Reality
Peyton would be 12 weeks old Saturday. She would be smiling, babbling, and possibly holding her arms out when Matt or I would have gone to pick her up. Her pretty purple hamper would be filled with pink and purple laundry. I would have pretty bows and headbands to put in Peyton's full head of dark brown hair, sitting in a basket on my vanity. Matt would be putting together Peyton's Baby Einstein Neptune Activity Saucer this week. I was so excited to receive it as a gift at our Baby Shower (it wasn't on our registry), and I gave Matt such a problem about packing it away in the closet (the recommended age for the saucer is 3+ months). I remember Matt telling me, "We'll pull it out in February... it'll go by quick!"
Reality is that my heart hurts so, so bad. Some days the pain takes my breath away (literally), and I feel like I am sure to go into cardiac arrest at any second. Most days though I daydream of life in a parallel universe. A universe where Peyton was born with a heart beat. A universe in which I am consumed in complete and utter happiness.
Reality is though that Peyton is not here. She is not smiling, babbling, or holding her arms out for Matt and I. Her hamper is packed away, and so are her articles of pretty pink and purple clothing. There is no basket of bows and headbands sitting on my vanity. And the Neptune Activity Saucer sits in the closet with the rest of Peyton's belongings.
Reality is that it has been almost 12 weeks since Peyton was born and entered into eternal rest. 12 weeks since we held our precious baby girl in our arms for the first and last times. 12 weeks since we had to say hello and goodbye in the same sentence. 12 weeks since we learned what love truly is and what it is like to really have your heart broken.
Reality is that we are just beginning this life long journey.
Cholestasis of Pregnancy
In my 34th week of pregnancy I began to itch intensely on my wrists, fingers, ankles, and the soles of my feet. At first I thought it was eczema but after a few days the itching got so bad that I was tearing my skin up and bleeding. I wasn't able to fall asleep at night either. After some research I learned of a condition called "Cholestasis of Pregnancy".
In the short, Cholestasis of Pregnancy is a condition where the flow of bile is either slowed or stopped, over flowing into your bloodstream and causes an intense itch.
I presented the condition of Cholestasis to my OB. He wrote me a prescription for benadryl for the itching, and insisted that there was no risk. After a week of taking benadryl, the itching was getting worse. I called my OB and insisted on blood work to test the level of bile salts in my bloodstream. He ordered blood work, but never did order the specific test for bile salts. At my next OB visit he told me my blood work was elevated but nothing to worry about. I asked if I should be induced because of the risk of stillbirth with Cholestasis. His words, word for word were "You have to look at the population as a whole, it's such a small percentage... you have a greater chance of walking out of here today and getting hit by a bus!"
After that appointment I sat in the car crying and crying. I contemplated on finding a new OB, but I wouldn't have gotten an appointment until after my due date.
I knew the itching was not right. But no one would listen to me. Not a single person.
There is not much information or research on why Cholestasis causes stillbirth.
In my heart I hope that the Cholestasis had nothing to do with Peyton's death... it's something we may never know for sure though.
The Autopsy
Today Matt and I met with our new OB to consult about Peyton's Final Anatomic Diagnosis.
Peyton had a subgaleal brain hemorrhage and thrombosis of the umbilical vein and proximal umbilical cord. However, the gross and microscopic findings suggest "subacute abruptio placentae" which led to meconium release and increased circulating nucleated red blood cells to be "at least" a contributing cause of Peyton's death.
What does all that mean exactly?
Peyton had a brain hemorrhage. Our OB suggests that it most likely happened in reaction to Peyton's death (meaning that it happened after she passed, and did not cause her any pain). Peyton had several blood clots in the umbilical cord and the maternal section of the placenta. Blood was built up behind the placenta. The placenta also had a concealed abruption which probably happened over the course of a few days to a week. Since there was an abruption it can be inferred that Peyton's body began producing extra red blood cells because of a lack of oxygen or nutrients from the placenta. The placenta detaching led to meconium release.
The placenta abruption is most likely the cause of Peyton's death. Right now we do not know what caused that abruption. We may never know.
Our OB is going to present our case to a Pathologist in Pittsburgh, and another Doctor, who both have a bit of experience with fetal deaths caused by Cholestasis. We hope they can help give us some more answers.
The Future
Our OB maintained the idea during our appointment today that she cannot give us the definite answers of why this happened. There are many pieces that are missing, or that just don't make sense.
She reassured us though that in any future pregnancies many precautions will be taken.
For one, if the itching reoccurs and/or persists my bile salts will be monitored and repeatedly tested. She will perform regular Non-Stress Tests. And at 36 weeks gestation, she will perform an amniocentesis to check the baby's lung development. If the baby's lungs are fully developed, I will be delivered immediately. She also reassured us that I will not go over 37 weeks gestation in any subsequent pregnancies.
Though we do not know why this happened to Peyton, I feel good knowing that we have an OB whom is willing to plan the future with us... who cares!
Hope
When I personally reviewed Peyton's Autopsy last week I was given a sense of "hope". I learned that Peyton had dark brown eyes, which she most likely inherited from Matthew's Mom.
When we were discharged from the Hospital on November 18th, Matt and I told one another how much we wish we had known what color eyes Peyton had.
We know now though. And if that is the only answer I am ever given, I think I'll be okay.
.
