How would you handle this?

[redbusbeepbeep]

I have a heart condition, it’s an elevated risk of aortic dissection and 2 family members have previously developed symptoms late on in both their 2nd pregnancies. Both family members actually died from this within the first 3 years of their babies life due to this.

With my first it was said they wouldn’t allow me to go past 38 weeks and I’d have a c section. 1st baby came at 37 weeks due to an unrelated issue, so it wasn’t mentioned.

Now I’m pregnant again and they are very relaxed about the whole thing and say I should be okay till 39 weeks. I’m not comfortable with this and very anxious but I find it really hard to argue with medical professionals. I want to trust their judgment but also why was it said in my 1st pregnancy but not being followed through in my 2nd?

can I simply request I go no later than 38 weeks?

In a word, no. When you have a conversation with your obstetric team you can mention it but the evidence is very much that risks outweigh benefits generally in terms of birth before 39 weeks. Few exceptions - very small babies, certain medical conditions, multiple pregnancy - but maternal request would get you planned delivery at 39 weeks at the earliest unless any additional concerns with the pregnancy .

Also think that if you spontaneously laboured at 37 weeks last time and all was well then would anticipate a second pregnancy/ birth would follow same trajectory - hence not planning birth until a bit later to give you the chance to do it on your own.

@DigbysMum23 but isn’t my risk of aortic dissection a serious enough medical condition? It was taken very seriously in my 1st pregnancy. I was told the risk increases the later you go in pregnancy that’s why no later then 38 weeks.

Chances are this baby will need to come earlier due to IUGR like my first but I’m just preparing myself if they don’t need to really.

@DigbysMum23 it was a planned c section at 37 weeks due to placenta previa and IUGR.

I also can’t have a vaginal birth as I’m not allowed to push, due to said heart condition, which is why it’ll be a planned c section.

Without seeing your notes I can't comment (work in maternity) but I would've thought at the very least would depend on any recent cardiac imaging.

@DigbysMum23 yeah I appreciate that. It’s a very complex situation which is hard to explain on here. It’s a rare situation within my family and has been unpredictable as far as aortic dissections go.

I think my main worry is why they were so adamant I couldn’t go past 38 weeks in my 1st pregnancy but now seem fine about it when they have acknowledged it’s even riskier the more pregnancies you have.

I have an appointment this week so will discuss with them but now times ticking I’m getting anxious

Also - LSCS usually done at 37 weeks for praevia (unless bleeding beforehand) and unless significant IUGR with baby estimated below 3rd centile again would be 39 weeks.

I bet and tbf delivering at 38 weeks does seem an odd recommendation to me - we normally go for 37 or 39 weeks.
All you can do is ask - am sure you're under maternal medicine team anyway, take someone with you can trust to the appt and write everything down.

Yeah my daughter was born on the 0.4th centile at 37 weeks but this one isn’t looking quite as small thank god!

I have no idea why 38 weeks. I just checked my old letters from my first pregnancy and even says on there no later than 38 weeks 🤷🏼‍♀️

I assume you are under consultant care - is it a different consultant to your first pregnancy? I think it might be worth asking for a second opinion. Do you also have a named cardiologist for ongoing care?

Yep consultant led but different consultant to my 1st pregnancy. I do see the same cardiologist although I’ve had my last echo and won’t be seeing her till after birth now

You have the right to a second opinion but you should be warned that you might need to be prepared to fight for it and you may want to enlist your partner or an assertive friend to advocate for you if you are anxious. Be prepared to make a nuisance of yourself and enlist PALS if necessary.

I would personally want a second opinion from the first consultant who led your care with DC1 (assuming they have not retired) and I would want your OB consultant to have sought an opinion from your cardiology consultant in assessing the risk around your birth choices. This kind of joined-up care should be standard but I am afraid it is not and you will need to advocate vigorously for yourself.

I wish you the very best of luck

@OhTediosity

Thank you so much for this. It’s hard because I have no desire to have my baby early, if anything I’d like to keep them in as long as possible but the anxiety over the whole thing is really getting to me now.

I have a growth scan this week so if the baby has dropped centiles I’ll be having her at 37 weeks anyway and I won’t have to worry. So I will just sit tight and see

Hello! Just wondering how you got on!? Just read this thread and interested as my husband had an aortic dissection aged 46, and thankfully survived.He was extremely fortunate. I sincerely hope everything went ok and all are safe and sound x