Friday, September 18, 2009

The word ‘catastrophic’ is not a favorite of mine

I began the day super pumped that we had hit 31 weeks. My bubble was quickly popped.

Dr. T – he did the popping. I’ve told you I love my doc. And I’ve told you he’s readable, which today I did not appreciate. I trust him with our lives – literally. He has been a God send to us and this pregnancy. I feel like us and him – we’re a team. I even expressed the other day that after Ella is born I am going to have a hard time adjusting to having a different doctor care for us. I feel he cares for us. Like really, personally cares. So this morning; @ his very first appointment of the day, when he looked like a man full of exhaustion and worry and weariness … I … well, began to feel the way he looked.

Ella’s NST was fine. She even had the hiccups and it was very cool to hear as well as feel them! Today’s u/s showed that the fluid has remained the same {no increase, so praise Jesus for that!}. I told him that I expected to feel worse, breathing wise – and I don’t. He asked about movement, and she’s been moving fine, so much so that the other day I felt like I could almost grip her little foot.

I am not sure if this has been posted on the blog {I know Jason put the info on Facebook when we were in the hospital}, but typically speaking the reasons for Polyhydraminos {too much fluid} are:
1. Fetal abnormalities {we’ve had 3 Level II ultrasounds and they have not been able to see anything wrong with her and we’ve had chromosome testing, which all came back fine.}
2. Gestational Diabetes {which I don’t have}
3. Unknown {which it seems where we are, we hope.}
I have read about RH issues being a factor, and I am RH -, though I have had my shots! But I think I am going to ask about this at the next appt.

The condition is causing pre-term labor {as you know}, and we’re at risk for my water breaking. I feel like a ticking bomb that may explode @ any moment.

So back to my bubble popping, after I cheerfully take my “we’ve made it so far” attitude and begin discussing cerclage removal, Dr. T. stops me with a “Well, we have a whole new series of worries on our hands now.”

Skid ……………… to a STOP.

He has two main worries. To be honest, they are not new to me. I’ve read about them. But reading about them is different than him looking worried as he expressed them to us.

1. Cord Prolapse. Which he explained and then followed up with “this could be very catastrophic” and is the point where I think I checked out. I wanted to ask him what he meant by the word catastrophic, but I didn’t b/c I was afraid of the answer.
Internet info in the most “human” words I could locate: CORD PROLAPSE: Cord prolapse is a situation in which the umbilical cord comes before or alongside the presenting part. This is a problem because the cord may become compressed in the pelvis and blood may not be able to flow freely through it to the baby. Polyhydramnios increases the risk of cord prolapse for several reasons. First, because the baby's presentation is unpredictable, the baby may be in an unfavorable position when the membranes rupture, and the presenting part may not fit into the pelvis well enough to keep the cord from falling out below. Second, because there is so much fluid, there is more pressure on the movable umbilical cord to move it out past the presenting part. This risk can be minimized by managing the rupture of membranes, paying close attention to the baby's presentation. If the membranes are ruptured with a pinprick while the baby's head is held low in the pelvis, the risk of cord prolapse can be minimized. PLACENTAL ABRUPTION: A placental abruption is a premature separation of the placenta from the uterine wall. This is a problem because it interferes with the free flow of blood between the maternal blood supply and the fetal circulatory system. A partial abruption may not be a serious problem, but if a significant portion of the placenta separates, the baby's oxygen supply is compromised so that the baby may begin to suffer severely from oxygen deprivation and may die. A significant placental abruption is a situation that warrants an immediate cesarean section to save the baby. Polyhydramnios increases the risk of placental abruption because of the mechanical forces at work in separating the placenta from the uterus. If you can imagine a filet of tofu (this is a vegetarian explanation) glued to the top of an inflated balloon, this is sort of what a placenta looks like inside the uterus. When the balloon starts to deflate, the amount of inside surface to which the tofu is attached starts to decrease. The tofu will start to buckle and separate in places and then may shear off partially or completely. This is less likely to happen if there is a small amount of deflation, and more likely to happen if there is more deflation. (By the way, this is also the way the placenta normally separates after birth, after the baby has been born. It is only a problem if it happens before the baby's birth.) When there is an unusually generous amount of amniotic fluid, the difference before and after rupture of membranes may be significant, especially if the presenting part does not fit well into the pelvis and seal the remaining fluid in the uterus. This sudden change in uterine size may cause a placental abruption. If there is only a mild to moderate amount of extra amniotic fluid, this may not be a problem. In any case, it is important that the presenting part be fit as snugly into the pelvis as possible so that the continuing production of amniotic fluid may fill the upper part of the uterus and guard against a placental abruption. (And, in a situation of polyhydramnios, this should happen even more readily than otherwise.) However, given the dire consequences of a placental abruption, it is essential that there be ready access to a cesarean section until membranes have ruptured and the amount of amniotic fluid has stabilized.

2. Excess bleeding after delivery. More internet info: POSTPARTUM HEMORRHAGE: Polyhydramnios increases the risk of postpartum hemorrhage simply because the uterus has been distended more than is usual for a singleton pregnancy. Thus, it can be more difficult for the uterus to contract completely, and it is essential that a diligent watch be kept to ensure that clots do not accumulate, thus making it even harder for the uterus to contract, thus causing more bleeding, more clots, etc. Diligent attention to uterine size and hardness should provide ample warning of impending postpartum hemorrhage. Massaging the uterus or nursing the baby (or otherwise stimulating the nipples) will help to keep the uterus contracted. It may be necessary to augment this with pitocin. {I had to be given pitocin after delivering the twins to make my uterus contract}

We talked about a likely c-section to prevent numero uno up there, but he kept saying we need to take things one day at time at this point. First, we work on getting out of the NICU stage. Then we take on the above. Everything is going to depend on my symptoms and Ella’s symptoms.

I realize that it is more than likely all will be fine. Call me hormonal, but I really just felt defeated after the appointment. Dr. T’s weary look entered my heart. I feel better tonight after some processing time and talking it out w/ some peeps.

Now, for some sweetness … when we were in the hospital we ordered this. If my girl was going to spend weeks in the NICU the very least I could do was make sure she was sweet and stylish in there. It came in the mail today, and I am thankful I can wait awhile to put it on her teeny head. :)

2 comments:

  1. Anonymous10:15 AM

    Thank you for sharing your story. The faith of your family has been a testimony to the greatness of our God. He truly can do the impossible, as He has proven in my life as well. Keep praising Him through this journey for He is doing greater things through this than you can even imagine. And I am praying for your sweet girl.

    ReplyDelete
  2. Your faithfulness will be rewarded! God is so good, and your list in the post below is evidence of that. He has brought you and Ella through so much already. He can definitely handle a few more.

    I'm in the middle of a Beth Moore study on Daniel (so phenomenal). One of the scriptures we looked at today was John 16:24 Ask and you will receive, and your joy will be complete.

    (friend chick from God's Chicks)

    ReplyDelete