A healthy person is...

"Pologirl" wrote in message
oups.com...

Bottom line: no news is good news.

I'm sorry I took so long to respond. I'm glad this is the case. Hopefully,
it still is!

This week's US again showed what appears to be a new, dedicated artery,
but the mass shows no significant growth since 2 weeks ago. Baby's
kidneys, bladder, heart, head, spine, placenta all look normal. The
bladder still appears to be pushed a little high in the abdomen, but
the kidneys and heart are where they belong. Growth is on curve, and 2
non stress tests were normal, all of which suggests the baby is simply
small, not suffering IUGR. The gazillion blood tests fishing for
possible maternal causes of IUGR are not all in yet, but all those in
so far are normal. The amniotic fluid was okay but less than last
week's abundant volume: I need to continue drinking far more water
than feels like enough. Ugh.

Hopefully, you aren't experiencing too much of the triple digit heat! It's
hard to stay hydrated in that. Things sound reasonably good.

The US radiologist was very surprised not to see significant growth of
the mass, and wondered out loud if the mass might not be a
sacrococcygeal teratoma at all. In which case, WHAT IS IT? It looks
even less like a neural tube defect... Argh. The MRI planned for
after the baby is born will be important here, to see before surgery
exactly how large this mass is and what organs are involved or
impacted. Once the baby is outside me, the MRI team can use a special
tiny-baby sized sensor array to get new images of much higher
resolution. Then the surgical team can make its own plan of attack.

It must be so frustrating not having clear answers.

I hope all is going well. These tests and last weeks must be getting rather
wearing. I hope Monkey Boy and you are doing well.

You continue to be in my thoughts.


--
Joy

Rose 1-99
Iris 2-01
Spencer 3-03
Grant 9-05 www.caringbridge.org/visit/grantphilip

Three NSTs this week and the baby looks good on all of them. Lots of
movement combined with long, strong accelerations and smooth
decelerations. Except this last NST also revealed one heart
deceleration to 100 bpm, which my midwife remarked (meaning to reassure
me) suggests the baby will not tolerate labor but that's okay since
I''ll be getting a C section anyway. (What?! Oh, never mind...)

The US showed a normal biophysical profile: the baby active, breathing
well, and with all systems still looking normal. However, the US
showed once again too little amniotic fluid (AF) and little or no
growth since 2 weeks ago. Femur length continues to grow on curve, but
that's about all. The most problematic "no growth" measurement is the
abdominal circumference, which in this baby's case is unusually
difficult to measure because the baby's abdomen is being squished into
a non-circular shape due to the combination of limited AF and position
of baby. There are two pockets of space, one on either side of the
placenta, which is posterior.

Just in case, I am being prepped for premature delivery with shots of
betamethasone to help baby's lungs mature, and I have advanced my
travel plans to early next week. I may well end up with an urgent (but
not emergency) C section at some point between 33 weeks and full term.
I have been advised to expect an order of bed rest for the remainder of
this pregnancy.

Monkey Boy is coping very well. He knows all about the trip and is
looking forward to it. I am coping well enough, primarily by doing
triage on my "to do" list and deleting every item that is not both
urgent and important.

I could use some references to good information on interpreting NSTs,
and on details of the mechanisms of fluid transfer among mother, baby,
and the AF "compartment".

Pologirl wrote:
Three NSTs this week and the baby looks good on all of them. Lots of
movement combined with long, strong accelerations and smooth
decelerations. Except this last NST also revealed one heart
deceleration to 100 bpm, which my midwife remarked (meaning to reassure
me) suggests the baby will not tolerate labor but that's okay since
I''ll be getting a C section anyway. (What?! Oh, never mind...)

This week's medical monitoring tally: yet another 3 NSTs plus 3 USs.
Sheesh. I have seen my chosen maternal fetal medicine (aka high risk
pregnancy) specialist. In Boston, the baby is measuring close to 50th
percentile, rather than below 10th percentile; and the amniotic fluid
score is "low normal" rather than severe oligohydramnios. The baby's
estimated weight is up a full pound, in just 3 days. Hah hah. See
what a huge effect the operator has on US test results!? What is
consistent, regardless of operator, is that all the baby's signs apart
from size are excellent.

The specialist's plan is to postpone delivery by another 4 weeks. I am
almost at 33 weeks now. I felt so obstinate, replying "I am holding
out for 7 weeks." I see no good reason to intervene! Given the course
of my untroubled pregnancy with Monkey Boy, and the absence of any
other evidence of trouble in this pregnancy, I still doubt there is any
IUGR. Nor that there is any problem with the amniotic fluid. So I see
no reason not to expect a normal vaginal delivery at full term.

The baby's sacrococcygeal teratoma is still there, but still has not
grown any larger relative to the baby!

My orders for now: NSTs twice a week, keep well hydrated, try to get
more rest.

"Pologirl" wrote in message
ups.com...

This week's medical monitoring tally: yet another 3 NSTs plus 3 USs.
Sheesh. I have seen my chosen maternal fetal medicine (aka high risk
pregnancy) specialist. In Boston, the baby is measuring close to 50th
percentile, rather than below 10th percentile; and the amniotic fluid
score is "low normal" rather than severe oligohydramnios. The baby's
estimated weight is up a full pound, in just 3 days. Hah hah. See
what a huge effect the operator has on US test results!? What is
consistent, regardless of operator, is that all the baby's signs apart
from size are excellent.


I got a huge smile on my face when I read this paragraph. Things sound
good.

The specialist's plan is to postpone delivery by another 4 weeks. I am
almost at 33 weeks now. I felt so obstinate, replying "I am holding
out for 7 weeks." I see no good reason to intervene! Given the course
of my untroubled pregnancy with Monkey Boy, and the absence of any
other evidence of trouble in this pregnancy, I still doubt there is any
IUGR. Nor that there is any problem with the amniotic fluid. So I see
no reason not to expect a normal vaginal delivery at full term.

I reached a similar point, and I persisted and delivered Grant vaginally at
40 weeks. I think I had some posts last year all stressed out about
induction, but I felt strongly about holding out to the last possible
moment. I went into spontaneous labor on my due date and had him within a
half hour of arriving at the hospital. I don't know how much it had to do
with it, him being full-term with a normal delivery, but he was released at
7 days old. We were told to expect at least a 10-14 day stay.

I think when it comes to mommy knowing, I think you've got it.


The baby's sacrococcygeal teratoma is still there, but still has not
grown any larger relative to the baby!

Great news!!!

My orders for now: NSTs twice a week, keep well hydrated, try to get
more rest.

Sounds good, pologirl. You continue to be in my thoughts.


--
Joy

Rose 1-99
Iris 2-01
Spencer 3-03
Grant 9-05 www.caringbridge.org/visit/grantphilip

Minor update: no change over the weekend. The BIDMC folks seem more
relaxed about my pregnancy status and prognosis. The amniotic fluid
still is low normal, which is acceptable. The NST and BPP still look
"excellent". However, I have been advised if at any point these do not
look good, I won't be allowed to go home. So now I bring an overnight
bag to each appointment.

The US equipment available at BIDMC has significantly better resolution
than the one back home. On BIDMC's equipment, the baby's
sacrococcygeal teratoma (SCT) is plainly visible: a globular mass
within a distinct capsule, mostly solid but with randomly distributed
cystic compartments. It is about 3x4 cm now, which still qualifies as
"small". It is anterior to the baby's coccyx (in front of the
tailbone). This form of SCT often is not apparent at birth and may not
be discovered for several years, during which time it could become
malignant. I am so grateful that this SCT was discovered on ultrasound!

Week 34. This week again the amniotic fluid was low normal, so no
oligohydramnios concern at this time, and two more NSTs and BPPs looked
"excellent", so the OB has less concern re IUGR. If all the good signs
continue next week, we can reduce the monitoring to 1x per week.

The baby is becoming habituated to being prodded during US exams, and
no longer reacts (protests) much. This week the baby even fell asleep
during the NST and would not wake up for the BPP. We resorted to using
a sonic vibrator (a buzzer), which got a huge reaction: a powerful
startle, mouth wide open, hands and feet flailing. Waah! Poor baby.
We also saw fingers playing with toes, and lips making classic suck
motions.

Pologirl wrote:
Week 34. This week again the amniotic fluid was low normal, so no
oligohydramnios concern at this time, and two more NSTs and BPPs looked
"excellent", so the OB has less concern re IUGR. If all the good signs
continue next week, we can reduce the monitoring to 1x per week.

The baby is becoming habituated to being prodded during US exams, and
no longer reacts (protests) much. This week the baby even fell asleep
during the NST and would not wake up for the BPP. We resorted to using
a sonic vibrator (a buzzer), which got a huge reaction: a powerful
startle, mouth wide open, hands and feet flailing. Waah! Poor baby.
We also saw fingers playing with toes, and lips making classic suck
motions.

Sounds good! ((hugs))

Sharalyn
mom to Alexander James (9/21/01)

"Pologirl" wrote in message
ups.com...

Week 34. This week again the amniotic fluid was low normal, so no
oligohydramnios concern at this time, and two more NSTs and BPPs looked
"excellent", so the OB has less concern re IUGR. If all the good signs
continue next week, we can reduce the monitoring to 1x per week.

Wonderful news!!! Wow, 34 weeks! I'm glad things are looking so
positive for those things. I imagine you are looking forward to less
monitoring.

The baby is becoming habituated to being prodded during US exams, and
no longer reacts (protests) much. This week the baby even fell asleep
during the NST and would not wake up for the BPP. We resorted to using
a sonic vibrator (a buzzer), which got a huge reaction: a powerful
startle, mouth wide open, hands and feet flailing. Waah! Poor baby.
We also saw fingers playing with toes, and lips making classic suck
motions.

ah... poor baby. Sounds adorable, though.

Joy

Well, today the baby was wide awake and gave a really good show. The
BIDMC staff stopped the NST at the 20 minute mark, after 3 good
accelerations including one that lasted a full 2 minutes. And the BPP
was fine and AFI was a very respectable 9. The OB gave me the option
of continuing to have 2x evaluations per week, if that would make me
feel safer. If this were my first, I probably would take the 2x
option, but I am confident that I will know if this baby's condition
changes, so I chose the 1x option.

We also visited the BIDMC L&D and NICU wards. At BIDMC, labor and
delivery usually take place all in one room, unless the laboring woman
starts out aiming for a vaginal delivery but then needs a C-section.
Then she gets whisked from a regular room to a C-section room. The
regular rooms have private half baths (shower rooms down the hall) and
space for a cot for DH to nap, but they are utilitarian by (ahem)
modern midwifery standards. After delivery, the woman is transfered to
a post-partum room. All of those were occupied so of course we could
not view them but we were told they are quite comfy. The NICU ward has
large double-occupancy rooms jam-packed with electronics. The
consulting NICU neonatologist assured me a NICU team will attend the
delivery and that I will get all possible help re nursing as early and
as naturally as possible. But I should expect per surgical protocol
that for some time (days?) the baby will get nothing by mouth; during
that time I will pump and freeze. Etc. Both L&D and NICU were busy
yet quiet and remarkably peaceful, and the staff gave me the distinct
impression that we (baby and I) should be no problem. That is very
reassuring.

At BIDMC, no one is the least interested in my weight. They do take a
urine sample every week, and my BP every visit in addition to the NST,
BPP, and AFI. But not once have they suggested a vaginal exam, nor
palpated my uterus or any other part, nor measured my fundal length. I
guess why bother with that when you've got an ultrasound machine in
every room?

"Pologirl" wrote in message
ups.com...

Well, today the baby was wide awake and gave a really good show. The
BIDMC staff stopped the NST at the 20 minute mark, after 3 good
accelerations including one that lasted a full 2 minutes. And the BPP
was fine and AFI was a very respectable 9. The OB gave me the option
of continuing to have 2x evaluations per week, if that would make me
feel safer. If this were my first, I probably would take the 2x
option, but I am confident that I will know if this baby's condition
changes, so I chose the 1x option.

Things sound like they are going very well, considering. What positive
news!

We also visited the BIDMC L&D and NICU wards. At BIDMC, labor and
delivery usually take place all in one room, unless the laboring woman
starts out aiming for a vaginal delivery but then needs a C-section.
Then she gets whisked from a regular room to a C-section room. The
regular rooms have private half baths (shower rooms down the hall) and
space for a cot for DH to nap, but they are utilitarian by (ahem)
modern midwifery standards. After delivery, the woman is transfered to
a post-partum room. All of those were occupied so of course we could
not view them but we were told they are quite comfy. The NICU ward has
large double-occupancy rooms jam-packed with electronics. The
consulting NICU neonatologist assured me a NICU team will attend the
delivery and that I will get all possible help re nursing as early and
as naturally as possible. But I should expect per surgical protocol
that for some time (days?) the baby will get nothing by mouth; during
that time I will pump and freeze. Etc. Both L&D and NICU were busy
yet quiet and remarkably peaceful, and the staff gave me the distinct
impression that we (baby and I) should be no problem. That is very
reassuring.

Sounds very similar to the facility I had Grant. Grant was born on a
Thursday morning, had his surgery that afternoon, and by Saturday morning (I
think), I was able to nurse him. I think they took the tube out on Sunday
or Monday, and he was a breastfeeding baby from then on. The details are
hazy! I should haul out The Notebook, or My Brain, and see if I have it
documented. Aha! I was incorrect, and I was able to nurse him Friday night
once. On Saturday, I put him to breast every three hours and that afternoon
we were discharged to the ICC (next door to the NICU), and by Sunday his IV
was out.

It sounds like you will be in a lovely facility. We didn't have a tour
of the L&D facilities, but I wish I had.

At BIDMC, no one is the least interested in my weight. They do take a
urine sample every week, and my BP every visit in addition to the NST,
BPP, and AFI. But not once have they suggested a vaginal exam, nor
palpated my uterus or any other part, nor measured my fundal length. I
guess why bother with that when you've got an ultrasound machine in
every room?

That's very interesting!

I am so encouraged to read your post, Pologirl. I hope things continue to
go so well, and you are in my thoughts.

Joy