Growth Update – Part 2

What a difference a day makes, especially when you’re at the mercy of pregnancy hormones!  I’m feeling MUCH better today after talking to our perinatologist (a doctor who specializes in high-risk pregnancy conditions).  In fact, I always feel better after talking to him.  He was the doctor who first diagnosed us and we see him at least once a month, so we’ve grown pretty close.  He’s extremely knowledgeable about gastroschisis, very cautious, and honest and straightforward in answering all of our questions.  We trust him 110%, and that’s something you can’t place a value on when you’re in a situation like ours.  Let’s just say he’s getting a REALLY nice fruit basket after this is all over.  

The basic gist is that they’re not seeing anything they didn’t expect to see and there is still no reason to deliver me early.  Yes, the LW is petite, and it would be nice if she measured a little bigger.  But he kept emphasizing that weight measurements for gastroschisis babies are notoriously inaccurate (see my post from yesterday).  They’re not something you want to hang your hat on.  Furthermore, the farther you get in the pregnancy the more the abdominal circumference factors into the equation, so the more inaccurate the prediction gets.  The important thing is that she IS growing.  Even when you factor in the underrepresented abdomen, she’s gained about ¾ of a pound since she was last measured 3 weeks ago.  Her head and femur bones grew and are much closer to average.  So he is not even putting her in the category of “growth restricted.”  They’ve also been measuring the umbilical cord doppler, which tells you how much blood flow is getting from the placenta to the baby through the umbilical cord.  Those measurements have always been excellent.  The main concern with low growth is that the baby isn’t getting nutrients from the mother.  But since the LW is growing and since there are no placental problems, they’ve ruled that out.  The LW is simply your average gastroschisis baby.  And for reasons that aren’t totally understood, these babies are almost always small. 

With regard to the intestines, they have noticed some segments of distended bowel in the past 2 weeks, which they expect to see at this point in the pregnancy.  This is because the bowel starts to get irritated after floating around in the amniotic fluid for so long.  They often compare it to your skin after you’ve had it underwater for a long time.  They really can’t tell how good or bad of a case it will be until the baby is born.  They look at the intestines in utero and they “hem and haw” (doctor's words) over what it might mean, but this almost never influences the decision to deliver early.  One exception is when the ultrasounds show distension in the intra-abdominal portion of the intestine (i.e., the part of the intestine that is still inside the body).  Some studies have shown that intra-abdominal distension COULD indicate a more complex case of gastroschisis.  But even then, it doesn’t always warrant early delivery.  Fortunately for the LW, they haven’t seen any intra-abdominal distension.  The distended segments are in the portion of the bowel that is outside the body.

There is also a chance that her stomach could be outside now.  It’s not uncommon for the stomach to slip in and out of the hole in the third trimester because it is connected to the intestines and things are starting to get crowded in there.  They haven’t seen the stomach for the past couple of weeks which either means that it has slipped out or that she hadn’t swallowed any amniotic fluid at the time, which fills up the stomach and allows them to see it on the ultrasound.  Although this sounds scary, according to our perinatologist and pediatric surgeon, it happens.  If the stomach has slipped out it doesn’t change her treatment, recovery time, or overall prognosis.  They just put it back in with everything else.

The last thing they’ve been keeping an eye on is her bladder, which has been full at every ultrasound I’ve had since I was admitted to the hospital.  That is definitely contributing to my low AFI.  The amniotic fluid is constantly being recycled through the baby as she swallows it and pees it out.  Yeah, gross.  For some reason, the LW likes to hold it in.  At first they thought she might have some sort of blockage, but if she did things would back up into her kidneys and her kidneys look fine.  Moreover, her bladder is always full to different degrees.  Sometimes it’s a little full, other times it’s REALLY full.  So they really don’t have a good explanation for what’s happening other than she’s a demure thing who doesn’t like to pee.  As long as the kidneys continue to look okay, they are not too concerned about it. 

So, the plan hasn’t changed.  My job is to keep incubating.  The older she is when she’s born, the better she’ll do in the NICU.  Lung development is particularly important because placing the abdominal contents back into the body can place pressure on the lungs, and if the lungs aren’t mature she could have to be on a ventilator while she’s hooked up to her silo.  It would be great if we could avoid that.  I asked him when the ideal time to deliver me would be assuming I don’t go into labor and everything continues to be stable.  He said theoretically they would want to deliver me at 38 weeks, which is when the majority of babies reach full lung maturity (I thought it was 39 weeks, but he said it’s actually 38 for most babies).  That puts us at June 30, which just so happens to be my sister’s wedding date.  Imagine that!  My sister and I have an ongoing joke that the Littlest Warrior has it out for her Auntie.  She’s already taken the Matron of Honor out of the game, and now she’s like a hurricane honing in on the big day.  Apparently with the Littlest Warrior it’s go big or go home.  But don’t worry, sis!  Unless it’s an emergency, I’ll insist that they schedule the delivery for the next day.  And you’ll still have my permission to give her shit for this when she gets older (in fact, I encourage it).

What are the reasons why they might deliver me before June 30?

1. If my water breaks or I go into labor.
2. If the LW starts to show signs of distress on the fetal monitor.  Speaking of which, my perinatologist recommended that I go back to the 1-in-4-hour monitoring to give myself a break every once in a while.  He said the few variables she’s had (occasional, short decels) are normal for any baby.  The majority of the time she looks excellent.  He said he’s seen cases where he thinks continuous monitoring is needed and this is not one of them. 
3. If my AFI dips dangerously low (i.e., below 4.0). 
4. If no growth has occurred the next time they measure her, which will be in another 3 weeks.

There you have it.  I don’t have any ultrasounds for the next few days, so I hope my next posts will be a little more lighthearted.  And maybe they’ll even include a belly pic. :)