Tuesday, May 13, 2014

Selective Reduction Procedure in Detail

When Dr. Adashek informed us that one of our triplets had anencephaly, Troy and I were devastated. I also had a horrible subchorionic hemorrhage that we found out was a result of that baby's placenta not being properly attached on my uterine wall.

If you need to catch up on our appointments and diagnosis before reading this (or a refresher on the order of events), you should. Our doctor explained all the risks or carrying the 3 babies vs. the risks of the procedure and he strongly recommended the reduction.


Triplet Update

Anencephaly and Subchorionic Hemorrhage

Waiting out the Hemorrhage

Doctor Update

Meeting with Doc about the Risks of Selective Reduction
This is the important one.

After we met with Dr. Adashek, he had set up for us to be his last patient of the day and our appointment was at 430pm. I remember feeling this overall sense of doom while we waited about an hour to be seen. You know how ob/gyns can be. Seriously, always running late. I had this horrible ache in my stomach and I was going back and forth between my heart rate skyrocketing and my respiratory rate racing.

They called us back into their largest room. Seriously big.

It started off with Troy, me, an ultrasound tech and an ultrasound tech student to observe. They did another ultrasound to confirm the bony prominences as markers for anencephaly and to measure the size of the hemorrhage behind the baby's placenta to make sure that it was stable (aka still there but the same size).

I was laying on an exam table and they pulled out a plank (it had the stirrups but they were tucked in) so that my head was at about 30 degrees up and my legs were straight out like a recliner.

After that was done, a nurse came in and stuck me for an IV and then Dr. Adashek stumbled in (he'd hurt himself in a soccer game).

He gave me a hug and then asked me, "What kind of drunk are you?"

I was like, "What?"

And he said, "When you and Troy go out for dinner and you get drinks, do you feel buzzed after 1 drink or after 3 or 4?"

And I was like, "somewhere between 2 and 3 drinks and I'm pretty set."

So then they shoot up my IV with some kind of sedative to make me relax. After about 2 minutes, I was like, "Woah, buddy. I'm a cheap drunk. I feel realllllllllly loopy."

And he was like, "Oh great!"

The way the room was set up, you could watch what the ultrasound tech was doing on a big flat screen TV on the wall. I immediately asked them to turn it off because I was watching my poor little baby squirm on the screen and I didn't want to watch her stop moving.

The people in the room during the procedure were me, Troy, the ultrasound tech, the student, Dr. Adashek, a nurse watching my vitals (blood pressure, respiration rate, heart rate, and oxygen sats) and also running my IV, and one other nurse who held my hand. Troy was standing behind my head. I had my right hand up over my head and my left elbow was bent with my hand resting next to my face so my belly was exposed. Troy was holding my right hand over my head and the extra nurse (basically there for emotional support) was standing by my left shoulder holding my left hand by my face. The ultrasound machine was directly to my right and Dr. Adashek was standing by my left hip.

The first thing they did was use a small needle with a local anesthetic to numb the entrance point for a bigger needle right above my belly button. Honestly, that hurt the most of the whole procedure. At this point, I pretty much kept my eyes and mouth closed during the rest of the procedure. A miracle for me, I know.

He told me what he was doing at every point so I didn't feel a need to ask any questions or watch. The tech kept the ultrasound on my stomach the whole time to see what they were doing with screen facing completely away from me and towards my feet.

The tech and Dr. debated for a few minutes the best place to aim the needle to avoid puncturing another baby, another placenta, the hemorrhage and how to most easily get the needle to the baby.

He inserted a long needle into my belly and put the needle into the baby's heart. I remember he commented that this would be a relatively "easy" procedure because there was no abdominal fat to penetrate before getting to my uterus. Once they agreed that the needle was in the proper spot, he injected potassium chloride into the baby's heart to make it stop beating. I remember him saying, "I'm going to inject the medication now" and he kept jerking the needle around in tiny intentional movements...pretty forcefully while pushing down the plunger. It was kind of akward for me. I'm not sure how accurate they are able to get with aiming the needle directly into the heart with screen imaging, so I think he was jerking the needle around to make sure the potassium chloride was distributed to where it needed to be INSIDE the heart and not just into the heart wall or something.

I remember that I had asked him if he'd ever done a reduction that didn't work and the baby survived afterwards. He told me that it does happen if they don't wait long enough (5+ min after the medication is inserted) to make sure the heart doesn't start beating again but that it has never happened to him personally.

This part was the WORST part of the whole procedure. We all waited for 5 minutes. The nurse was stroking my hair back and Troy would occasionally squeeze my right hand. The tech, student and Dr. Adashek were all staring at the screen but making small talk. I remember being SO annoyed and pissed off during those 5 "waiting minutes."

A lethal injection was just put into my baby for it to die and everyone was talking about Dr. Adashek's private plane that he owns and the process to get his license and he told us a story about having a bit of a hard landing one time. It seemed like such petty, trivial conversation considering what had just transpired. I know they were passing time and trying to be nice but GOOD GOD. And Troy was chatting with him like it was nothing that we were waiting to making sure the baby didn't "come back to life."

Seriously. Longest 5 minutes of my life.

The clock finally passed 5 minutes and he was like, "Let's wait 2 more minutes."

I was dying inside.

Then he pulled the needle out of my belly and started telling me what to expect for the next few days. The actual procedure has the same risks of miscarriage as doing an amniocentesis, which people do ALL THE TIME. So that made me feel a little better that we weren't going to lose the whole pregnancy. Which I was terrified was going to happen. He said that a majority of people lose a pregnancy after a reduction or amnio as a result of infection from the insertion site of the needle, but he was very clean. The odds of losing the whole pregnancy were about 1 in 300. They wanted me to stick around for about 30 minutes after the procedure to make sure I was okay.

They answered all of my crazy questions. The baby that the reduction was performed on was located under my stomach on my upper left side. They said the procedure would have been more risky if it was the one on the bottom, right by my cervix because a cervix can be unpredictable during a reduction and it could start dilating if it recognizes that a fetus has died.

Since I had the reduction at 16 weeks gestation and the baby's bones were still the density of cartilage, as the other 2 babies grew bigger and stronger, they would essentially just grow into the space that the other baby had occupied. The baby would get (for lack of a better word) smooshed into the wall of my uterus as the other babies grew because it's bones weren't fully formed. After delivery of the babies, the baby and it's placenta would be delivered as "afterbirth materials" along with the other 2 placentas and put in bags as bio-material.

So when I wrote the story of Kinley and Caris's delivery and I talked about how long and hard they massaged my belly, it was because I told Dr. Adashek, "You better make sure that you get EVERYTHING out of there. If I'm doing delivery recovery and going pee and 'baby material' comes out on one of those maternity diapers, I'm going to be scarred for life." I was terrified that a teeny baby arm was going to come out after the babies were born. I literally had nightmares about it. Right before I started pushing Kinley out, I was like, "You are absolutely positive that nothing resembling a dead baby is going to come out right now? You promise me. Right now." And he was like, "I promise you. That baby we did the reduction on has turned into an unrecognizable blood clot. Do not worry about that. Now let's deliver your twins. Push."

We got home about 7pm and my friend Katie brought us a chicken macaroni and cheese casserole for dinner.

A piece of good news was also confirmed by doing the reduction. The horrible, scary bleed stopped almost immediately. By doing the reduction, Dr. Adashek proved his theory that the baby's placenta wasn't all the way attached to the uterus and that was the source of the heavy bleeding. Once the connection between the placenta and wall of the placenta wasn't needed anymore, the placenta detached that the blood vessel connections stopped bleeding. Within 2 weeks I was passing the clots from the bleed and it was completely over and they could barely pick it up on the ultrasound within a month.

My sister flew in the next day to keep me company on the couch because I was on strict orders to drink TONS of water and lay around for about a week. The strange thing is, I started feeling the babies move like THE DAY AFTER the reduction. It was like Kinley and Caris KNEW I was upset and they were trying to be like, "We're still here mom. It's going to be okay now."


  1. As a mother strongly considering a reduction, I just wanted to thank you for writing this post! I am so happy that everything worked out for you!

  2. I had my NT scan yesterday. It was my 8th ultrasound for this pregnancy because I am high risk due to my age and that I previously had GD with my first pregnancy. Well, 7 of the 8 ultrasounds showed that I had di-di twins and we were excited. Yesterday, they found another baby, triplets! Unfortunately, 2 of the 3 are monochorionic diamniotic and therefore I am being referred on to do selective reduction. Your blog entry has been incredibly helpful. Thank you!


Thanks for reading!