APAS, Pregnancy Complications, and Treatments

If I had a hard time conceiving naturally, sustaining a pregnancy is a whole new level of difficulty. Soon after I found I was pregnant, I went to Hi-Precision Diagnostics lab to test for APAS. I first heard about it after my second miscarriage in 2016, when my OB suggested I take a blood test. I didn’t know much but from what I understood, some women have difficulty getting pregnant or sustaining a pregnancy due to problems with their immune system. I shrugged it off back then because I didn’t plan on trying for another baby anytime soon.

But when I tested positive that fateful night of July 30, 2018, all the fears of my past miscarriages overwhelmed me. I just had to know if I was one of those women, and if I did have APAS, I knew I had to manage it right away to keep my baby alive. True enough, the results came and one of the levels was elevated. The mystery as to why I couldn’t conceive as easily as “normal” women was finally solved.

I researched about APAS online and stumbled upon a Facebook group of Filipino women struggling with reproductive immunological disorders. Joining the group proved to be helpful, as I read other women’s experiences and recommendations. While there are sad and scary stories, there are also inspiring posts of miracle babies and those are what I held on to.

One of my blood test results for APAS. Here it clearly shows that I’m positive for Cat 2.

What is APAS?

Let me cite this explanation by Smart Parenting: APAS, or antiphospholipid antibody syndrome, is “an autoimmune disorder [that] occurs when the body’s immune system makes abnormal antibodies that attack and damage tissues or cells.”

As an autoimmune disorder, APS occurs when the body makes antibodies that mistakenly attack phospholipids, a type of fat that’s found in the blood. This then causes blood clots to form in veins and arteries, which can lead to numerous problems and complications.

As far as I understand, there are five categories for this reproductive immunological disorder:

Category 1 is the Leukocyte Antibody Test, or when the woman lacks blocking antibodies needed to prevent her immune system from rejecting the baby.

Category 2 is when a woman’s blood is too sticky or thicker than normal. The blood flow is hindered, putting the developing fetus at risk.

Category 3 is the presence of antinuclear antibodies (ANAs), which attack the cells of a mother’s womb and the fertilized egg.

Category 4 is the autoimmune response to sperm antigen, which blocks fertilization itself.

Category 5 is the elevated presence of natural killer cells. While these are crucial to fight off infections and diseases, too much of NK cells can fight off pregnancy as well.

**Until now, I do not fully understand the science and explanation behind APAS, so I’m sharing this PDF file if you want to read up on it. This blog (click here) has also been a great resource for me.**

My blood tests indicated that I’m positive for Category 2. Just 1 out of the 5 categories. Still, this disorder will prove to affect my pregnancy greatly. My immunologist confirmed that most of my succeeding complications were a result, or related to APAS.

How my doctors managed my APAS

The first step for me in battling APAS was finding a perinatologist, or an OB-Gyne trained to handle high-risk pregnancies. There aren’t many from where I live, so while St. Luke’s Global is a three-hour drive from our place during the rush hours, it seemed to be the right and only choice for me. After a week of searching and panicking that I was wasting precious days without proper medical care, God directed me to a doctor who was readily available to see me.

She also referred me to an immunologist, who would manage my APAS. I was prescribed to take aspirin and inject heparin daily. These are blood thinners that would prevent my blood from clotting and harming the fetus. The immunologist wanted to address what was making my blood thicker than normal. He suspected that my immune system was more hyper than usual. To address this, he advised me to take two kinds of probiotics to “distract” my immune system. Aside from these meds, I was also put on steroids for three weeks to help calm my immune system. (At one point, I was taking up to 15 pills per day!)

SCH (Subchorionic Hemorrhage)

My Week 6 scan was encouraging–we saw the baby’s heart fluttering. On the downside, there was a small subchorionic hemorrhage forming in my uterus. SCH is a scary thing for me. Aside from the shock of seeing blood on my underwear, I believe I lost my last pregnancy because of this. I was put on strict bed rest as I was spotting on and off for about four weeks.

My immunologist suggested that I undergo intra-lipid infusion–a simple procedure where you’re given a blend of fatty acids and lipids through an IV. This was supposed to help the baby grow faster than the SCH. Thankfully, the blood clot was gone after one round and my bed rest was lifted just as I was entering my second trimester. I did continue the intra-lipid infusion for a total of five rounds, once a month.

Gestational Diabetes

In one of my routine blood tests, my perinatologist was alarmed that one of my sugar levels was higher than normal. It wasn’t that serious, she said, but she still referred me to an endocrinologist who then referred me to see a nutritionist. So during my second trimester, I was seeing four specialists: a perinatologist, immunologist, endocrinologist, and nutritionist.

Incompetent Cervix

My gestational diabetes was still manageable with proper diet until my 27th week–when I was admitted to the High-Risk Pregnancy Unit because my cervix was short and funneling already. My perinatologist was afraid I would go into pre-term labor, so I had to stay at the hospital for two days to get two rounds of steroid shots. These would help the baby’s lungs mature in case of premature birth. Because of the steroids, my sugar levels shot up and from this point on, I was prescribed to inject insulin four times a day.

By this time, my body could already feel the effects of all the drugs I’ve been taking. I was also getting physically weaker because I had to be put on bed rest again due to my incompetent cervix. Shortly after I was discharged, I saw a urogynecologist who inserted a pessary to temporarily close my cervix. This would hopefully buy me more time and prevent it from further dilating. My husband also got me a wheelchair so I could go around and have a small semblance of normalcy. I did not like the feeling of being lethargic and drug-induced, but I had to be diligent for the baby’s safety. I vowed to de-toxify after the pregnancy to regain my strength and chi.

Oligohydramnios (Low Amniotic Fluid) & Pre-eclampsia

Of all the complications I’ve been dealt with, nothing was more depressing than finding out that my amniotic fluid levels are abnormally low. This happened in my 29th week, and I had to stay at the hospital for a total of 11 days so I could be put on IV round the clock. I got discharged for three days but had to be re-admitted because my fluids are still getting low and my perinatologist did not want to risk a pre-term delivery. I was only 31-32 weeks by this point.

I stayed three more weeks at the hospital, and even spent my birthday and Valentine’s Day in confinement.  It was during this time that my blood pressure spiked up and I tested positive for pre-eclampsia. I also started having mild but regular contractions, so I had to take another medication to stop the contractions and also regulate my blood pressure.

I was getting weak, bored, and anxious. I questioned all the choices we made that led to this depressing point but I argued that we stuck to our doctors’ plan like obedient wards. Apart from my emotional distress, we were also getting drained financially. My husband and I are middle-class, working individuals and in no way do we have unlimited funds. If we totaled all the medications, doctors’ fees, procedures, and hospital confinements, the sum would be enough to build our home. I want to honor my husband for keeping his head in spite of our situation. Throughout our challenges, he’s prevented me from having panic attacks and always reassured me that everything will be okay.

37 weeks and counting

As I type this, I am now on my 37th week. My pessary has been removed, and I’ve stopped taking all my meds. I could give birth any time now! No one expected me to reach this far, not even my doctors. As my OB said, I’ve been dealt with every complication she could imagine, but my baby and I made it through.

This baby is truly a miracle. From his conception to his development and even the in-betweens. Even our financial status is a miracle–we’ve never spent this much money on anything, and yet we’ve also never made this much money in the span of eight months. It’s been a series of complications, but it’s also been a series of answered prayers. Truly, we’ve felt God’s faithfulness every step of the way.

The battle isn’t over yet. To be honest, I’m scared about labor and delivery. Because of my many complications, bed rests and hospital stays, I wasn’t able to prepare for childbirth. But in that moment of fear, I will try to remember the journey I’ve been through, and how God held my hand through it all.

“My grace is sufficient for you, for my power is made perfect in weakness.” Therefore I will boast all the more gladly about my weaknesses, so that Christ’s power may rest on me. -2 Corinthians 12:9

PS: I purposefully did not cite the names of my doctors and the cost of each treatment/procedure. If you want to learn more about how they managed my complications, or if you’re looking for recommendations, please PM me and I’d be glad to answer your questions! 🙂

A Childless Mother’s Honest Take On Mother’s Day

“When are you having kids?” is the most irritating question people have asked me. The only thing that tops it is, “Why don’t you have kids yet?” I hate it even more if the questions are coming from people who I haven’t had a real connection with for who knows how long.

For a woman who’s had two failed pregnancies, I’d like to give a bunch of answers. Mainly, I’d want to tell them to shut up and keep their condescending thoughts to their insensitive selves. Oftentimes, some would even follow up with “Just pray. Have faith.” I know some of them actually mean well–the others just want to gossip–but it is enough to make me want to punch either them or myself.

Of course, I don’t do that. I simply pause, smile, and say, “Maybe in time.”

I am a mother. I just don’t have my children with me here. I’d like to believe they’re in heaven–because if heaven is what you want it to be, I’d want mine with my unborn children so I could hold them someday.

I’m actually fine with my situation, really. Sure, experiencing two miscarriages in a row is painful and disheartening. But I’ve dealt with those and moved on. Still, there are days when I think about the what-could-have-beens and I can’t help but shed a few tears.

Every Mother’s Day is the worst. I open my phone and I’m flooded with “Happy Mother’s Day” greetings, but they’re not for me. I text my mom and greet her, knowing that no one will do that for me. I see my friends–old classmates and former colleagues–all posting photos of their growing family, and there’s a frightening thought that creeps in: Will I ever have that? 

A back-and-forth conversation with myself takes place inside my head:

I may never have that.

Don’t say that. “Just have faith.”

Sometimes, my optimistic side wins the debate. Sometimes, it’s my glass-half-empty self that gets the last say. It doesn’t matter, though. What matters is the now, and my now isn’t exactly what I dreamt it would be.

My first miscarriage was in 2015. I learned I was pregnant on my 5th week, and by the 6th week, I was bleeding profusely. The doctors couldn’t see a yolk sac, and they ruled it as a “chemical pregnancy.” The next year, I was ready to work on getting pregnant. I did all the works–acupuncture, fertility shots, regular ultrasounds to plot my ovulation. After around three months working with my Chinese acupuncturist and one cycle with my fertility specialist, I was ecstatic to find out I was pregnant!

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