October 2, 2007

Restricted

It's been interesting around here since my last post. I did go to Boston and had a great visit. When we got back, the dog took another turn for the worse, had to go back to the vet, and we were asked to decide between putting him down and another expensive surgery. We decided to go forward with the surgery because there is one last treatment option that hasn't been tried, and it didn't seem right to give up without trying everything. If this last option (steroid drug therapy) has no affect of his intestines' habit of attacking themselves and dying off, it's the end of the line for my pup. So far, so good post surgery, but it will be some time before we know if the drugs are working.

Next I went in for my regular OB visit and high-strung newbie doctor freaked out about my blood pressure, decided strict bed rest was in order, and instructed me to come back a few days later for a recheck. When I went back last Friday, the OB I saw agreed with all the other docs who had previously said basically that my BP is worth keeping an eye on, I should take it easy and continue regular monitoring, but bed rest wasn't indicated since everything else looks good and the baby always does great on the monitors. Phew. Minor freak out over.

Until Monday, when I went to the Perinatologist for my "final" ultrasound. Now I don't know if being in the business of dealing with high-risk pregnancies makes the Peri's naturally more inclined to be cautious and nervous, but this guy was much more concerned about my BP. Then again, he was the first to have real evidence of a potential problem: even though the baby looks very healthy, it's measuring about a week and a half behind. He looked at the blood flow through the umbilical cord and it looks perfect, as well as the blood flow in the heart and brain, so that's very reassuring. Also reassuring that the stomach is displaying breathing motions. But since this was the first scan since week 17, we don't yet know if we've got a smallish but healthy baby, or if we're seeing the onset of growth restriction caused by my hypertension (a top reason for small for gestational age babies).

So I have to go back to the Peri weekly now so we get an idea of the pace of growth as well as to continue to check the blood flow to the baby. And I get to be on strict bed rest. Maybe I'm in denial or maybe I'm an idiot, but I am honestly not very worried at this point. A week and a half behind just doesn't sound that horrible to me, and everything else about the baby is very, very healthy. There's a family history of small babies (I was 5lbs something, my sister was 6). I don't mean I'm not taking it seriously, I have done plenty of googling on the potential risks to small for gestational age babies. I certainly don't want a tiny little preemie to have to fight for her life and spend weeks in the NICU, but it also seems like there's reason to believe things are still going pretty well.

The Peri is talking in terms of "hopefully making it to 37 weeks if nothing worse develops." Something worse would be:
- further signs of preeclampsia (my giant jug of 24-hours worth of refrigerated urine remains LOST at the lab but so far no other problems detected)
- next week's scan shows baby is not just small but growth has significantly slowed
- doppler indicates abnormal blood flow to baby
- no doubt there are other unimaginably awful things I have neglected to google

If any of these things happen, they will weigh the risks of preterm delivery against the risks the baby faces in utero. They may do an amnio to determine lung maturity, though it bodes well that the belly appears to be making breathing motions. If none of these things happen, it sounds like the Peri would still make a case for inducing me at 37 weeks once the baby is considered term. Incidentally, 37 weeks would be 11/3. J and I both have birthdays on the 3rds and the egg retrieval was on 3/3, so that seems somehow fitting. My birthday is actually tomorrow, I guess I'll spend it working from bed. Yay me.

I'm weirdly unphased by all this other than being highly irritated with bedrest one day into it. Partly I think I do have good reasons to feel okay about things. I could have left the Peri with way worse news than she's just a little small. But partly I think I'm so accustomed to things not going as planned after all the years of infertility that it just seems like par for the course. And throughout the process, I've gotten pretty confident in what can be accomplished with a combination of frequent monitoring and medical intervention. We'll just take it one step at a time and see what makes sense as we get more information. Bed rest on the other hand, is just damn aggravating.

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Further googling tells me that if we're a week and a half behind, we're in about the 25th percentile for 32 weeks. Clinically small for gestational age babies are below the 10th percentile. If we stay in the 25th percentile, that would be just under 6 pounds at 37 weeks or just under 7 pounds at 40 weeks. This all seems pretty good as long as growth continues at a normal rate. We'll find out next Thursday at the next appt. with the Peri. Meanwhile baby is kicking me in the ribs and pelvis at the same time with a vigor that feels pretty healthy to me.

13 comments:

My Reality said...

First of all, Happy Birthday tomorrow.

I am sorry you are stuck on bedrest. Can you at least stop working? At least a little.

I am sure your baby girl will be ok. I kind of agree that it doesn't sound overly alarming, but better to be safe than sorry.

Fingers crossed that everything stays ok and there are no signs of anything else going on.

K77 said...

Happy birthday for tomorrow (it's today here). Mine was on 3/3 so I will agree that 3 is a good number.

I am sorry to hear you've had some health scares, but I am sure everything will be ok. Isn't ultrasounds pretty unreliable for guessing weights outside of the first few weeks?

Bumble said...

Happy Birthday Sarah!!!

I'm sorry to hear you've got all this on your plate now too, but I'm happy to hear you aren't too worried about it. Stay away from Google! I'm sure everything will be okay with the little one too. I'm here if you need to chat okay! Not long now at all!

Artblog said...

Sounds really complicated all that :( fingers crossed for you.

Happy birthday!!!!

X

Valerie said...

Happy Birthday! Bedrest sucks but I know you will get through it like a champ. It seems to me that you have all your bases covered as far as monitoring so I think everything will be just fine.

twirl said...

Sorry about the rest, but glad they're keeping an eye on things. Hopefully you're just cooking up a totally normal smaller baby. The visible breathing movements are a good sign though.

Happy Birthday!

Rachel said...

Happy Birthday!

You sound very relaxed about everything. It sounds like you are in good hands. I hope everything goes OK.

I'm glad you had fun in Boston.

Watson said...

Hey there,

Happy belated b-day wishes to you!

I am sorry about the bedrest, but it sounds like you have a good attitude about it, which is key. I think it's good you're not totally freaked out, see what happens over the next week or so.

I'll be thinking of you and hoping all is well!

megan said...

happy belated birthday! i'm glad you got to go to Boston and had a great time, but sorry to hear about your dog. that's so hard. i hope that this most recent treatment does the trick.

i can't believe they LOST your jug-o-pee. that's craziness.

i hope next week's scan isn't worrisome and the next few weeks fly by uneventfully.

Anns said...

HAPPY BIRTHDAY!!!!!

Sounds like a lot going on... stay calm and all will work out for the best.

Anns xo

Anns said...

PS: I'm thinking of the pooch too... the dog that is, not you know what.

Ok that's it... I've totally tied my words up all over.

Good night!

peep said...

Happy birthday! I hope bed rest is treating you well. Good luck with the next scan and good for you for keeping a good attitude.

Sara said...

Happy birthday (a few days late)! I hope that the bed rest isn't driving you completely mad.

I'm sorry to hear about all of these new complications. It sounds like it is reasonable not to panic, though. 1.5 weeks is nothing in the course of 40 weeks. That's well within the range of normal variation. Good luck with your next scan, and your bp.

Thanks for the comment on my blog. I'm sorry that you're dealing with this too, but I appreciate the support.