Tuesday, March 22, 2011

31 weeks, trouble brewing.

Yesterday was 31 weeks which is a pretty good place to be, gestational age-wise.I'm expecting to make it another week, but I'm not sure how much farther beyond that we are going to make it.

The good news is that Luke is doing well. He easily passed the biophysical profile today (they did that before the NST just in case). I know he had one good acceleration on his NST but he needed two, he had a few more accelerations but they weren't quite high enough to count as reactive. But best of all, again no decelerations at all. (He was in a different position again today, so I'm really thinking his feet above his head and pressing into the cord may have been the problem.) And today I had the good nurse who always saw his decelerations before.

The bad news is that now that Luke is behaving, I'm showing some somewhat alarming warning signs. If it was just one of them or I didn't have the history and risk factors that I have, it probably would pretty easily be dismissed. But since that's not the case, it really seems to be that trouble on the horizon. My hands and feet are a bit swollen and I had an unusual amount of weight gain, especially for me this pregnancy, which indicates it's not just my imagination. My blood pressure has been funky. Every day for the past week or so, I've had one blood pressure that has been off, sometimes not too bad, like only +10 higher than my normal, and sometimes a bit alarming, like +20 higher than my normal. Sometimes it's only the top number high, sometimes the bottom, sometimes both. And I monitor my blood pressure three times a day, it's always off at a different time, but then the other two numbers for the day will be normal or even lower than normal. And then there's the heartburn. I've had heartburn off and on since the mid 2nd trimester. And it's always freaked me out a little bit, because when I was pregnant with Olivia, I had severe heartburn pretty much constantly for about 2 weeks before it turned into upper right quadrant pain and HELLP syndrome. (It wasn't that I mistook my upper right quadrant pain as heartburn, they were definitely different, it was just having that as a prelude to trouble has made me uneasy whenever heartburn comes around this time.) Earlier in this pregnancy, though, the heartburn was always in my throat and more like acid reflux, it was relatively mild, and generally went away with a few Tums unless I got crazy and ate something like chili. I haven't even had heartburn in a month or so, but all of a sudden it's been back (about last week), it's not in my throat anymore but deep in my chest, and it's constant and severe. Any one of those things alone would be okay, I know swelling can be normal, I know heartburn can be normal, and I know 2 of 3 normal blood pressures is not that alarming, but all together and with my past, 36 weeks is looking doubtful, and if we do somehow make it that far, it's especially doubtful that they are still going to bother with an amnio to check his lungs first.

Yesterday I saw my high risk doctor and my blood pressure was pretty far up there especially for me (133/88, top number is about +20 and bottom number +15 from my normal.) I wasn't sure that it would concern her, still being under 140/90, but luckily she looked at it and said right away, "that's high for you, isn't it?". We went over all of the other suspicious things and now my usually very calm and cool high risk doctor is not feeling so optimistic. She's been saying this whole time not to worry until she tells me to worry, and that she will tell me when she's worried. (Not that it has ever worked.) Yesterday, she didn't exactly say she was worried in those words, but she said, "You are making me very nervous." She was glad that I had monitoring  today and Friday (blood pressure was 127 / 72 , another one of those high for me top numbers), she wants to see me again on Monday and was emphatic to call if anything new is amiss. She also ran a full panel of labs and said I'd be hearing from them if anything was off with my bloodwork, so I assume it was okay since I haven't heard from them. (And I don't really expect it to be off at this point, I think what is going on now is mostly a prelude to trouble that this time we know about, but not really trouble yet. And despite whatever may be going on with me, the baby is seemingly perfectly content and active.)

Because she's seeing me next week anyway, and it doesn't *seem like* at this point, that we'll be delivering this week, she decided to hold off on steroids until next Monday. There are two good reasons for this, first and most importantly, the steroids are most effective the closer to delivery they are given (but better a little early than not at all for premature babies.) If trouble comes up this week enough to send me to the hospital, then I still will end up getting them this week. But if everything stays status quo, it's really a lot better for the baby for us to get them next week. (I don't think she'll push it back any further than that with all of the ominous signs.) Secondly, almost everyone has said that the steroids are going to screw up my blood sugar levels. My blood sugars have been fantastic and very easy to maintain with very minimal effort on my part. So if we can keep them fantastic for one more week without adding steroids to screw them up, that's okay with me too.

I'm remarkably nonchalant about this newest drama. I guess since we started this pregnancy with a 60-70% risk of pre-eclampsia just from my history, then there was notching in the blood flow early on, which is an added risk, and then it turns out I had gestational diabetes, which is another added risk....it is kind of  expected. Really, it's quite astonishing and fantastic that we've made it this far....8 whole weeks farther than I made it with Olivia and we can probably stretch this out for AT LEAST one more week, hopefully 2 more. I can't get too horribly down about that. The main thing that's bugging me about it is not knowing how much longer we get. I would really like to not deliver next week with my OB out of town for a conference. And I would really like to make it to the 3D ultrasound on Monday.My baby shower is supposed to be April 3rd but that's looking a bit iffy, but if I can make it to that, then the next day will be 33 weeks, and my OB will be back. But my body and history has had horribly bad timing in the past (not only because Olivia died so close to 24 weeks, but because I had started a new job in August and they were switching over insurance plans at the time. So I had their old plan for only September, and a new plan starting in October. They had 3 different levels of plans, and I wasn't due until January and this was decided before there was any drama, so I picked the worst plan for September and the best plan for October on. She was born on September 28th and I was discharged from the hospital on October 2nd. Picking the worst plan cost us several thousand dollars in deductibles/medical bills, which we would have at least been spared from if the date had happened to be October 1st.) So, I'll be holding my breath through next week with my OB out of town and the baby shower that Sunday.

There's always a chance that things may take a turn for the better or at least stay the same, but I'm not really holding my breath on that.


Kimberly said...

Thinking of you and wishing you the best, Angie! I hope all of the symptoms are just coincidence! I'm so happy Luke is doing so well.

*Laura Angel said...

Thinking of you! I will tell you that 3 weeks prior to me going into labor with Carter, my hands swelled a bit, and I has the exact same issues with my pressures. Hopefully you can hold off a few weeks!

I was always told the bottom number is more worrisome as that is how hard your heart is working at rest?

I will say that my heartburn WAS HORRIBLE at the end with Carter and it was not PE. Which is wonderful ;)!

rebecca said...

Ugh, that definitely is a bit anxiety provoking, but glad you're taking things well and hoping with you that baby is able to stay with you a bit longer before making his appearance into the world. Sending lots of positive thoughts and hope for a longer pregnancy your way!!!

Brooke said...

Thinking of you and Lucas. You come across as so calm and cool and collected, which I take to be a sign that you trust your medical care and know that you're taking all the right steps. I am sure that you're still feeling anxious, but I hope that whatever happens in the next few days/weeks, you are beginning to feel confident that you will have a good outcome and be bringing home a sweet baby boy.

MrsH said...

I think that things are going a lot better than I thought they would when I first read your blog and Olivia's story. 31 weeks and occasionally high BP is not the worst. You have made it a very long way. But I understand worrying about it though. You want the NICU stay to be as brief and atraumatic as possible, and that means keeping Lucas in as many days as you can. Take it easy, try to be relaxed most of the time, it does make a difference on preeclampsia's progression. I saw patients go as far as four more weeks from the onset of the preeclampsia when they were preterm. That is not the norm, but you never know.

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