisions based on the results of cell free DNA
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  screening tests. So.
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  I mean I do you remember, I'm sure you you've had this test
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  which is done basically as soon as you hit about 10 weeks.
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  It can be done a little sooner, but you need to have some fetal
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  cells circulating in your bloodstream and that usually is
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  about 10 weeks. When you have enough percentage
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  that then they can do run this test.
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  But I'm sure you've had this test performed.
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  Absolutely. Yep.
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  We have done the full gamut of DNA testing and it was, it was
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  around 10 weeks. And it was also the one I only
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  remember specifically, too, because we got the gender reveal
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  early. Because.
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  Of right, right. And so this test it it's it's an
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  amazing blood test. It's basically taken out like
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  some of the more traditional testing, but they're more
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  invasive testing where you can definitively be able to tell
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  using the baby's own skin cells, using the placenta to give you
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  similar information. But this is just a blood test,
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  it's non invasive. It has changed the landscape of
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  genetic testing because I would say 98 to 99% of women utilize
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  this test to at least get that first look, see as to whether or
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  not the baby has anything going on with their genetic makeup and
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  as well as finding out what the gender is.
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  A lot of times we get the I want the gender test, please so.
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  It's exactly right. That's how I remembered it at
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  first, yeah. And then understanding later
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  down the road like the importance behind it, especially
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  being advanced maternal age and and things like that, you know
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  testing for different things that you can know early or then
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  have a game plan or or do further testing to see if it is
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  an actual thing, right? And so this cell free DNA
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  screening test can give you some early information about whether
• 18:20
  your baby has Down syndrome, whether your baby has an extra
• 18:26
  chromosome at the other common genetic issues that a baby may
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  have that can still lead to a a live born but may then have
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  other consequences. So like still birth or life
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  limiting diagnosis and that's like trisomy 13 and trisomy
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  trisomy 21 and again fancy medical meaning that there's an
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  extra chromosome at that location.
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  You know, long time ago, you know, we all had, we all have 42
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  chromosomes of which we have, am I saying that right, 46, sorry,
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  not 424046 chromosomes of which 22.
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  Yeah, 22 we have 22 pairs and then we have our sex chromosomes
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  XXX or XY. So we have a 46 and they number
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  it from 1 to 22. So I'm not that's how they did
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  it and that's how they stuck with it.
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  So you have two chromosomes at every position, 1 to 22, and
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  then 45 is either X and 46 is either X or Y.
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  You know, 45 is either X or Y and 46 is either X or Y.
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  And trisomy just means there's three instead of two at that
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  particular location. What this number two is saying
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  is that actually that blood work is a screening test.
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  And this goes into what's a screening test and what's a
• 20:11
  diagnostic test. Yeah, so a screening test just
• 20:16
  screens the possibility. It doesn't give you the actual
• 20:21
  diagnosis. And that is so hard.
• 20:24
  Because you get a a test back that says, OK, your baby doesn't
• 20:30
  have XY or Z, but then your baby has an anomaly, A structural
• 20:36
  problem. Either the heart's wrong, the
• 20:38
  brain looks funny, the bowels are outside, there's something
• 20:43
  not going well with your baby. But wait you know my testing was
• 20:51
  was normal or you could have the other thing where something
• 20:55
  comes up like your baby has Down syndrome or you know has that
• 20:59
  extra chromosome at least on that testing.
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  But everything on ultrasound looks normal.
• 21:07
  So what this is saying is that actually that self re DNA test
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  is a screening test because there is a percentage where or
• 21:17
  probability that it could be a false positive.
• 21:23
  And so the next test would be to do an invasive test, which is
• 21:28
  depending on where you are in your pregnancy, you could do
• 21:31
  something called chorionic villa sampling, which where they just
• 21:34
  sample the placenta. That is usually done in the time
• 21:38
  frame of 10 to 13 weeks. Or you do amniocentesis which is
• 21:44
  done after. It can be done as early as 15
• 21:49
  weeks, but usually done 16 weeks and beyond.
• 21:53
  You can do an amnio at any point in time, generally after 15
• 21:57
  weeks. Yeah.
• 21:59
  Well, and I think that is so important like you said, the
• 22:01
  screening versus the diagnostic just because like they're saying
• 22:04
  here don't make an irreversible decision or something, you know,
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  based on the screening, go for further testing, do something
• 22:14
  more than, yeah, just this base, it's almost like a baseline,
• 22:18
  right, Is that? Gives you that first look, see
• 22:25
  and and swear again if you if it comes back where your baby might
• 22:31
  have something that you're like, Oh my gosh.
• 22:34
  Right. Is it?
• 22:36
  Then you need to talk they you've heard.
• 22:45
  If you're OB or your provider performs this test you will also
• 22:51
  then speak with a genetic counselor who will break that
• 22:54
  test down further for you and explain why it's only a
• 22:57
  screening test. It's not 100%.
• 23:00
  It doesn't mean necessarily your baby has that and so that that
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  that is that is why this recommendation which is don't
• 23:09
  decide. For example, my baby has this,
• 23:13
  so now I want to interrupt the pregnancy.
• 23:17
  Right. No, that's that's important to
• 23:20
  know. Absolutely.
• 23:23
  It says to like don't screen for fetal growth restriction with
• 23:27
  Doppler blood flow studies. That's interesting.
• 23:31
  Right, right. Right.
• 23:32
  So, so this, this how this is broken down is that you
• 23:38
  otherwise have a normal pregnancy, nothing's going on.
• 23:43
  What this is saying don't go looking for problems, don't go
• 23:48
  looking for this problem based on this study.
• 23:52
  So we used to look at like uterine artery dopplers and
• 23:59
  depending on the way that waveform might look, you know
• 24:05
  that flow of the blood going through that artery, you may
• 24:11
  then your pregnancy may be then at risk for having a baby who is
• 24:17
  smaller than it should be. This is just saying don't screen
• 24:23
  for that using that blood flow study.
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  And you know the reason for that is that there's just, you know,
• 24:34
  it's just not, it's just inconsistent.
• 24:38
  So the research that has been done has not shown that it's
• 24:41
  been positively associated that the abnormalities in those blood
• 24:47
  flows doesn't necessarily mean that you're going to have a baby
• 24:51
  that's growth restricted. So they're just saying don't
• 24:57
  scream for that. OK, Now that's good to know too.
• 25:02
  Absolutely. I'm, I'm telling you, these are
• 25:03
  great. I mean, you know, things to
• 25:05
  know, things that you know you didn't think about or didn't
• 25:08
  know previously or things that you were tested for, you know.
• 25:11
  And and now it's not like you said, even after a couple years
• 25:14
  it becomes the way medical goes and how quick it changes, you
• 25:19
  know, and research is done. It's interesting.
• 25:23
  Right. And I mean, you know, with
• 25:25
  Google, the Internet, I mean, we are all looking for information
• 25:29
  and we, we are looking for reasons as to why this happened
• 25:35
  to us. You know, why did I end up with
• 25:37
  that then led to me being delivered early or, you know,
• 25:42
  why did I lose my baby? Could it be because I had this
• 25:46
  or or that? And then OK, now I'm being told
• 25:50
  I need, you know, my doctor wants to do this for me.
• 25:52
  Is that really truly beneficial? Or is it something that I don't
• 25:57
  need and maybe we do something different?
• 26:01
  Absolutely, yeah, yeah. And it says, like here too,
• 26:08
  don't use progesterone for preterm birth prevention and
• 26:13
  uncomplicated multifetal gestations.
• 26:17
  Yeah, so that's just multifetal gestations.
• 26:20
  It's just, again, a mouthful for twins.
• 26:24
  Right. Yeah.
• 26:24
  I was going to say, is it twins or multiples?
• 26:26
  Like I I OK, good. Yeah, just a mouthful for for
• 26:33
  something that's really easy as twins and triplets, we don't
• 26:37
  really see quads anymore. I mean, so, OK.
• 26:40
  Yeah, yeah. But you know, progestins have
• 26:44
  gone up and down and actually, you know, I think at some point
• 26:47
  we should probably go over the progesterone data because now
• 26:50
  they progesterone has been taken off as being done for preterm
• 26:57
  birth prevention. I'm sure all of there is a
• 27:00
  generation of women who've had the shots.
• 27:04
  Oh. Yeah, my husband, oh, God, loves
• 27:06
  him every week on, you know, switching butt cheeks.
• 27:09
  Poor guy. Well, I was not good with the
• 27:12
  shot getting shots either. So, you know, it took sometimes
• 27:15
  it took me about 30 minutes to 45 minutes to work up to it, but
• 27:17
  yeah. Right.
• 27:18
  Yeah, exactly. So I you know this is actually
• 27:23
  saying don't even use it for multiples for some as twins and
• 27:29
  and actually we kind of knew that but I I think we you know
• 27:33
  well I can't hurt you know if we give it multiples or you know
• 27:40
  the data out there actually was we we really didn't recommend it
• 27:45
  just because it might be more harmful to use it in in twins
• 27:52
  and and triplets. So this just I think this is
• 27:55
  just saying please don't do it it it has not been shown to
• 28:00
  reduce preterm birth. Wow.
• 28:04
  Yeah, and I find it interesting too that it's saying
• 28:06
  specifically multiples. What about singular?
• 28:12
  It that more research has come out that has shown that it
• 28:18
  hasn't been beneficial. So that's why the FDA pulled it
• 28:25
  that OK, it can't be used for that indication anymore.
• 28:29
  Now that is for the IM injection.
• 28:34
  They did not pull the vaginals. Yeah.
• 28:39
  Yeah. So that is still being used.
• 28:44
  And really we use that for, I mean, typically in the past for
• 28:48
  short cervixes. So someone comes in with an
• 28:51
  unexpected short cervix. We still use vaginal
• 28:56
  progesterone for that. I know that people have been
• 28:59
  using it for prior preterm birth even without a short cervix, so
• 29:05
  going to that instead of having the injections.
• 29:11
  OK, wow. Oh, my goodness.
• 29:15
  Well, this has been great. Serena, we're at, you know, our
• 29:17
  time for this week's segment, so we'll have to continue on this
• 29:21
  article. We'll probably need about, you
• 29:23
  know, two more parts of this together, but this is just also
• 29:29
  important, not just around, you know, the four different topics
• 29:32
  that they're mentioning in this article, but then also opening
• 29:35
  up the deeper discussion to even dive in more to abruptions and
• 29:42
  you know, preterm progesterone and all that stuff, you know,
• 29:45
  things that it just opens the door for so much more.
• 29:48
  And I can't thank you enough for that.
• 29:50
  Right. And as we were going through
• 29:52
  each one, I'm like, OK, I need to stop talking because we we
• 29:57
  are only on question one or you know, the first thing.
• 30:01
  I'm like, Oh my God, I took up 10 minutes just trying to
• 30:03
  explain what you know, because it is, it is a mouthful.
• 30:07
  And then it's like, wait a second, what are they actually
• 30:10
  asking or what are they actually saying?
• 30:13
  And you do need to bring this to your doctor and say, OK, spell
• 30:18
  it out for me because all of these medical terms, I need it
• 30:22
  broken down. I need to tell me what it means.
• 30:27
  Yeah. I always say dumb it down for me
• 30:28
  and not because I'm dumb. It's just like, honestly, I I
• 30:32
  can't use medical lingo. Like, you know, especially when
• 30:35
  that was floating around during a tragic, traumatic event that
• 30:39
  was happening with Brooke and like they were throwing out
• 30:42
  medical terms like all the medical team around me.
• 30:44
  So it was like whenever I was hearing those medical terms, it
• 30:46
  was a lot. I was like, oh, OK let's, you
• 30:49
  know, it's it's just a lot to process.
• 30:51
  So it is good to take these. I I love that advice that you
• 30:53
  gave. Yeah.
• 30:55
  Yeah. Yeah, absolutely.
• 30:56
  Yeah. We only got through, let's see,
• 31:00
  about 20%. Yeah, well.
• 31:02
  Serena, thank you so much for coming on, for opening this
• 31:05
  dialogue, you know, for starting these conversations.
• 31:07
  It's a great starting point, especially for someone like me.
• 31:11
  You know, when I was thinking about conceiving or trying to
• 31:14
  conceive after our loss, you know, where do we go?
• 31:17
  What's the game plan for next time?
• 31:20
  And just having a list of things and talking to my doctor about
• 31:22
  it and my maternal fetal medicine team just means so
• 31:25
  much. So thank you for being here.
• 31:27
  Thank you. I mean, I think I really love
• 31:30
  this article. And I I really, I didn't realize
• 31:36
  how much I would have to break it down because it to me it's
• 31:39
  like, huh, And like it's hard and there's so much in each one.
• 31:46
  I I mean, of course I'm reading it through, going oh, yeah,
• 31:49
  yeah, yeah, yeah, yeah. And then actually now talking it
• 31:52
  through with you, I realize, wait a second, it's not so easy
• 31:55
  as that. It's.
• 31:57
  Not as straightforward Eddie like I would think.
• 32:00
  Yeah, yeah. But I love this.
• 32:03
  And I can't wait for Part 2 and probably Part 3.
• 32:10
  Oh well, thank you so much, Serena.
• 32:13
  And thank you so much listeners and survivors for tuning in.
• 32:17
  Please follow and subscribe to our podcast so we can help reach
• 32:20
  as many survivors as we can so they can find our podcast.
• 32:23
  Just to hear about different topics and about, you know,
• 32:26
  living after loss and what that looks like to know that they
• 32:28
  have a community of survivors behind them.
• 32:31
  So we are always with you, fertility, loss, pregnancy loss
• 32:33
  and baby loss survivors. Thank you.