Tuesday, October 9, 2012

Week 31 Perinatal Appointment

Well, I had my first perinatal appointment this morning since returning home from the hospital just over a week ago.  And while I'd love to say that the doctors announced that I'm perfectly healthy and ready to go back to pregnant life per-normal, they, unfortunately, did not. 

It was an odd appointment - not like any of the others that I've had before.  Instead of getting another sonogram and then seeing one of the doctor in one of their cushy offices, we were taken into an exam room (I'd almost forgot what those look like) and asked how I was feeling rather than told what has new.  I explained to the doctor that I am continuing to get contractions, that they're worse and more frequent when I stand, that Baby's been moving about less than before and that I've generally been feeling like absolute blah.  Listening with an increasingly concerned face (never what you want to see), the doctor stepped out of the exam room and asked the sonographer to do the previously unplanned sonogram. And off to get sonogram #12 we went... 

Checking only the crucial bits and not doing a full examination of the baby, the sonographer admitted she was sad to see me on a week where she otherwise wouldn't have.  Reassuring me that she's there whenever I need her to be (and decreased fetal movement is a good reason to need her), she checked to see if I was effaced from the contractions (which I am not, thank God), she checked the amniotic fluid level (down from 28 to 17, so back to normal ranges) and she checked the injured portion of the placenta.  She showed us where the blood clot has formed under the membrane next to the placenta edge AND she found the source of the bleed... an undeniable partial placenta abruption.

At the hospital we'd been told they couldn't identify anything except a "dark portion" of the placenta edge where blood flow was no longer occurring (the clotted area) and that the hemorrhaging must have been from an injury to that edge.  Today, however, the sonogram clearly showed another dark spot a little ways in from the known clot that medically confirms a degree of detachment and bleeding between the placenta and the uterine wall.   While there is a bit of comfort provided by the fact that we have an answer for what exactly happened, it's definitely a more concerning complication than an abstract injury to the edge of the placenta because once you've had an abruption, they're more likely to occur again.  So that continues to be scary. 

Here's a visual for a couple of the complications with the placenta that
I have had with this pregnancy. The partial previa has fortunately cleared
itself up, but the abruption will stay "as is" due to my gestational age
(assuming it's not further injured that is).

The last thing that the sonographer checked was Baby's biophysical profile - which I am pleased to report Baby scored a perfect 8 out of 8 on.  Seeing as she only got a 6 out of 8 at the hospital on Sept 29 due to her limited practice of breathing, this was a comfort to learn because it means her lungs are continuing to mature for delivery.  Which, by the way, she apparently has decided to get ready for by flipping over (yay! vaginal delivery is a serious possibility!) and no longer firmly planting her head under my rib cage.  From what the sonographer could tell, it's this new position that Baby is in that is causing the decrease in the fetal movement I feel because she's not only behind the anterior placenta, she's also facing backward.  So any movements she makes either need to be quite large or lateral to translate into more perceptible kicks... though I must say her hiccups are far more obvious now than ever!

Reviewing all of this, the doctor was glad to see that Baby is still the resilient little toughie that she's been and that the contractions haven't been causing distress to her or further damage to the placenta.  She instructed me to continue to stay on modified bed rest and to call them immediately if the contractions increase to four or more an hour that last over a minute.  But seeing as I'm "only" (ha, that word is used oh so loosely) getting them every 15 minutes for 30 seconds when I stand or sit up, that's "just" (again, ha) a sign of significant uterine irritability caused by the abruption.  Because blood remains behind the placenta and in the clot, she said to expect the contractions to continue... lovely.    Beyond that, the doctor requested that I start weekly appointments the week after next and she expressed hope that I'll only need to do weekly non-stress tests rather than biweekly or more.  We'll see how that goes.

All in all, I guess you could say that it was an uneventful appointment in that we didn't learn of some new complication or problem we need to address. Baby and I are looking stable on bed rest and there is still a fair shot that I could make it into November before she is born.   I guess my bond with the couch will continue to grow and my slower weight gain will sustain (still five pounds down from before the hospital) - for better or for worse. I'll keep you posted.

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