intermezzo

Thanks for all your kind and thoughtful comments on the anniversaries of having and losing A & C. I didn’t manage to post on Wednesday, but I did think of all your babies lost far too soon. And of my own, of course. It is strange to have their actual anniversary, and this “public” anniversary, so close together. Last year I was still in a complete haze. I’ve been out at night again (in part simply because it gets dark earlier), looking at their stars, remembering those nights one year ago.

Strawberry Baby is still tucked inside and enjoys kicking my ribs. We had a growth ultrasound last week, which I thought would be reassuring around all these anniversaries, but ended up freaking me out because one of the head measurements was in the 2nd percentile or so. The MFM in charge of the ultrasound clinic that day didn’t think this was anything to worry about (“these numbers and percentiles make it look way more scientific than it really is”), but I guess it’s too easy to concern a mother who has lost a child (or more). So I read some papers and learned that (a) girls tend to have significantly smaller heads, and (b) nobody gets really concerned unless the head is 2 standard deviations smaller than the mean, or even 3, depending on how conservative one is (because, y’know, we can’t all be in the 50th percentile). And we’re not even at 2 stddevs. So I was mostly reassured, but still brought it up with my doctor. Who hadn’t even noticed, but went back to look at the numbers and said that, as long as it’s not 2 stddevs below the mean, he’s not concerned. He also explained that (counter-intuitively for me) with increased gestational age ultrasound becomes less accurate. Mainly because it is difficult to measure larger 3-dimensional objects correctly when you’re looking at a “slice” through them – chances are that your slice isn’t quite in the right place.

What he remains concerned about is my blood pressure – I suppose it doesn’t help that it was 140/90 in the office, even though at home it hovers around 120/80 and it’s usually pretty good at my non-stress-test appointments, too. My liver enzymes and platelets and urine remain fine, fortunately. It’s not so much what he says, but I can see in his face that he worries. For a while I thought, well, he’s an MFM, being worried is his job. But it’s not that. I finally remembered the first, and really only, time I’d seen him worried – at the anatomy ultrasound with the twins, when my cervix was already so very short. The situation is different now in that we actually have options for what to do. I will be full term in 2 days (incredible), so I’ll be followed closely with twice-weekly NSTs in addition to the usual weekly appointments, and he’s thinking about induction at 38w or so, depending on how things develop. (There seems to be a difference in recommendations at that point between gestational hypertension and preeclampsia, but I didn’t quite get it.) Which is rather soon – but of course I’m happy to do anything that helps keep Strawberry Baby safe.

(This was supposed to be a short post. So much for that.)

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An unexpected turn of events

Or perhaps not that unexpected – my doctor was worrying about this all along. My blood pressure has always been a bit high in their office, but as long as it was fine at home I blamed that on anxiety. However, now it’s creeping up even at home…
It would seem a bit ironic for my cervix to hold up marvelously but have other parts of my baby’s support system waver. I hope we can hang in there a little longer, but in the end Strawberry Baby’s well-being is the most important.
Stay tuned. Maybe at least I’ll get back to blogging more regularly.

baselines

Last week was my cervix baseline ultrasound. I’d be lying if I said I wasn’t nervous, in particular since I’ve been feeling a little pelvic pressure/soreness on and off since 8 weeks – the only time when I didn’t have this was on holidays. Clearly, I should spend more time there… Nevertheless I was quite calm riding up the hill. We had the same lovely tech as last time, though she didn’t remember us. She asked me to guide the probe, which after countless fertility-related transvaginal ultrasounds I found funny. Then she said I could see the cervix on screen, while I just saw a gray mass (and something wiggling in the corner that probably distracted me a little). It wasn’t until she started measuring across it that I realized the gray mass was my cervix. Wonderfully long and closed, measuring longer than I had dared to hope – 4.3cm. Next the tech asked me to put pressure, “as if to push out the baby”. Well, I put some pressure, but not quite enough to actually push out a baby. It doesn’t seem like a good thing to do, so far from term… My cervix was unimpressed. She explained that a truly incompetent cervix will suddenly get very short when pressure is applied, even though it may seem long when relaxed. (I’ve never heard of this before – while it makes sense intuitively, this would mean there is a predictive test for IC, making me wonder why not all pregnant women are tested for this.) As a final test, she put (gentle) pressure on top of my uterus, again without any apparent effect. Then, lucky me, she wanted to look at Strawberry Baby via abdominal u/s – actually I think she spent at least as much time looking at our wiggling little one as at my cervix. Little (big?) Strawberry is doing well, measuring a few days ahead (15w1d when the calendar said 14w4d) and has heart and stomach and other organs all in the right place. Good news all around!

Yesterday I had an OB appointment. My doctor was happy about the cervix length but a bit concerned about my blood pressure. It often goes up at doctors visits, so I wasn’t too surprised, and of course losing the twins didn’t help – my anxiety issues have become much better, but they’re not completely gone, and I will be worrying about losing Strawberry Baby until we reach 28 or 32 or 36 weeks (and probably beyond that, but in different ways). Nevertheless, he is a very careful guy and wants baseline checks of my liver enzymes and a 24h urine collection, and for me to keep track of my blood pressure at home so that we can discuss it at the next appointment. I genuinely appreciate his proactive approach, and will try to follow his advice not to worry about it.

The next cervix ultrasound is in a week, so I hope we’ll get to see Strawberry Baby again! Soon we might even be able to see if it’s a boy or a girl… which I think will be bittersweet either way, given that the ultrasound when we found out the twins were girls was also the one when my cervix was so awfully short and things started to go downhill. I’m so hoping for a better outcome this time, and so glad that, for now, things look great.