Ever since my hospitalization at the beginning of January, I had been traveling from Corvallis to Portland every Friday for a day-long appointment at OHSU - fetal heart rate monitoring, ultrasound, meeting with the doctor. Each Friday, I packed an overnight bag. They had been telling me since January 5th that I needed to be prepared to be admitted to the hospital at any time. It turns out that even though I was dutifully packing and bringing my bag, I didn't actually believe the part about the hospitalization.
On Friday, February 3rd, they performed another growth ultrasound. This was 2 weeks after they last measured Anna's growth. According to the measurements, she had only gained 63 grams. A normal fetus at her gestational age (33 weeks and 5 days at the time) should be gaining about 200 grams over the course of two weeks. Anna had already been diagnosed with IUGR (Intrauterine Growth Restriction), so they didn't expect her to grow at the normal rate, but they still expected to see her grow along her own curve.
Most alarming to the doctors was the fact that her abdominal growth was nearly immeasurable. Dr. M told me that the time had come . . . I needed to be admitted to the hospital until the baby was delivered. This was a shock to me. I think that, after four weeks' worth of "normal" appointments, at which everything seemed to be holding steady, I had convinced myself that there wasn't much to worry about. Plus, Dr. M was still talking about trying to wait until 37 weeks to deliver. That was over three weeks away! Three weeks in the hospital? I couldn't fathom it.
Plus, what would Gabe do? It's not like he can't function without me (frankly, he's much more capable than I am), but he'd be so far away. And he couldn't take three weeks off work - not if he wanted any time off after the baby was born - so we'd have to spend most of that time apart. After a lot of discussion, Dr. M agreed that I could go home to Corvallis one last time before checking into the hospital. I returned home on Saturday morning after outpatient monitoring and stayed until as late as possible on Sunday.
I was due back at the hospital for more monitoring on Sunday. I stayed in Corvallis as late as I possibly could and didn't get to the hospital until about 9:30pm. I thought I was going in for more outpatient monitoring and that I would be able to leave afterward and stay with my parents, who live only 5 minutes from the hospital, but that wasn't in the cards.
One of the consistently reassuring things during all of these weeks of monitoring had been my blood pressure. However, at this appointment, I started having increased systolic blood pressure readings. They took my BP about 5 times while monitoring Anna's heart rate and kept getting similar numbers, so this wasn't a fluke. Dr. M wanted to perform some tests to make sure I didn't have preeclampsia, so they drew my blood and began a 24-hour urine collection.
I was officially admitted to the hospital on Sunday, February 5th, and I would be there until Anna was born.
Coming soon: Part Two: The Hospital
Saturday, February 25, 2012
Saturday, January 21, 2012
My baby's on steroids
It's been two weeks since my hospital stay an since then I've had four appointments for monitoring. The baby's heart rate has been steady and encouraging at each visit. Last Friday, the Umbilical Artery Doppler (this is used to measure the blood flow from the baby to the placenta; one of the doctors compared it to taking the baby's blood pressure) had slightly elevated readings, but nothing that concerned the doctors.
Today, in addition to the UAD and the heart rate monitoring, they did another growth ultrasound. Minion has now officially been diagnosed with Asymmetrical Intrauterine Growth Restriction (IUGR). It's asymmetrical because her two head measurements are actually in the 40th to 44th percentile, while her abdomen and femur measure below the 5th percentile. Yes, she will be born with a large (for her size) head and a little body. The doctors say she's been diverting the nutrients to her brain and her heart, where they are most needed. My dad says she's going to be smart and skinny.
At 31 weeks and 5 days, her weight is estimated at 2 lbs 12 oz (the median is about 3 lbs 12 oz). The cause of the low weight is likely due to the fact that she's not getting enough nutrients due to my malabsorption, which is a characteristic of post-gastric bypass individuals. However, the IUGR leads the doctors to look at other considerations. Luckily, most of my readings are good. My blood pressure is low, my amniotic fluid levels are normal and the recent fetal heart rate tracings have been encouraging.
The concern, again, is with the blood flow from the baby to the placenta. Dr. M spent a lot of time with me today, going over the results and explaining the way things should be working, versus the way they are working. There's one vein that provides blood flow from the placenta to the uterus - this seems to be working fine. There are two arteries that carry used blood, CO2 and waste products back from the baby to the placenta for filtering. This is where the restriction is occurring and it's more restricted this week than it was last week.
Restricted blood flow is something they want to watch closely, but it's not a reason to deliver the baby - yet. However, if I go in for monitoring at any time and the blood flow has become absent (no diastolic pressure - blood only pumps when the baby's heart contracts, but not when it relaxes) or reversed (arterial blood flowing from placenta to fetus), they will want to deliver immediately.
So I got a Betamethasone steroid shot in the buttocks, with a second shot to follow tomorrow. This will increase Minion's lung function in case she has to be delivered before 34 weeks. At 34 weeks, a newborn's lungs have generally developed well enough to function on their own. Dr. M is still hoping that I'll make it to 37 weeks, but wants to be prepared in case next week's UAD tests have unfavorable results.
No matter when our baby is born, she will most likely be very small and will get to spend some time in the NICU. The doctors and Gabe and I will do everything we can to get the baby as close to term before delivering as possible but there's the chance that, at some point, she'll be safer outside the womb than in it. At this point, I just need to keep up with the monitoring appointments and the prescription of reduced stress. Easier said than done!
Today, in addition to the UAD and the heart rate monitoring, they did another growth ultrasound. Minion has now officially been diagnosed with Asymmetrical Intrauterine Growth Restriction (IUGR). It's asymmetrical because her two head measurements are actually in the 40th to 44th percentile, while her abdomen and femur measure below the 5th percentile. Yes, she will be born with a large (for her size) head and a little body. The doctors say she's been diverting the nutrients to her brain and her heart, where they are most needed. My dad says she's going to be smart and skinny.
At 31 weeks and 5 days, her weight is estimated at 2 lbs 12 oz (the median is about 3 lbs 12 oz). The cause of the low weight is likely due to the fact that she's not getting enough nutrients due to my malabsorption, which is a characteristic of post-gastric bypass individuals. However, the IUGR leads the doctors to look at other considerations. Luckily, most of my readings are good. My blood pressure is low, my amniotic fluid levels are normal and the recent fetal heart rate tracings have been encouraging.
The concern, again, is with the blood flow from the baby to the placenta. Dr. M spent a lot of time with me today, going over the results and explaining the way things should be working, versus the way they are working. There's one vein that provides blood flow from the placenta to the uterus - this seems to be working fine. There are two arteries that carry used blood, CO2 and waste products back from the baby to the placenta for filtering. This is where the restriction is occurring and it's more restricted this week than it was last week.
Restricted blood flow is something they want to watch closely, but it's not a reason to deliver the baby - yet. However, if I go in for monitoring at any time and the blood flow has become absent (no diastolic pressure - blood only pumps when the baby's heart contracts, but not when it relaxes) or reversed (arterial blood flowing from placenta to fetus), they will want to deliver immediately.
So I got a Betamethasone steroid shot in the buttocks, with a second shot to follow tomorrow. This will increase Minion's lung function in case she has to be delivered before 34 weeks. At 34 weeks, a newborn's lungs have generally developed well enough to function on their own. Dr. M is still hoping that I'll make it to 37 weeks, but wants to be prepared in case next week's UAD tests have unfavorable results.
No matter when our baby is born, she will most likely be very small and will get to spend some time in the NICU. The doctors and Gabe and I will do everything we can to get the baby as close to term before delivering as possible but there's the chance that, at some point, she'll be safer outside the womb than in it. At this point, I just need to keep up with the monitoring appointments and the prescription of reduced stress. Easier said than done!
Sunday, January 8, 2012
Minion's first hospital visit
It's obvious that I have not been using this blog as originally intended. It's been over two months since my last post. Gabe pointed out, though, that there was never a better reason to update than now. So I'll share the events that have occurred since Wednesday.
Because of my history of gastric bypass surgery, I've been seeing a Maternal Fetal Medicine team since the beginning of my pregnancy. Essentially, they're the high risk specialists. The team is based out of OHSU in Portland, but they travel to Salem every Wednesday to provide services there. This past Wednesday was the first time I had seen them since we moved to Corvallis.
One of the things that they've been watching closely is the rate of the baby's growth. My body doesn't absorb all of the nutrients from my food and, therefore, the baby doesn't get all of the nutrients either. At the 25 week growth ultrasound (5 weeks ago), the doctor expressed some concern about Minion's size. She was in the 24th percentile for overall weight. The doctor said this wasn't anything to be worried about yet (they don't worry until the size is below the 10th percentile), but that he wanted to keep a closer eye on the growth and see me again in 4 weeks, hoping that Minion's size would progress and she would be around the 50th percentile.
This past Wednesday (at 30 weeks), Gabe and I drove up to Salem for a growth ultrasound. Meeting with Dr. T afterward, we hoped to hear that Minion's weight had increased, that she was now in the 50th percentile. No such luck. The news was that her measurements now put her in the 14th percentile. Four measurements are used to arrive at this conclusion - abdomen, femur and two head measurements. Unfortunately, the abdomen size was under the 5th percentile, which had Dr. T very concerned.
Due to the small size of her abdomen, Dr. T had the ultrasound tech check the blood flow through the umbilical cord, from the placenta to the baby and back again. This test found some restricted blood flow, a sign that the placenta may not be functioning as it's designed. Dr. T's recommendation? To get checked into the hospital for monitoring and get steroid shots to increase the baby's lung function, in case of early delivery.
Needless to say, Gabe and I were thrown for a loop. Check into the hospital? But we were only there for what we thought was a routine ultrasound. A potential early delivery? How early? Would we have a baby in the the few weeks? In the next few days???
Corvallis doesn't have a high risk (MFM) team, so our options were to be admitted to the hospital in Salem or to drive up to Portland and check in at OHSU (we could also have chosen Eugene, but that's even farther south than Corvallis). Because Dr. T's team works out of OHSU and because my family lives in Portland, we decided that would be the best place for us. We drove back to Corvallis, packed some bags, arranged care for the dogs (THANK YOU to Gabe's wonderful co-workers, Jennifer and Roni) and took off for Portland.
Arriving at OHSU around 9:30pm, we were admitted to Labor and Delivery, where we met Dr. T's colleague. Dr. M told us that Dr. T had called to brief him on our situation. Also, there had been some recalculations done. Thankfully, the baby's size is not QUITE as small as we'd been told in Salem. Instead of the 14th percentile, she's actually in the 22nd percentile. Her abdomen size is actually the 8th percentile instead of the 4th.
These numbers are more encouraging and they decided to hold off on the steroid shots (since these are most effective if the baby will be delivered within 96 hours). But the measurements still put Minion on the verge of being diagnosed with Intrauterine Growth Restriction. Combined with the umbilical cord blood flow readings, they still wanted me in the hospital to be monitored. So, into the bed I went and got hooked up to the contraction monitor and fetal heart rate monitor.
Over the next nearly 48 hours, I was monitored almost constantly and the Umbilical Artery Doppler was repeated with more favorable results. Since it doesn't look like I'll be delivering in the next 96 hours (thank goodness!), Gabe, the doctor and I decided to forgo the steroid shots for now. There were some unusual heartbeat readings that concerned the doctor. She called them "late decelerations" and their presence basically means that the baby appears to not be handling stress well. Whenever I had a contraction (which I didn't even know I was having!), the baby's heart rate would dip.
So, what does all this mean? Baby is okay for right now and we're hoping that I'll be able to carry to term or at least get a lot closer. I will be monitored twice a week as an outpatient. On Tuesdays, I will go to the OB's office in Corvallis and the baby's heartbeat will be monitored for 20 minutes. On Fridays, I'll do the same thing at OHSU in Portland, in addition to getting an Umbilical Artery Doppler. Every other Friday will be another growth ultrasound in addition to the other tests. Dr. T said I should pack a bag for each appointment, as any abnormal readings will earn me another stay in the hospital.
I will also be doing my own testing at home for fetal movement. I'm supposed to lie down and count 10 separate fetal movements, then make note of how long this took. If it takes more than an hour or if there's a noticeable change in the length of time, then I'll need to call the doctor. So far, she's been a champ and it's only taken 20 minutes at most. Also, I need to eliminate stress from my life (and the baby's), meaning no more work.
From here on, the testing will help the doctors determine when is the best time to deliver. They obviously want to leave the baby in the womb as long as possible to grow and thrive. But they also want to know when she's no longer thriving in there, because then they will want to deliver her.
I feel good about the diagnosis; although there's a lot of information to digest, there isn't an immediate threat to the baby and I know that we're getting great care and we're going to make the best decisions for her health. The hard part to wrap my head around is the uncertainty of it all - will I end up in the hospital every week? When will the baby be here? I really need to take care of my stress and anxiety levels. So that's my job for the next several weeks. That and preparing for the baby's arrival.
Thank goodness I have a lot of help and support. The outpouring of affection and concern from friends and family has been amazing. And I have the best husband in the whole world. I love you, Gabe.
Because of my history of gastric bypass surgery, I've been seeing a Maternal Fetal Medicine team since the beginning of my pregnancy. Essentially, they're the high risk specialists. The team is based out of OHSU in Portland, but they travel to Salem every Wednesday to provide services there. This past Wednesday was the first time I had seen them since we moved to Corvallis.
One of the things that they've been watching closely is the rate of the baby's growth. My body doesn't absorb all of the nutrients from my food and, therefore, the baby doesn't get all of the nutrients either. At the 25 week growth ultrasound (5 weeks ago), the doctor expressed some concern about Minion's size. She was in the 24th percentile for overall weight. The doctor said this wasn't anything to be worried about yet (they don't worry until the size is below the 10th percentile), but that he wanted to keep a closer eye on the growth and see me again in 4 weeks, hoping that Minion's size would progress and she would be around the 50th percentile.
This past Wednesday (at 30 weeks), Gabe and I drove up to Salem for a growth ultrasound. Meeting with Dr. T afterward, we hoped to hear that Minion's weight had increased, that she was now in the 50th percentile. No such luck. The news was that her measurements now put her in the 14th percentile. Four measurements are used to arrive at this conclusion - abdomen, femur and two head measurements. Unfortunately, the abdomen size was under the 5th percentile, which had Dr. T very concerned.
Due to the small size of her abdomen, Dr. T had the ultrasound tech check the blood flow through the umbilical cord, from the placenta to the baby and back again. This test found some restricted blood flow, a sign that the placenta may not be functioning as it's designed. Dr. T's recommendation? To get checked into the hospital for monitoring and get steroid shots to increase the baby's lung function, in case of early delivery.
Needless to say, Gabe and I were thrown for a loop. Check into the hospital? But we were only there for what we thought was a routine ultrasound. A potential early delivery? How early? Would we have a baby in the the few weeks? In the next few days???
Corvallis doesn't have a high risk (MFM) team, so our options were to be admitted to the hospital in Salem or to drive up to Portland and check in at OHSU (we could also have chosen Eugene, but that's even farther south than Corvallis). Because Dr. T's team works out of OHSU and because my family lives in Portland, we decided that would be the best place for us. We drove back to Corvallis, packed some bags, arranged care for the dogs (THANK YOU to Gabe's wonderful co-workers, Jennifer and Roni) and took off for Portland.
Arriving at OHSU around 9:30pm, we were admitted to Labor and Delivery, where we met Dr. T's colleague. Dr. M told us that Dr. T had called to brief him on our situation. Also, there had been some recalculations done. Thankfully, the baby's size is not QUITE as small as we'd been told in Salem. Instead of the 14th percentile, she's actually in the 22nd percentile. Her abdomen size is actually the 8th percentile instead of the 4th.
These numbers are more encouraging and they decided to hold off on the steroid shots (since these are most effective if the baby will be delivered within 96 hours). But the measurements still put Minion on the verge of being diagnosed with Intrauterine Growth Restriction. Combined with the umbilical cord blood flow readings, they still wanted me in the hospital to be monitored. So, into the bed I went and got hooked up to the contraction monitor and fetal heart rate monitor.
Over the next nearly 48 hours, I was monitored almost constantly and the Umbilical Artery Doppler was repeated with more favorable results. Since it doesn't look like I'll be delivering in the next 96 hours (thank goodness!), Gabe, the doctor and I decided to forgo the steroid shots for now. There were some unusual heartbeat readings that concerned the doctor. She called them "late decelerations" and their presence basically means that the baby appears to not be handling stress well. Whenever I had a contraction (which I didn't even know I was having!), the baby's heart rate would dip.
So, what does all this mean? Baby is okay for right now and we're hoping that I'll be able to carry to term or at least get a lot closer. I will be monitored twice a week as an outpatient. On Tuesdays, I will go to the OB's office in Corvallis and the baby's heartbeat will be monitored for 20 minutes. On Fridays, I'll do the same thing at OHSU in Portland, in addition to getting an Umbilical Artery Doppler. Every other Friday will be another growth ultrasound in addition to the other tests. Dr. T said I should pack a bag for each appointment, as any abnormal readings will earn me another stay in the hospital.
I will also be doing my own testing at home for fetal movement. I'm supposed to lie down and count 10 separate fetal movements, then make note of how long this took. If it takes more than an hour or if there's a noticeable change in the length of time, then I'll need to call the doctor. So far, she's been a champ and it's only taken 20 minutes at most. Also, I need to eliminate stress from my life (and the baby's), meaning no more work.
From here on, the testing will help the doctors determine when is the best time to deliver. They obviously want to leave the baby in the womb as long as possible to grow and thrive. But they also want to know when she's no longer thriving in there, because then they will want to deliver her.
I feel good about the diagnosis; although there's a lot of information to digest, there isn't an immediate threat to the baby and I know that we're getting great care and we're going to make the best decisions for her health. The hard part to wrap my head around is the uncertainty of it all - will I end up in the hospital every week? When will the baby be here? I really need to take care of my stress and anxiety levels. So that's my job for the next several weeks. That and preparing for the baby's arrival.
Thank goodness I have a lot of help and support. The outpouring of affection and concern from friends and family has been amazing. And I have the best husband in the whole world. I love you, Gabe.
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