Tuesday, February 3, 2015

Week 37 Update

With yet another week gone and still no arrival of baby, HB and I found ourselves in NOVA for another MFM check up today.  Doing one last non-stress test, sonogram and pelvic exam before going ahead with the planned induction next week, the morning's check ups made me feel both more confident that we have a plan and less sure that we'd actually go through with it: 
  • The NST was reactive and perfect.  The nurses had the radio cranked up loud and while it wasn't Blake Shelton or Kanye West, Baby seemed to find the additional ruckus worthy of contributing phenomenal heart rate acceleration and a down right wiggly performance.   Showing a content and thriving baby, this test doesn't guarantee a thing in terms of when labor could or will begin but it does indicate that he's doing exactly what he needs to be doing without distress so proactive action before induction isn't necessary.  
  • The pelvic exam was more or less the same as the last several weeks.  Slightly dilated and partially effaced, Baby wasn't showing much interest in making an "early," unscheduled exit as he is still floating - or perhaps he is swimming - at minus 2 station.   Requiring that I come back again next Tuesday morning to see if a cervix ripener would actually be necessary later that evening or if I could skip the evening check-in and proceed straight to Pitocin on Wednesday morning, the exam generally seemed to reinforce our plan for induction. 
  • The sonogram, however, indicated that next week's plan for induction may be a pipe dream for predictability.  Knowing for at least one fact that it'll be messy, the sonogram showed that my amniotic fluid index levels had further increased from it's previously "high" measurement of 28.6 cm.  Taking three measurements of the fluid pockets in the four uterine quadrants - 40 cm, 36 cm and 38 cm - to create a best-guess average of 37.8 cm, my case of polyhydramnios (or, as my belly has  come to be called, "poly") is much more significant than earlier in the pregnancy.   
The situation with polyhydramnios is that by week 35, fluid levels should begin to drop rather than increase which would indicate that complications upon membrane rupture may be more likely - for example, umbilical cord prolapse and prolonged uterine hemorrhage post-delivery.  As most pregnant women have an average of 14 cm of fluid around this point of the pregnancy, poly cases are classified as any AFI higher than 25 cm of fluid - which means that last week's measurements had me as a minor case, whereas this week we've been bumped up to "severe." 

While far from reassuring that things will play out smoothly in this last week, the good news from today's appointment is that the worst-case scenario involving polyhydramnios - fetal death - isn't a high concern for my doctors given the fact that the NST results are exactly where they ought to be.   I'm feeling somewhat hopeful that things will continue to be as uneventful as they have been these past several weeks and that we'll repeat our mommy-daddy "date night" of induction next week just as we did with GV, but only God knows what is really in store.  

Either way, Baby in bound in T-minus 7 days or less.  

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