Update on "Mary"
Mary came into the office last week for her first offical prenatal appointment. That's the one we schedule at 12 weeks (give or take), right at the end of the first trimester. The reason this date was particularly significant for Mary was because the great majority of miscarriages happen before the end of the first trimester. She was past the first hurdle.
Her cone biopsy was 6 weeks ago. The margins were clear (i.e. they got all the cancer on her cervix). She hasn't had any bleeding or cramping, and has been feeling increasingly pregnant.
There are still more hurdles to overcome. She might end up with an 'incompetent cervix', which is a cervix that is unable to support a pregnancy to term. She is at high risk of preterm labour. There's no predicting how her cervix may respond to the weight of the growing fetus. She has opted to have a c-section to be scheduled a few weeks before her due date on the advice of the oncologist.
But we found the heart rate with the doppler. Mary's face softened as she heard the strong heart tapping away at a perfectly normal 155 beats per minute. She had already admitted to be that due to their reluctance to get too hopeful, her and her husband hadn't really let themselves get attached to this growing baby inside of her.
I asked her if she'd like an ultrasound. There isn't really a medically indicated reason for one at this time-- it's a bit late for a dating ultrasound, and far too early for one to check the fetal anatomy or the position of the placenta. But I thought she needed one for her own well-being... not just to confirm that all was well, but I secretly hoped that if her and her husband actually got to SEE this little miracle, they'd let themselves get excited about it. As though seeing it on a screen would make it real. She accepted.
So far, so good. In the words of Mary herself... cautious optimism.