AFI Update & Extra-Abdominal Bowel Distension

My AFI was 5.8 today compared to 6.8 on Monday.  The umbilical cord Doppler was still good.  The LW is still doing great on the monitor.  So everything is pretty much the same, but as expected, they are noticing more bowel distension as I get closer to term.  There is one segment in particular that looks really swollen.  Even I noticed it on the ultrasound and it was so big that I couldn’t even tell that it was intestine.  The doctors have seen this segment before, and they continue to say that when it comes to giving the LW the best head start she can get, gestational age is more important than extra-abdominal bowel distension.  See my previous post on this subject.  I also found a published study in the Journal of Pediatric Surgery that supports what the doctors are telling me.  The study identified four factors that were statistically relevant to length of stay in the NICU: 

1. Gestational age
2. If a silo is needed (compared to primary closure)
3. If GI complications occur (like atresia, perforation, or resection)
4. If other, non-GI anomalies are present

The study found that intestinal distension seen on prenatal ultrasounds is not an accurate predictor of length of stay in the NICU.  Some subjects with dilated bowel had GI complications, but others did not.  They concluded that distension produces many false positive predictions of adverse outcome, and does not reliably predict GI complications or the need for a silo.  However, the absence of bowel distension did reliably predict less complex cases and shorter NICU stays.  So basically, if you don’t see distension you know you’re in pretty good shape.  But if you do see it, it doesn’t necessarily mean anything.  You could still have a quick and easy run in the NICU with no complications, or you could end up having a more complicated case.

 

Despite what I’m being told and what I’m reading, I’m still having a weird gut reaction to this large segment of swollen bowel.  So I expressed my concerns to my ob/gyn when she came in today to check on me.  She has been my biggest advocate through all of this.  She comes to see me every day she’s in the office, she calls me on her days off if I have questions, and she reviews every one of the LW’s monitoring strips with a fine-toothed comb.  Like me, she is extra cautious about everything and always takes the most conservative approach.  But most importantly, she listens to all of my concerns and never brushes me off, and she always makes sure that I get answers.  If she can’t answer my questions she makes sure that the perinatologists do.  I told her that I know they generally don’t think that bowel distension is a reason to deliver me early, but now that I’m almost 36 weeks, is there a point where too much is too much?  Because this particular segment looked really big to me.  I told her that I wanted my primary perinatologist to look at the photos of the swollen bowel from today’s ultrasound and confirm that waiting to deliver me is still the best option.  So she is going to call him to review the photos together and he is going to stop by or call me tomorrow to discuss.  I’m proud of myself for listening to my instincts and voicing my concerns.  You can’t have that nagging feeling in the back of your mind when you’re in a situation like this.  I’m sure I will feel better after talking to him tomorrow.