What a big day! First of all, I'm now 35 weeks and second, I received my last P17 injection this morning! I never thought I would get through all 20 shots and here I am, all finished!
I saw Dr. Davis this afternoon. We really didn't have much to discuss and my cervix wasn't even evaluated. My fluid level is holding steady at 10.5 and my NST was good - baby was reactive and no contractions were detected.
Concerned about my increased irritability, I asked Dr. Davis how I would know if I was going into labor. He said whenever I'm unsure just go to the hospital like I did over the weekend. He said I might go back six times between now and my scheduled c-section and that it is okay to be evaluated and sent home.
Baby Boy remains breech, frank breech to be exact. It seems like he's been in this position for as long as I've been evaluated. Of course this brings with it new worries for me such as his hips and possible need for braces or physical therapy after birth. But it's nothing we can't handle.
Oh, and he may just have a name. We are keeping it under wraps...
Showing posts with label AFI. Show all posts
Showing posts with label AFI. Show all posts
Thursday, January 29, 2009
Tuesday, January 6, 2009
Another Moved-Up Appointment
My appointment with Dr. Davis was scheduled for today, Tuesday. But, considering the events or shall I say lack-of events, as in a major slow down in Baby movements, I called to push my appointment up a day.
Sunday night was a difficult night for me. I had terrible left-sided pain that radiated to my lower back. I chalked it up to GI stuff as pregnancy causes a major halt in my digestion process. Gotta love Miralax! I couldn't get comfy and in my bouts of tossing and turning, noticed that Baby Boy was not moving in his normal fashion. I woke early Monday morning still noticing there was no movement. I hopped in the shower thinking that would help and nothing. I sat back in bed and had Hubby feel too. We pushed and poked and still nothing. I ate a bowl of cereal and drank a glass of juice thinking that should do it and yet nothing happened.
I called Lisa to see if they could accommodate an after lunch appointment as My Girl already had a scheduled-just-moments-before ENT appointment to have her newly swollen tonsils evaluated. Lisa was just as nice as always, informing me they were crazy booked both Monday and Tuesday and if I didn't mind waiting, come on over between 1 and 1:30. Mind waiting? Heck no, I'm used to it by now and was actually looking forward to it with a fresh book in my hands.
I was relieved to see Baby Boy's heartbeat on the ultrasound monitor. And with the probing of the transducer across my abdomen, Baby Boy decided to push back - finally! My fluid level continues to increase and was 11.6. My cervix was 2.7.
During my NST, Baby Boy must have been recharged from his long slumber as he was bouncing off my uterine walls! He had great accelerations in his heart rate and we both got a glowing report.
My visit with Dr. Davis was just a thorough as ever. He addressed my concerns about the following:
1. I mentioned that with My Girl, my membranes were exposed for five days, never rupturing. I asked if this means I have "strong" membranes and if this is even something that exists. He assured me that yes, there is in fact something to be said for bulging membranes that didn't rupture which leads him to believe I produce strong membranes.
This "history" was the build up to my real question about the chances of rupturing membranes in this pregnancy. I realize Dr. Davis can't predict the future but I did walk away with the reassurance that I am probably at a lesser risk for rupture since My Girl's membranes, under way extreme circumstances, stayed intact.
2. The other part to my membrane question was that in the event of rupture, does the TAC reduce the risk for a prolapsed cord. The answer to that was yes.
3. I also inquired about Fetal Fibronectin (fFN) testing http://www.marchofdimes.com/professionals/14332_1149.asp and whether or not it was something that we should consider. It was discussed that because of my tendency to worry, if I got a positive test back, I could very easily worry for no good reason. This test is best when it provides negative results, meaning delivery within a two week period is unlikely. I agree with Dr. Davis but still felt the need to ask.
4. My cervical length has decreased to a functional length of 2.7. This decrease in length is a normal part of pregnancy, which Dr. Davis explained is why the TAC is placed around the cervix and not sewn directly into the cervix. My TAC is still doing its job: my cervix is still closed with no funnelling.
5. Unfounded are my fears of uterine rupture. My mind can't seem to keep away from the fact that although my 24 week c-section was performed as a low-transverse incision (the preferable way but not likely with such an extreme premature birth), I was still cut at 24 weeks, way before my uterus had a chance to really expand. I am much larger now than I ever was with My Girl and that scares me. Dr. Davis took the time to perform another ultrasound, personally confirming there is no sign of uterine thinning or separation at my previous scar.
So yesterday was yet another of the many great visits I have had with Dr. Davis. I don't know where I would be without him. He puts my mind at ease and never undermines any of my concerns. Today I am officially seven weeks beyond where My Girl was born! Wow, seven extra weeks!!!
Sunday night was a difficult night for me. I had terrible left-sided pain that radiated to my lower back. I chalked it up to GI stuff as pregnancy causes a major halt in my digestion process. Gotta love Miralax! I couldn't get comfy and in my bouts of tossing and turning, noticed that Baby Boy was not moving in his normal fashion. I woke early Monday morning still noticing there was no movement. I hopped in the shower thinking that would help and nothing. I sat back in bed and had Hubby feel too. We pushed and poked and still nothing. I ate a bowl of cereal and drank a glass of juice thinking that should do it and yet nothing happened.
I called Lisa to see if they could accommodate an after lunch appointment as My Girl already had a scheduled-just-moments-before ENT appointment to have her newly swollen tonsils evaluated. Lisa was just as nice as always, informing me they were crazy booked both Monday and Tuesday and if I didn't mind waiting, come on over between 1 and 1:30. Mind waiting? Heck no, I'm used to it by now and was actually looking forward to it with a fresh book in my hands.
I was relieved to see Baby Boy's heartbeat on the ultrasound monitor. And with the probing of the transducer across my abdomen, Baby Boy decided to push back - finally! My fluid level continues to increase and was 11.6. My cervix was 2.7.
During my NST, Baby Boy must have been recharged from his long slumber as he was bouncing off my uterine walls! He had great accelerations in his heart rate and we both got a glowing report.
My visit with Dr. Davis was just a thorough as ever. He addressed my concerns about the following:
1. I mentioned that with My Girl, my membranes were exposed for five days, never rupturing. I asked if this means I have "strong" membranes and if this is even something that exists. He assured me that yes, there is in fact something to be said for bulging membranes that didn't rupture which leads him to believe I produce strong membranes.
This "history" was the build up to my real question about the chances of rupturing membranes in this pregnancy. I realize Dr. Davis can't predict the future but I did walk away with the reassurance that I am probably at a lesser risk for rupture since My Girl's membranes, under way extreme circumstances, stayed intact.
2. The other part to my membrane question was that in the event of rupture, does the TAC reduce the risk for a prolapsed cord. The answer to that was yes.
3. I also inquired about Fetal Fibronectin (fFN) testing http://www.marchofdimes.com/professionals/14332_1149.asp and whether or not it was something that we should consider. It was discussed that because of my tendency to worry, if I got a positive test back, I could very easily worry for no good reason. This test is best when it provides negative results, meaning delivery within a two week period is unlikely. I agree with Dr. Davis but still felt the need to ask.
4. My cervical length has decreased to a functional length of 2.7. This decrease in length is a normal part of pregnancy, which Dr. Davis explained is why the TAC is placed around the cervix and not sewn directly into the cervix. My TAC is still doing its job: my cervix is still closed with no funnelling.
5. Unfounded are my fears of uterine rupture. My mind can't seem to keep away from the fact that although my 24 week c-section was performed as a low-transverse incision (the preferable way but not likely with such an extreme premature birth), I was still cut at 24 weeks, way before my uterus had a chance to really expand. I am much larger now than I ever was with My Girl and that scares me. Dr. Davis took the time to perform another ultrasound, personally confirming there is no sign of uterine thinning or separation at my previous scar.
So yesterday was yet another of the many great visits I have had with Dr. Davis. I don't know where I would be without him. He puts my mind at ease and never undermines any of my concerns. Today I am officially seven weeks beyond where My Girl was born! Wow, seven extra weeks!!!
Wednesday, December 31, 2008
Yesterday's Appointment with Dr. Davis
Yesterday I celebrated 30w 5d and Baby Boy has officially had the benefit of an additional six weeks in the womb compared to his sister born at 24w 5d.
At yesterday's appointment, Dr. Davis performed a growth scan and Baby Boy is measuring on target for his gestational age. His approximate weight is 3 lbs 6 oz, a whole two pounds heavier than his sister was at birth. Curious as to how much Our Girl weighed at this stage, I referred to her NICU calendar where I tracked something positive each and every day of her NICU stay. (I still keep a daily calendar of what I consider to be "milestones" or cute things she says or does. In fact, today is the last day of my second Hallmark calendar (started the day of discharge) and I need to decide if I will keep a third year of notes for her. Baby Boy of course will have at least as much as his sister... so I hope and plan to, anyway.)
So the NICU calendar indicated that 30w 5d was day 42 of our NICU stay. Our Girl had just self-extubated the day prior which happened to be Labor Day and was off the vent successfully the third and final try. She was on a CPAP of 7 or 8 and weighed 2 lbs 5 oz. Clearly, the hard work of surviving takes its toll on these micro preemies. Just baking away as nature planned, allows for crucial weight gain and development that is seriously thrown off course when these tiny babies are thrust into the world too soon. It is realizations and comparisons such as these that really break my heart. Although, if you watch the attached video of My Girl singing "Jingle Bells", my thought is that most people would never know her life began the way it did.
While Baby Boy's measurements all average out to his actual gestational age, his tummy was measuring on the small side. What I love about Dr. Davis' techs, is that they just do the testing necessary to confirm that all is okay. Yesterday, this meant that without instructions or asking permission, my tech went ahead and confirmed that blood flow was appropriate and that Baby Boy wasn't compromised in any fashion. This is very reassuring as I love the better safe than sorry approach to medical care and you can't check me or my baby enough! For this reason, I have decided to have Dr. Davis and his team continue to follow my pregnancy on a weekly basis, performing the necessary growth scans, AFIs, NSTs, cervical checks and lower uterine segment screening for any sign of thinning.
It is very true that although my whole day is consumed by a Dr. Davis visit, I have a routine down and the techs in the office all know me and my situation. I feel 100% confident and comfortable with the care I am receiving and with little time left in my pregnancy feel it's in every one's best interest to keep a good thing going.
In other news, my fluid level came up to 10.5 this week. Each week since I was flagged for potentially low levels, my fluid has increased. This is all reassuring. My NST was reactive as well although uterine irritability was detected but I suppose that is nothing new.
I felt bad when as Hubby and I entered Dr. Davis' office to talk, his phone rang and he was clearly discussing with the person on the other end that I was going to be one of his OB patients. Long story short, I explained that I am more comfy delivering closer to home and so our plan for the remainder of the pregnancy is that Dr. Davis will continue to follow me weekly (as mentioned above) and my new group will see me every other week and ultimately perform my amnio and delivery. Gosh, it feels like a weight has been lifted off my shoulders! I have it figured out!
Earlier today, I put a call into the new doc I met on Christmas Eve. She called me back this afternoon and I confirmed that I would love for them to take me on as a patient, all the while co-treating with Dr. Davis. It made me feel so good that she was excited to talk to Dr. Davis not only about my records, but also about Transabdominal Cerclage! She was thrilled to learn of another doctor who performs the surgery! Spread the word!!!
So while I was hesitant to put up two Christmas trees this year because I had visions of being on bed rest or worse, in the hospital or visiting Baby Boy in the NICU, I am happy to report that instead of all the negative thoughts, I am actually able to help Hubby take the trees down! I wouldn't be here, on the eve of the New Year, the eve of 31 weeks, on my feet, helping out without this TAC!!!
At yesterday's appointment, Dr. Davis performed a growth scan and Baby Boy is measuring on target for his gestational age. His approximate weight is 3 lbs 6 oz, a whole two pounds heavier than his sister was at birth. Curious as to how much Our Girl weighed at this stage, I referred to her NICU calendar where I tracked something positive each and every day of her NICU stay. (I still keep a daily calendar of what I consider to be "milestones" or cute things she says or does. In fact, today is the last day of my second Hallmark calendar (started the day of discharge) and I need to decide if I will keep a third year of notes for her. Baby Boy of course will have at least as much as his sister... so I hope and plan to, anyway.)
So the NICU calendar indicated that 30w 5d was day 42 of our NICU stay. Our Girl had just self-extubated the day prior which happened to be Labor Day and was off the vent successfully the third and final try. She was on a CPAP of 7 or 8 and weighed 2 lbs 5 oz. Clearly, the hard work of surviving takes its toll on these micro preemies. Just baking away as nature planned, allows for crucial weight gain and development that is seriously thrown off course when these tiny babies are thrust into the world too soon. It is realizations and comparisons such as these that really break my heart. Although, if you watch the attached video of My Girl singing "Jingle Bells", my thought is that most people would never know her life began the way it did.
While Baby Boy's measurements all average out to his actual gestational age, his tummy was measuring on the small side. What I love about Dr. Davis' techs, is that they just do the testing necessary to confirm that all is okay. Yesterday, this meant that without instructions or asking permission, my tech went ahead and confirmed that blood flow was appropriate and that Baby Boy wasn't compromised in any fashion. This is very reassuring as I love the better safe than sorry approach to medical care and you can't check me or my baby enough! For this reason, I have decided to have Dr. Davis and his team continue to follow my pregnancy on a weekly basis, performing the necessary growth scans, AFIs, NSTs, cervical checks and lower uterine segment screening for any sign of thinning.
It is very true that although my whole day is consumed by a Dr. Davis visit, I have a routine down and the techs in the office all know me and my situation. I feel 100% confident and comfortable with the care I am receiving and with little time left in my pregnancy feel it's in every one's best interest to keep a good thing going.
In other news, my fluid level came up to 10.5 this week. Each week since I was flagged for potentially low levels, my fluid has increased. This is all reassuring. My NST was reactive as well although uterine irritability was detected but I suppose that is nothing new.
I felt bad when as Hubby and I entered Dr. Davis' office to talk, his phone rang and he was clearly discussing with the person on the other end that I was going to be one of his OB patients. Long story short, I explained that I am more comfy delivering closer to home and so our plan for the remainder of the pregnancy is that Dr. Davis will continue to follow me weekly (as mentioned above) and my new group will see me every other week and ultimately perform my amnio and delivery. Gosh, it feels like a weight has been lifted off my shoulders! I have it figured out!
Earlier today, I put a call into the new doc I met on Christmas Eve. She called me back this afternoon and I confirmed that I would love for them to take me on as a patient, all the while co-treating with Dr. Davis. It made me feel so good that she was excited to talk to Dr. Davis not only about my records, but also about Transabdominal Cerclage! She was thrilled to learn of another doctor who performs the surgery! Spread the word!!!
So while I was hesitant to put up two Christmas trees this year because I had visions of being on bed rest or worse, in the hospital or visiting Baby Boy in the NICU, I am happy to report that instead of all the negative thoughts, I am actually able to help Hubby take the trees down! I wouldn't be here, on the eve of the New Year, the eve of 31 weeks, on my feet, helping out without this TAC!!!
Tuesday, December 16, 2008
Monitoring, Monitoring and More Monitoring...
Today I saw Dr. Davis. I probably should clarify what seeing Dr. Davis entails: first of all, unless there is an issue, I usually see one of the very skilled ultrasonographers in the Antenatal Testing Unit for any combination of studies including, fetal growth scans, cervical measurements and amniotic fluid level checks (AFI). The images are then transmitted via computer to his office and usually after a pretty long wait (I don't mind, he's worth the drive and every minute I've spent waiting in his cramped waiting room) he calls me back to talk. He reviews the images, takes his own measurements, answers my questions and never makes me feel rushed. The visits usually end with a hug and he walks me out to the desk with my chart and gives my follow-up instructions to Lisa, the scheduler.
All of Dr. Davis' techs are great and I like them all, having confidence in each of them. However, that being said, Patty is still my personal favorite as she was there at my preconception consult. She performed my scan today and I explained to her that I was concerned I didn't receive an accurate AFI on Friday. After a quick peek at Baby Boy, Patty moved on to assess my fluid level. There was a big black area that could have been mistaken for fluid (I really learn something new each time I get a scan) but once Patty turned the color on, highlighting what I imagine to be blood flow, it was determined that the big mass of black was not fluid but a lump of cord. This technique was not employed during my Friday scan when my AFI came back at 15.
Bottom line, my fluid is nine this week, up from last week's seven. This is an improvement but nothing like the 15-16 range which is considered "normal". After my ultrasound I was hooked up for a non-stress test (NST) where both the baby and I were being monitored: he for heart rate and me for contractions. It really was painful to hear the nurse say that Baby Boy is still real small and that it may be hard to pick up heart rate accelerations because he is still "neurologically immature". Janice is a very nice woman also and very knowledgeable, I might add. I explained to her how much it hurts to hear something like that as My Girl was born exactly four weeks earlier at 24w 5d gestation. Moments like these are really sad and painful reminders of just how much My Girl was gypped by not getting more time in the womb. It's an open wound for me.
Anyway, Baby Boy looked great and I informed everyone I saw that I've had a really good week. I then saw Dr. Davis who confirmed that things are looking good but it's in my best interest and my baby's to continue to monitor things with weekly AFIs and NSTs. I couldn't agree more when he commented about how much we've invested in this pregnancy (as does any expecting mom, I would hope) and that it would be a shame to have something that is presenting as a potential issue slide past us and become an issue such as growth restriction or fetal demise. He is being extra cautious with me and I really appreciate that approach!
So, this leads me to my big dilemma which I imagine more light will be shed upon tomorrow when I meet with Dr. C: do I drive all the way to South Jersey each week or will my local group be willing to support this aggressive approach to monitoring?
All of Dr. Davis' techs are great and I like them all, having confidence in each of them. However, that being said, Patty is still my personal favorite as she was there at my preconception consult. She performed my scan today and I explained to her that I was concerned I didn't receive an accurate AFI on Friday. After a quick peek at Baby Boy, Patty moved on to assess my fluid level. There was a big black area that could have been mistaken for fluid (I really learn something new each time I get a scan) but once Patty turned the color on, highlighting what I imagine to be blood flow, it was determined that the big mass of black was not fluid but a lump of cord. This technique was not employed during my Friday scan when my AFI came back at 15.
Bottom line, my fluid is nine this week, up from last week's seven. This is an improvement but nothing like the 15-16 range which is considered "normal". After my ultrasound I was hooked up for a non-stress test (NST) where both the baby and I were being monitored: he for heart rate and me for contractions. It really was painful to hear the nurse say that Baby Boy is still real small and that it may be hard to pick up heart rate accelerations because he is still "neurologically immature". Janice is a very nice woman also and very knowledgeable, I might add. I explained to her how much it hurts to hear something like that as My Girl was born exactly four weeks earlier at 24w 5d gestation. Moments like these are really sad and painful reminders of just how much My Girl was gypped by not getting more time in the womb. It's an open wound for me.
Anyway, Baby Boy looked great and I informed everyone I saw that I've had a really good week. I then saw Dr. Davis who confirmed that things are looking good but it's in my best interest and my baby's to continue to monitor things with weekly AFIs and NSTs. I couldn't agree more when he commented about how much we've invested in this pregnancy (as does any expecting mom, I would hope) and that it would be a shame to have something that is presenting as a potential issue slide past us and become an issue such as growth restriction or fetal demise. He is being extra cautious with me and I really appreciate that approach!
So, this leads me to my big dilemma which I imagine more light will be shed upon tomorrow when I meet with Dr. C: do I drive all the way to South Jersey each week or will my local group be willing to support this aggressive approach to monitoring?
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