Wednesday, September 28, 2011

14 week appointment and med update

(apologies for the formatting issues, I've been fighting with Blogger for over an hour, and I give up)

Since I’m now 15 weeks 2 days, I thought I should probably update with the 14 week appointment. Where does the time go?!?!

First a med update:

12 weeks 6 days: done with estrogen tablets

14 weeks 3 days: done with Gestone (progesterone in oil)

Yes, this nasty stuff

15 weeks 1 day: done with Prednisone (may the puffiness in my face soon disappear)

Crinone, you are next to go (hopefully within 2 weeks)

Okay, 14 week appointment…

Baby A:

Baby B:

The ultrasound tech confirmed genders on both, and after discussing it with my husband, we will be sharing the news. I want to wait a little bit longer and have a few more ultrasounds (just to be sure). Also, after talking to some friends about what happened last time, the consensus is that some people are just rude and will therefore make inappropriate comments, but that’s certainly not a good enough reason to spoil the fun for everyone else. So yes, a gender announcement within two-ish weeks!

My doctor seems very pleased. My labs are great, BP was 106/68, and she checked my ankles for swelling, none. The medical student that was with her decided to use the Doppler to check the heartbeats and had I not JUST come from a 30 minute ultrasound, I would have been terrified; she couldn’t find Baby B’s heartbeat. Baby A was fairly easy to find, Baby B was, as usual, all over the place and impossible. Finally my doctor took the Doppler and even she was only able to find Baby B for a couple of seconds (not even the 6 seconds necessary to get a decent count).

She’d already received the ultrasound pics and report. Baby A is measuring at 17%; Baby B is measuring at 12%. She said she’s not concerned since they’re within 5% of each other. I did mention the perinatologist’s comment about wanting the babies out by 38 weeks. She said that they would absolutely be out between 37-38, probably closer to 37. There's just too much that can go wrong past that point and particularly with my risks, they're better out than in. Overall, a great appointment. I see her again on Monday.

Sunday, September 18, 2011

13 weeks 3 days, first appointment with the new perinatologist

On Thursday, I had my first appointment with the new perinatologist. Things started as usual, going over medical history with the nurse, and then an ultrasound.

All but one picture I was given are 3-D, so if you find it creepy, sorry. The ultrasound tech guessed the gender of one of the babies, though it’s still really early, and honestly, after a comment we received when we shared Kate’s gender, I’m not sure if we’re going to tell this time, or not.

Babies: both are measuring well, within 2 days of each other (very important) and their heartbeats are great.

The perinatologist was impressive. We covered a lot (most of it was him asking questions and going over the game plan, though he continuously asked me if I had questions, too). Basically every risk with a singleton pregnancy is multiplied 4-5 times with twins. So while there was a great risk of fetal demise with Kate, it’s even worse this time. He wants the twins out by 38 weeks (he said especially because they are IVF twins, which I need to get more clarification on, since I’ve never heard of that before). Though he doesn’t expect me to make it to 38 weeks, anyway. He’ll do the anatomy scan and look for chromosomal issues at my next appointment (17 weeks) and at the 21 week appointment, he’s going to do a fetal echocardiogram. Apparently IVF babies have a slightly increased risk of cardiac issues, again, multiplied risk with twins.

At 32 weeks, if not before, I’ll start BioPhysical Profiles (non stress tests and ultrasounds) once or twice a week. I had them with Kate, and actually found it somewhat comforting to be monitored so closely.

As for travel, the short answer is no. He said that while he doesn’t know what kind of care is offered in Slovakia, he does know what’s offered in the U.S., and it would be too risky for me to travel. We talked about it in detail, but yeah, short answer, I’m not going to Slovakia. He said he “highly recommends against it.” So that’s that.

Tomorrow I see the high risk OB again, and I’m interested to hear her opinion after reading the perinatologist’s report.

Sunday, September 11, 2011

12 weeks 5 days, visit to the ER

first Rhogam shot for this pregnancy

first, and hopefully last, ER visit for this pregnancy

So, I’ve been really bad about updating the blog, but once again, I’ve been plagued by first trimester cramping and spotting. For weeks I excused the cramping as uterine stretching, and it most likely is. Well, the other night the spotting increased, then bleeding, then intense cramping. By yesterday afternoon it was just too much.

And once again, the hotel shuttle driver to the rescue (It was just about time for Kate’s nap, plus my husband had packing to do, so it was easier to go alone). I just have to say once again, I adore the staff at the hospital I go to; EVERYONE I dealt with yesterday was professional and kind.

My first nurse had also done IVF, so I think she took a special interest in me. She was beyond sweet and attentive. When I was being wheeled to ultrasound, she said to be sure to push the call light when they brought me back, so she could check on me right away. I was wheeled back to ultrasound and very relieved to hear the words, “There are two heartbeats.” Both babies are measuring well.

Baby A: 6.3cm, measuring 12 weeks 5 days, heart rate 157 bpm

Baby B: 6.4 cm, measuring 12 weeks, 5 days, heart rate 161 bpm

The ER doctor recommended “total rest” until I see the perinatologist on Thursday. He also thought I should have a Rhogam shot, which I agreed with, but he wanted to discuss it with the OB on-call, first. I knew it was going to be a long wait as he walked out the door and I heard them call the first of MANY traumas.

I waited, and waited, and waited. The night nurse came back to tell me there was a problem in the pharmacy, and they “hoped” to have the Rhogam ready around 8pm. When she finally came to give me the shot, she apologized profusely for the delay. My response was, “Meh, it’s the ER, it’s life, it happens.” She said she wished everyone was as understanding.

Arrived in the ER: 3:15pm

Discharge papers printed and brought in: 4:58pm

Walked out of the ER: 8:46pm

It was a long evening, but the absolute most important thing is that both babies are alive and well.

Friday, September 2, 2011

11 weeks, nuchal scan

On Monday I had another big appointment (sorry it took so long to update, busy week).

First I had a meeting with the genetic counselor. She gave me several options for testing, including integrated versus sequential, and CVS, and an amnio, and more blood tests. I was already scheduled for the nuchal, not because we would have terminated had there been a problem, but because I’m a type A, organizer, planner extreme and if there were an issue, I would have had time to prepare and get the best specialists on board, etc. Anyway, I'm just not comfortable with the more invasive testing, given the miscarriage risk. I went ahead with the nuchal, as planned, though I learned that the blood test portion isn't really relevant because they can't tell what percentage of the numbers are coming from which baby. Interesting.

The genetic counselor also asked if I knew the conception date. I told her yes, that it was an IVF pregnancy. She asked if I'd had "real IVF." Err, yes, it *seemed* fairly real at the time. She said that a lot of women come in and say they've had IVF, meaning IUI. Wow. I seriously can’t imagine having a medical procedure performed and not knowing the proper name of it.

In other news, we talked about my upcoming appt with the new peri and she said he likes to follow his IVF patients very closely. Which might translate into, I'm not going to Slovakia. We have a lot to talk about. It sounds like between the new peri and my maternal fetal medicine doctor, I'll be in every other week until 20 weeks, then weekly. Wowza.

The ultrasound portion was fabulous. The tech spent a lot of time on each baby (neither was cooperating). And maybe this is normal for the U.S. (if so, I’m insanely jealous), but they had a huge flat screen monitor on the wall, so it was very easy to see what she was measuring and all of the details. Another woman was training to be board certified in the nuchal scan, so she came in after the test and spent another 30 minutes practicing with the ultrasound and taking pictures. During some of the first round of photos, Baby A reached up and wiped his/ her hand across its forehead, as if to say, too many pictures. Kate did the same thing during her nuchal scan. So cute!

The nuchal number was normal for both babies. Full report to follow.

At 11 weeks:

Baby A: measuring 11 weeks 0 days, CRL 4.08cm, heart rate 176

Baby B: measuring 11 weeks 2 days, CRL 4.51cm, heart rate 171

I’m concerned about the difference in CRL, but the ultrasound tech said it wasn’t a big deal.

Follow up: Yesterday a woman from the hospital left a voicemail for me stating that she had the results, and gave me 45 minutes to call her back before she was to leave for the day. Unfortunately I didn’t get the message until really late last night. Why she didn’t call my cell phone is a mystery. Anyway, I called this morning and of course she’s out until Tuesday. The good news is that the results were faxed to my high-risk OB. One brief message and returned phone call (within 20 minutes), and though she hadn’t read the full report, said that everything looks “great.” Great, coming from her, will more than get me through the weekend. Thrilled.