Thirty Five Weeks

I had my weekly scan this morning. The baby is doing well she’s active and the dopplers are good but the amniotic fluid levels are only so so. The AFI has been yo-yoing over the last few weeks and today it’s back to being borderline. I don’t have to see her until next Monday as all the other measurements were good.

I caught Tom’s cold over the weekend and not shaken it off yet, the obs and gyne clinic is at one of the far ends of the hospital, I now find walking up from the car park to the clinic is exhausting. I was not at my best when I saw the consultant, which is probably why she ordered me to rest this week. So Tom is now at his Nana’s and I’m tucked up in bed with the iPad.

As I’ve got rest I’ll leave it there.

14 weeks

I had an ultrasound scan today.  Healthy baby is healthy and active.  The parasite twin is showing signs of swelling but is not of immediate concern right now.  I will have a scan at Norfolk and Norwich University Hospital next week, this scan will be to look the healthy baby’s heart, I’m hoping that everything will look tickety boo.  The week after that I have another u/s scan at QEH then we are back to Queen Charlotte’s for them to have another look.

We had a sliver of good news on Friday, the results of the triple test and nuchal fold arrived and the baby is at low risk of Down’s Syndrome 1 in 707 – no need for further investigation unless we want it.  As an amnio can cause a miscarriage and my risk of miscarriage is high enough already I don’t think we’ll go for an amnio.

And meanwhile in the background I will have my usual midwife appointments, which I’m very glad about, I like my midwife, she was my midwife while I was having Tom and we get on well, she’s sympathetic and supportive.  She rang me last week to see how I was coping, she’s a good un.  I’m seeing her this Wednesday.

Finally – I still own the flat I lived in, in Huntingdon, until Friday it was tenanted, on Saturday it officially went on the Market, the second set of people to view it put in an offer, which I accepted.  Hopefully everything will go smoothly as they have their mortgage and solicitors in place it will complete quickly.

Queen Charlotte’s

We had the first appointment with the consultant at Queen Charlotte’s Hospital yesterday.  They have a department dedicated to the more complicated pregnancy.  Perfect place for us.

With each scan the audience gets bigger, at the first it was just the sonographer, the second sonographer and student, at the third the consultant sonographer and a student midwife.  Yesterday for the forth scan we had two sonographers, the consultant and another doctor.  If I get to thirty seven weeks they’ll have to show the ultrasounds on a big screen in one of the hospital conference rooms in order to give all the interested parties a view.

The consultant confirmed what Queen Elizabeth Hospital had said, it is acardiac twin and a seemingly normal twin.  He said that there was no agreed way of treating this problem, and whatever we do will carry its own risks.  He was happy that at the moment the parasite twin was not an immediate threat to the healthy baby, who was healthy at the time of the scan. He said that if we got to roughly 20 weeks without intervention the likelihood of it being needed drops remarkably.

I think I babbled at this point. I wanted to say I want to take the route that gives the baby the best possible chance of survival but I have no idea what came out. Fortunately what he is suggesting seems to me to be a good way of managing risk.  He wants me to have an ultrasound every week so that they can check the rate of growth of the twins, how the heart of the viable twin is coping. That can happen at QEH. If there is any sign of trouble I could be back at Queen Charlotte’s within 24 hours if necessary.  He did warn that situation could take a turn for the worse very quickly and that I could lose the baby between scans without any warning.

He warned us that there was a far higher chance than normal, that the viable baby has a chromosomal problem ie Downs.  We need to discuss with our local consultant on Monday about whether the combined test needs to be redone, I think she said that it would probably be wrong as the sums would have been calculated on the basis of a singleton.  When we had the nuchal fold scan done, sonographer told me that the baby’s nuchal fold scan was well within normal limits but we do need to check.  I’m hoping that the results give us a very small risk of downs so that we can avoid having an amnio done.

He also wants the healthy baby to have a heart scan so that they can have a detailed look at how it’s bearing up.  This will be done either at Addenbrooks in Cambridge or at Norfolk and Norwich University Hospital in Norwich before we go back done to QCH for another appointment with the consultant.

After the appointment I felt much happier than I have done since Friday morning.  The consultant didn’t tell us anything that we hadn’t already been told by QEH but he did say that the healthy baby was presently healthy and that there was no immediate need for treatment. Our risks haven’t changed, but for Wednesday at least it seemed that they had reduced somewhat.

The One Where Things Got A Lot More Complicated

I’m pregnant with twins but one has no chance of life as it has no heart and its upper torso is missing.

At my first scan we saw a small round mass behind the baby, as the sonographer couldn’t detect a heartbeat, we assumed it was dead. Sad, but really we had nothing to complain about.

However our baby was too small for any decent measurements, s/he was not as far along as we first expected, so we all trooped back on Wednesday just gone for scan number two.

The baby had grown, measurements were taken, However the “dead” twin had changed as well. I could see what looked like a spine developing in it, structure that hadn’t been apparent last week, it had grown but still no heartbeat. The sonographer said that she wanted the consultant to take a look at the dead twin and I would probably see her in a fortnight’s time for a further scan.

Friday I received a call from the lead midwife on the obs & gynae outpatients ward. The consultant had looked at the scans of the twins, decided that I was an urgent case and she wanted to see me on Monday, today. The midwife explained that they believed that the “dead twin” was very rare pregnancy complication called an acardiac twin.

I had that scan today, the consultant confirmed that I’m carrying what appears to be a normal baby and a non viable one. The non viable one is a parasite on the baby, due to connected blood vessels in the placenta, the healthy baby is pumping blood around for two. According to The Fetal Treatment Center of the University of California in San Francisco

This is a very rare problem, happening on average once in every 35,000 pregnancies. One twin is usually completely normal. The other is body-like tissue, often with legs and a lower body, but no upper body or heart. Abnormal blood vessels on the placental surface allow the normal twin (aka pump twin) to pump blood though the tissue of the abnormal one. Because the pump twin heart has to pump for two, there is a high risk of going into heart failure. This would then lead to death of the normal twin, unless it is delivered if it is far enough along in pregnancy.

As it is rare, QEH doesn’t treat it, I have been referred to Queen Charlotte’s Hospital in London who have the expertise to tackle the problem.

We were devastated on Friday but are now feeling a bit of hope. The untreated rate of survival for the healthy twin is between 25 and 50 % the rate of survival with treatment is between 75% and greater than 85%.

However healthy is a relative term in this case. It is at risk of brain damage due to loss of blood/blood pressure, it is at risk of damage to the heart from the pumping for its twin and there is a higher chance that it has downs syndrome.

Extreme premature birth is a risk of treatment and also sometimes the best chance of survival for the viable twin. Prematurity carries its own risks as well. Our chances of having a live baby with a fighting chance of a full and healthy life are reasonable but not guaranteed. These are the odds we have to live with as there is nothing I can do to improve them except rely on the miracle of science based medicine to give us the best chance possible

38 Week Midwife’s Appointment

I saw the midwife for my 38 week appointment yesterday.  The first thing she said to me was “You look fed up with it all” Which would be just about right I am fed up with it all.  However I shouldn’t complain because allowing for swollen ankles and feet, complaining back muscles and bitching acid reflux which I think we can set aside, I am very picture of maternal health.   My blood pressure is excellent, my urine is protein, blood and glucose free and according to some my coat is glossy and my nose damp.

Jnr appears to be in tip top position as well, he’s still kicking away like a junior Johnny Wilkinson, he’s measuring bang on for dates and is just about in the “starting blocks” for birth.  The head is still 3/5ths engaged which is a tad disappointing I was hoping that it might of sunk down a little lower, would have reduced the heartburn for one.

I’ve started to have painful “practice” contractions, they are very irregular I didn’t have any yesterday but I had two today and last Friday for about an hour I was beginning to think that I might be starting labour.  Today’s were about 8 hours apart and very different in nature the one in the morning lasted for about 5 minutes and felt like the whole of my stomach was being compressed and pushed down on.  The one I had this afternoon felt like a heavy period cramp but only lasted for a minute at the most.    With such variation and long gaps between them I don’t think I need get excited right now.

Simon took a calculated risk that we wouldn’t be otherwise engaged today and had a wisdom tooth removed and filling put in.  For the last few weeks he’s been in intermittent pain, sometimes he’s not been able to sleep because of his toothache, so about 2 weeks ago he took himself off to the dentist who said the wisdom tooth had to come out because it wasn’t doing anything useful and decaying and ooh lookey that other tooth needs a filling.

The tooth was removed under local anaesthetic and before that wore off the worst side effect was Simon’s igor impression but as the pain has come in, he’s become pretty down in the dumps.  He’s got my symathy, I’ve never had a tooth removed and I’ve only ever had one filling but I’ve suffered muchly with earache over the years so I know how miserable pain in that general area can be.  So perhaps it we don’t any baby turning up this weekend not if the Daddy is going to be a tiger with a sore jaw.

Midwife appointment week 21

Everything is tickity boo, so there isn’t that much to report, Simon came with me and he got to hear Junior’s heartbeat for the first time. I am still bang on for dates which is nice and there is nowt going on that is out of the ordinary.

However definitely of interest for anyone* who lives in Britain and is thinking of popping a sprog after the 6th April 09, is a new one off grant called the Health In Pregnancy Grant – it’s a one off payment of £190, not means tested, or taxable and there is much more information about it on the revenues website. Health In Pregnancy

*there are a few exceptions and exemptions with this but that is always the way of the world with benefits.

21 week scan

I had my 21 week scan today, I’ve not got a picture to show you I’m afraid, as Junior was being non co-operate and was most definitely not presenting his or her best side to the ultrasound. Because the baby was lying in an awkward position the ultrasound operator was not able to get all the measurements she wanted so I have to go back in 2 weeks time for another go at it.

The operator tried to get Jr to move into a more “photogenic” position, first she made me lie on my right side then on my left, finally she had me lie flat again. She raised the foot end of the bed I was on by about 10 degrees which did feel odd and even with all this maternal movement it still didn’t make the baby turn over though it did wiggle its head.

What she did measure was good.

The placenta has attached itself up high in my womb and Junior is on the button measurement wise for dates.
The cranial measurements were good.
The spine looked good too.
Junior seems to have the right number of limbs and the bones looked alright.

We saw the baby wave its arms about like a good un and the hands moves and the toes, Simon says basically my child was doing an impression of me and refusing to turn over when prodded.
The heart was beating but she couldn’t do all the measurements she wanted on it, as the spine was in the way. Because of the spine it wasn’t possible to do all the giblets and puddings measurements but we could see its little stomach which seems to be in the right place. She did a quick doppler on the kidney region we could see the renal vein (? I can’t remember if it a vein or an aorta) split into two.

She couldn’t get all the measurements she wanted on the face because of the baby’s position. But to us everything looked tickety boo.

We don’t know what sex Junior is yet because the way the legs were folded up over the vital area, so operator couldn’t get a good look at the feet which means we can’t rule out a club foot yet, and she said they like to get a measurement when the leg is stretched out.

I am a bit disappointed that we couldn’t be done and dusted with that scan but I am not worried because if she had seen something wrong she would have told us and they would have scheduled a repeat scan within a few days with an obstetrician in attendance, not wait two weeks to see how it goes. So I would all in all mostly good.