35w, 6d

Yesterday was the big ultrasound at Memorial Hospital.  After a less-than-restful weekend, I was extremely nervous to get there.  Of course, there was drama with getting the proper paperwork transferred between hospitals, but I was granted an ultrasound at 2:45pm.

Chris was able to get off of work and a neighbor came to watch Amelia during and after nap.

I nearly threw up on the way there from nerves.

Once there, the tech did an hour-long ultrasound.  Of course, we knew which measurements to look for and once a few came up as "31w" or "32w, 2d", my heart sank.  I knew the baby had some issue and it wasn't just a discrepancy based upon technician prowess.  Baby never woke during the ultrasound and would not show her face! 

The tech estimated her weight to be 4 pounds, 10 ounces - negligible growth since Friday, but she didn't regress at all.  Memorial Hospital and Evans Hospital use different growth charts.  According to Evans (the Army hospital), she was at the 17th% and we will deliver at 10% or below.  According to Memorial Hospital, she is in the 3 or 4% and they deliver at 3%.  The doctor estimated that on Evans' chart, she'd be around 10-11%.  NOT what you want to hear.

After much discussion and more ultrasound, the doctor recommended delivering within the next week and no later.  This immediately put me into shock and I barely remember riding home.  This morning, I have my regularly scheduled non-stress test.  If my blood pressure has risen (and I can't imagine why it would have...haha), they will induce Wednesday or Thursday at 36 weeks.  If my BP is stable enough, they'll let me go a few more days.

Baby was diagnosed with IUGR, intrauterine growth restriction.  It is the asymmetrical type, as her stomach measurement was lower than all other measurements.  She was consistently 3 weeks behind, except her stomach was a full month behind.

The IUGR was caused three-fold in my case: 1) placental breakdown, 2) cord abnormality, and 3) chronic hypertension.  My placenta and cord are not processing 100% of the nutrients to baby and she has adapted to less nutrients.  This doesn't mean she isn't getting any nutrition, just that she is so small because she's used to less.

Thankfully, the doctor suggested no long-term issues for baby.  In the short term, we will have to monitor/deal with respiratory maturity, hypoglycemia, and temperature regulation.  It is too late for steroid shots (thank goodness), as I am past 34 weeks.  It is unknown whether she would need oxygen or a CPAP in the short term.  It will be based upon her scores and early test results.  With the hypoglycemia, it will be a little more difficult to establish nursing and many doctors will push to supplement.  I truly hope this isn't the case, as nursing is dear to my heart, but I am preparing to do what it takes to fatten this peanut up. 

I think the worst is the unknown at this point.  They will study my placenta and cord once she is out to determine other factors they can't see on an ultrasound.  Towards the end, the doctor noted she might have a loose knot in the cord and to not be surprised if that was the case.  He didn't think it had any bearing on this case, just wanted to let me know.

It mostly depends on who the OB on call is this morning and how my pressures are doing.  They have not been stellar on my at-home cuff, so Chris and I are both preparing for a delivery this week.  Thankfully, everything is set up, washed, installed, etc...  We have wonderful neighbors and friends who can take over the Amelia shift until my parents can get here.

Whew.

35 1/2 weeks

At Friday morning's appointment, we passed our non-stress test (baby movement and heart acceleration over time), but my pressures were higher.  Consistently 130s/95 or so.  The nurses let me go with a grumblegrumble since I had an afternoon appointment with the OB.

At the afternoon appointment, my BP was up a little higher (145/106).  I had gained a pound, which they were happy about, but for the 3rd week in a row, my uterus size (aka fundal height) had not increased.  This quite concerned the OB and, it being a Friday afternoon, she quickly left to make some phone calls.  She was able to catch an ultrasound tech in radiology and immediately sent me over for a growth scan.  It being a "stat" order, I wasn't allowed to see the screen in case something was wrong.  I was able to learn Betsy is still a girl and has hair (thank goodness the heartburn has a reason).  Unfortunately, based on measurements, she is about 2-3 weeks behind.  According to the ultrasound, which can be off, she is 4lbs, 6 ounces and in the 17th percentile for growth.  This is worrisome because she was 50th% at 20 weeks and 33% a month ago.  Something is causing her to trend lower and lower on the growth charts.

Radiology sent me up to Labor and Delivery to talk to the OB on shift, since it was now after 4pm on a Friday.  The OB referred me to the big hospital (non-Army) downtown for an HD ultrasound early next week.  They want to try to identify the cause of the slowed growth.  Is it from the placenta not getting her enough nutrients?  Something else?  They didn't want to discuss those types of options with me yet, instead waiting to see more ultrasound results next week. 

Apparently, our new goal is getting to 37 weeks.  I still want to make it to 39 weeks.  My weeks "roll over" every Wednesday.  I am currently 35 weeks, 4 days and quite scared.  If she dips below 10% for growth, they will induce me.  I am afraid of a NICU stay, especially since that would mean being away from Amelia for an extended period or leaving Betsy at the hospital to care for Amelia at home.  Last delivery, my BP spiked and I had to stay for 5 days.

So now, we wait.  Is it placental breakdown due to chronic hypertension?  Is she just a small baby?
They won't put me on any sort of BP medication (beta blocker) because its side effects include lowering baby's weight. 

I am eating, but not sleeping much. 

I will call first thing Monday morning to schedule my ultrasound at Memorial Hospital.  From there, I will have my regularly scheduled non-stress tests on Tuesday and Friday, as well as my 36 week appointment on Wednesday morning.