10 December 2010

36 Weeks Pregnant

Well, we went in for our 36 week appointment today (which involves the Group B Strep test and whatnot). We were scheduled for an ultrasound to check on the baby's position. I figured he was still breech (which he is) and that we would be going in for a version early next week. BUT, the ultrasound showed troubling growth and now the breech factor is the least of the doctor's concerns. Overall, the little guy is measuring less than 10th percentile now. Ordinarily, I would chalk that up to the huge margin for error, but apparently, his abdominal measurement is less than 2nd percentile, which makes the doctor think that we are dealing with IUGR (Intrauterine Growth Restriction) instead of just a small child. SO, this means that they want to monitor the blood flow in the umbilical cord much more closely and see me twice a week from here on out. We will have non-stress tests on Mondays and ultrasounds on Thursdays. Apparently, if this is IUGR, my placenta is not doing its job well enough and it might be better to have the baby early. As long as the blood flow remains good, though (which it is now), it's probably better to carry him longer. I am supposed to be keeping a close eye on his movement to avoid a still birth. (It was pretty unsettling that she used the word "stillbirth" repeatedly during the appointment today.) Hopefully checking weekly is often enough to catch any changes soon enough.

I am supposed to be on "modified bedrest" (too bad this is the busiest time of the year for me) moving from bed to couch, etc. I nodded and smiled, but I still have 6 performances left in the next 8 days. I will try to take it easy in between, though.

She mentioned that they would send the placenta to pathology once he's born and that with future pregnancies we might talk about taking Baby Aspirin. Interesting indeed, huh? I am now more convinced than before that the Baby Aspirin I took through the first trimester might have saved this pregnancy. She didn't mention taking any now, but Dan found this on the AAFP website after the appointment:

Low-dose aspirin (150 mg per day) as a treatment for IUGR has been studied over the past several years. One study found that when aspirin was given to women in the third trimester who had abnormal umbilical Doppler indices, fetal weight and head circumference parameters were improved compared with a placebo group. In a second trial, aspirin, given in a dosage of 150 mg per day with dipyridamole in a dosage of 225 mg per day and administered at 15 to 18 weeks of gestation in high-risk patients, resulted in a lower incidence of still-birth, placental abruption and IUGR. Birth weight was improved, and no excess of maternal or fetal aspirin-related side effects occurred. It would seem prudent to consider low-dose aspirin therapy in selected patients with risk factors for IUGR.

I know it's not good to take Aspirin of any kind around the time of delivery, but I'm pretty convinced it would be a good idea to take some now.

So, we go back in on Monday for the first non-stress test. And then again on Thursday for an ultrasound. The doctor we saw today prefers to try external versions around 37 weeks (which will be this coming Thursday), so if he's still breech at that appointment, I guess that would be the next step. She offered to have us see the high risk pregnancy doctor, but I think we'll be just fine with the doctors we have. So, we'll see how these next couple of weeks play out. Sounds like they try to keep IUGR patients pregnant until 38 weeks if they can, but often deliver by 39 weeks. I'll keep you posted...

The New Numbers
Baby's Length - I won't venture a guess since he's measuring small
Baby's Weight - 4lb 9oz according to the ultrasound estimate today (less than 10th percentile)
Baby's Heart Rate - 147 beats per minute
My Weight - Up 1 pound in the past week (Up 32 pounds overall)
My Blood Pressure - 116/60
Fundal Height - 31cm (5 weeks behind)

4 comments:

Dan said...

one thing I would add is that the ultrasound tech said she doesn't trust abdominal measurements for babies laying the way he was (basically flat on his back). She pointed to that, and some other measurements (blood flow in the cord and in the baby) that looked good and said it's probably just a constitutionally small baby. The doc obviously gave sort of a different emphasis to the abdominal measurement. Lots of facts to try and digest.

Anonymous said...

I'm so sorry to hear that you receive such worrisome news at the end. But it sounds like you have a very thorough, caring doctor to guide you through these challenges. I know that even modified bedrest can drive you nuts. I was on restricted movement with both pregnancies a variety of times and it is truly difficult when you have a little one and work. It was either that or risk delivering at 31 weeks with Catie or DVT with Annie. But you can do it. Really take it easy. It's amazing how many activities can be accomplished when resting on the couch. As a bonus, you'll get lots of snuggle time with Emily, which you will really appreciate one you have to divide your time between the two. As far as kick counts, take them seriously. They are a huge indicator of problems. I went in with both pregnancies because I hadn't felt much movement, and it was a good thing I did. Both girls were delivered at 38 weeks and everything went smoothly. God has this little guy safely in His hands and will show you the right path to take. You'll be meeting your little sweetness soon and whatever inconveniences may occur in the next week won't matter at all when you cuddle him. Praying for some peace for you and Dan.

Jess

Bill and Emily said...

It sounds like your little guy is doing very well. I'm sorry you're facing this at the tail-end of the pregnancy but it sounds like you have a good doctor and that aspirin is a wise choice. Take care of yourself and relax!!!

AO said...

We are praying for you as you face these final stressful weeks - so much waiting and anxious news packed into such a small time. Hoping for your little one's safe and healthy arrival!