Monday, September 17, 2012

31 weeks= drama

Some of you may remember back when I was pregnant with Luke, when I got admitted twice in the same week, back to back days, for different reasons. On that Friday, we went for monitoring, where Luke did HORRIBLY with some ugly decelerations (more than once) that were so bad that the nurse wanted to fax the test strip to my high risk doctor directly, followed up with a failing biophysical profile--he was too lazy to practice breathing and his movements were more sluggish than usual--my MFM had us head to the hospital, where they quickly hooked me up to monitors and watched him for a couple hours. He did perfectly, then they followed up with a biophysical profile again, where he passed easily in 5 minutes. All that drama for nothing.

The next day, I was laying on the couch watching tv when I started having contractions. I was told to call if I have more than 5 in an hour. I had more than that, called, they told me to go in. Same place, the very next day, more monitoring for both contractions and his heart rate. (He did perfectly.) I had an irritable uterus from a UTI, they sent me home with antibiotics after a few hours.

Silly me, thinking this pregnancy has been so mellow and drama free with the exception of the hand saga, I often almost forget I'm pregnant. Last week I was mildly alarmed when I was spilling a little protein at my OB, but then I wasn't spilling any at my high risk doctor, so it didn't seem too terribly alarming. Then I started feeling like I was getting swollen, especially in my face around my sinuses/the bridge of my nose, it felt like I was getting a sinus infection, but didn't. Which is kinda a big deal, because swelling in the feet during pregnancy is normal...the face, not so much. But swelling is tricky, I didn't think I looked more swollen, and maybe it was all in my head.And my blood pressure was really good.

My first appointment today went well, unlike his big brother, the little boy in utero is super cooperative and easily passed the nonstress test and my fluid levels were good. No drama there, at all, except he flipped from head down to breech which is a whole lot more comfortable for me, although it's surprising an almost 5 lb baby still has that much room in there. But no big deal, having a c-section, he can stay breech (and just might).

My second My blood pressure was good. My 24 hour urine results, not so much.

The diagnostic criteria for preeclampsia is two blood pressure readings of 140/90 or higher, and 300 mg of protein in a 24 hour urine test. (The in office dip tests are supposed to give them a general idea. Last week my test was +1, which is supposed to be an estimate of 100 mg. +2 is a guess of 200, etc., and they only go up to +3. But they are notoriously inaccurate. One of my friends had a 24 hour urine test of 250 mg when her office test was completely clear. One sample at one random time doesn't mean that the kidneys aren't spilling protein, even with a completely clear test. Or someone can get a +3 test if they are dehydrated, but not actually be spilling 300 mg over 24 hours, so they can be inaccurate both ways, but a whole lot more convenient than saving your pee in an orange jug for 24 hours.)

 Anyway, last Monday, I had a +1 test in my OB's office, but a clear test in the afternoon at high risk. Wednesday through Thursday I did my 24 hour urine test and blood work. It came back at 700 mg of protein and my uric acid was "a little high" (something to do with the kidneys, not sure what, it's not super important in terms of preeclampsia). I am pretty sure my high risk doctor accidently muttered the 700 mg and could tell immediately I knew what that meant by the look on my face (BAD!) because we have spent a lot of time together and freaking out about it isn't going to help anything. She quickly said, "That's not bad enough to pull the trigger.  If you get to x000's then we probably will." (Can't remember if she said 2000 or 5000, either way, I'm going to be reluctant to deliver if I'm "only" spilling protein, though I'd rather not have kidney damage along the way so we'll have to weigh the options carefully if it comes to that. Spilling protein isn't good for *me*, but my understanding is that it isn't really putting the baby at risk, as long as my blood pressure and everything else stays normal.)

So, this changes things. It seems like she's now preparing for *when* trouble comes vs. *if* it is coming. Because there is not really a good reason to be spilling that much protein, when I never have spilled that much in pregnancy before. (With Olivia, we never had time for a 24 hour urine, my office dip tests were always completely clear, so who knows how bad my kidneys were doing or for how long.) I did "baseline" 24 hour urines before I got pregnant with Luke, and a baseline 24 hour urine early in my pregnancy with Luke, we didn't do one this time, but last time there wasn't any/much.

I'm now getting steroid shots to help develop the baby's lungs, tomorrow and Wednesday. (It is ideally 2 doses, 24 hours apart, as close to delivery as possible) She made a comment that she wanted them done by the time I go back for monitoring Thursday, which should probably have us all a little alarmed, because the unspoken meaning is, I want them done by Thursday so we can deliver then if we need to. I am only going back Thursday for an NST and fluid check, though they'll also check my blood pressure and she specifically said she'll "see me then", so we'll see how that goes. Then I go back again Monday, so I guess I am on weekly appointments now, plus she is sending the results "and a note" to my OB, so who knows what my next few weeks will look like. I don't think she is inclined to put me in the hospital or on full bedrest, if it gets that bad, they'll likely just deliver because of my extreme history and the fact that we are in the 30's weeks-wise with a nice sized baby.

Mostly, we are still in good shape. The baby is doing well. I'm only a few days away from 32 weeks and will have steroids for his lungs soon. They are watching everything closely. I don't think they'll let me go to 37 weeks anymore unless things take a drastic turn for the better. (Like if my next 24 hour urine test comes back under 300 and my swelling goes away, which is not very likely.) With the protein as high it is, most likely they will call it quits if we can make it to 36 weeks. I would love to make it 37, but I just don't know that it's very realistic anymore with the direction things have turned. Right now, I just want to make it to October with the baby still in utero and doing well. Bonus if we can make it to 35 weeks or more. (At 35 weeks, NICU time is 50/50 odds. Luke was born at 36 weeks and didn't need it but it happens sometimes.Before 35 weeks, he'd most likely need some NICU time to learn to eat and regulate his temp and stuff. So 35 weeks is a good "first" goal, but that's a month away and we may not get that lucky this time.) If I make it to 35 weeks, I'll probably still deliver at the non-baby factory hospital, but before then, baby factory it is because I don't want to risk the baby needed transferred to a higher NICU and us being in two different hospitals.

So blech. I'm not on bedrest but on "seriously, take it easy! No running around like crazy!"-rest. Which I think might mean that any trips to the zoo in the next few weeks are out of the question. (Not like we would have time for that anyway with all my appointments.)

Fingers crossed we can keep this baby baking for awhile longer, we have way too much still to do.


Brooke said...

Oh, gosh Angie. I really wanted you to breeze through this to 37 weeks. I love knowing that Dr. Moore has a close eye on you, and that she's going to be cautious and careful about this little one. I'm sure taking it easy is NOT so easy with Luke around. Let me know if there's anything I can do to help you out.

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