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!