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A Canadian cycling in the US

Follow the twists and turns of an ART newbie navigating international IVF in the USA!

January 2010 - Posts

  • 30w - 3D u/s pics of the girls

    I cheated a little on my bedrest and went to have some 3D fun!  I was in there over an hour (but lying down, so not cheating *too* badly, lol).  It was a lovely experience.  Here are the best shots:

    Baby A (she was harder to capture):

    (temporarily removed - 300 x 270)

    Baby B:

    (temporarily removed - 300 x 280)

    Baby B again:

    (temporarily removed - 300 x 280)

    The sonographer thought the girls looked alike.  What do you all think?  Either way, I think both girls look like DH, especially B!!  lol  (So did our son when he was a newborn.)

    Now, I just need to keep them cooking at least a few more weeks.  I have another OB appointment this upcoming week, so I'll know how well (or not) my cervix is holding up then.

    ETA after my OB appt (30w1d):

    We went for our routine fetal growth ultrasound and the news on the girls is good!  Both babies continue to put on weight well.  A is estimated to be 3 pounds 2 oz, and B is estimated to be 2 pounds, 14 oz.  They are in the 38th percentile and 22nd percentile respectively.  B has always been a little smaller.  The important thing is that each girl is following her growth curve normally.  Both the sonographer and my OB said the girls are a very good size for their dates, for twins.  Yay!  According to my research, babies who are 3.5+ pounds at birth fare better than those smaller (another milestone is reached at 5.5 pounds... I would love to make it that far, but I know we may not).

    Cervix is still ~13mm, but is now 60% effaced, and dilated externally to 1cm.  Cervix is also feeling a bit softer.  My OB thinks I "probably" won't deliver within the next 1-2 weeks (32 weeks), but most likely within the next 3-4 (34 weeks).  It cannot be known for sure what will happen, but I'd be super happy with 34 weeks!

    Just to be safe, she recommended I take the steroid shots now, and I accepted.  So the nurse gave me the first shot and I did the second myself 24 hours later.  If I don't deliver by my next OB appt (32 weeks), I will likely be offered one more round.  I think I can live with that.  She also said the nature of my delivery will depend on the gestation and whoever's on-call when I go into labor.  If I make it to 32-33+ weeks, and A is head-down, she and some of her colleagues would let me try for a vaginal delivery.  But it will depend on the attending OB...  she's talking like there is a good chance is will NOT be her.  She says some of her colleagues are less experienced with twins and vaginal deliveries, and so they may push me for a Cesarean.  So I'll have to wait and see what happens when labor actually occurs.  If it occurs before 34 weeks, they will try to stop it, which may or may not work.

    Lastly, I had failed the glucose screen test (I was 8.2, normal threshold is 7.8).  So I had to do the 2 hour diabetes diagnostic test and... I passed! (barely).  BUT, I don't have to worry about that anymore.  Yay!

  • 28w3d - Status of cervical changes (getting a little worse)

    So I finally saw my usual OB today, haven't spoken to her since my issue was initially discovered.

    The good news is that the babies are doing well.

    She wasn't planning to do a transvag u/s, but I firmly requested one, so she did agree.

    My cervix measured ~1.6 cm today (vs 1.9 cm 2.5 weeks ago).  Funneling/effacement has increased somewhat also, I'm now at ~50%.  Yikes!  She said my cervix is somewhat dynamic, as the measurements did vary a little each time she took them.  But I could see for myself that my cervix has changed more since last time.

    Anyways, my OB said she finds this progression more or less expected, especially since it's twins.  Also, Baby A is now head-down, which can exert more pressure on the funneling cervix.  She confirmed that strict bed rest is absolutely required.  Which I have been obeying very well for the last week!!  lol

    She also did a manual cervix check, which was painful.  She said the external cervix is "a bit soft but not too bad".  She said also it and Baby A are "high" which apparently is a good thing.  She said she can feel that "there is still some cervix left".

    However, based on the u/s, she did suggest to me I have the steroid shot now (to mature the babies' lungs in case of imminent delivery), which I chose to decline.  We talked about it, and I know that those shots are only effective for ~7 days.  And she and I both agreed I "probably" won't go into labor within the next two weeks... so I chose to avoid a situation where the babies potentially receive several doses of the shots.  So we agreed to re-assess at next appointment (in 2 weeks) and see how it's going then.

    So far, the external os is closed, but she said if the membranes start to bulge, she will want to admit me for hospital bedrest.  (I sincerely hope to avoid that.)

    Anyways, overall, the appointment went well, she gave me time to ask all my questions.  BTW, at this hospital they will not do the FFN test unless the patient is experiencing preterm labor, which I am currently not.  So I could not have that test done today, although I wish I could have just for peace of mind.

     

     

     

  • 28 weeks - Made it to bedrest milestone #1! (research included - longish)

    Okay, you probably know by now I'm a bit of a research nut.  Even more so now that I have lots of computer time on my hands!  lol

    Apparently there are 3 major gestational milestones for women (like myself now) at risk of preterm labor/birth (PTL / PTB):

    24 weeks - Baby(s) are potentially viable.  But likely to have long-term issues.  I was past this point when my cervix issues were discovered.
    28 weeks
    - Baby(s) lungs can be made relatively mature with steroid shots, if labor is thought to be imminent.  However, there are still some risks of long-term issues.
    32 weeks - Baby(s) almost fully developed.  Would still need steroid shots before delivery for lung development.  But there is a 95% chance of survival, and risks of long-term complications are reduced.  However, some weeks in the NICU would still be required.

    (In my case, 32 weeks would be Feb 14 - Valentine's Day.  Hearts  Cute!  Although I'd want them baking even longer!  lol)

    So I am at 28 weeks today (yay!) and so far have had no signs of PTL.  I can say my Braxton-Hicks contractions *have* been reduced while on bedrest (BR), but they still do occur sometimes (and are more uncomfortable now than before, not sure why).  When they occur, I try to rehydrate with water, and sometimes also use a heating pad on low heat to relax my uterus and stomach muscles.

    However, I won't know what my cervix is actually doing until my next transvaginal ultrasound (TVU).  I see my OB in a few days and will ask her for one then.  I will also ask her for a fFN test (fetal fibronectin test).  This is a non-invasive cervical swab test that can help predict if a woman is likely or not to go into labor within the next 7-14 days.

    BTW, my cervical issues were actually diagnosed by an on-call OB two weeks ago, and I have not even spoken to my regular OB at all yet!  Bah, public heathcare!!!  So almost everything I have learned (and to do / avoid) so far has been based on my own research and initiative.  My OB only works a few half-days per week and early on when I asked her what to do in an emergency, she told me to contact the hospital's Birthing Center.  Niiice!!!!  lol  So, as usual, I don't expect or receive much guidance from the physicians I am dealing with.  Fun!!!  Yes, I have issues.  lol  <end rant>

    Anyways, I've found some new support groups on BBC - one for women on bedrest and one for women with cervical issues.  I've also found a ton of medical studies about cervical length and/or funneling and the associated risks of PTL, etc.  However, most of those studies were done on singleton pregnancies, which are not always directly applicable to multi-fetal pregnancies.

    Here is by far my favorite medical article so far regarding cervical changes.  It's recent, and I found it very educational.  It contains some great supporting graphs and tables.  See especially Figure 2 (I believe my funnel was last a "Y" - apparently second best of four stages) and also Figures 4 and 5 for proposed management plans for patients like me.  I am going to discuss these plans with my OB next meeting.  Essentially, I believe I should be having fFN tests + transvaginal ultrasound checks of my cervix every 2 weeks.  Let's see what she says!  lol

    In summary, based on what I've found so far, I believe my cervix issues put me at a 30-50% chance of delivering before 35 weeks.  But that could be any time between now and then (7 weeks!).  Let's see.

    BTW, there is thought to be some linkage between subchorionic hematomas (SCH), which I had in the first trimester, and an increased risk of PPROM (preterm premature rupture of the membranes) and PTL (preterm labor).  When I was experiencing my SCH, I had read about this, but did not really believe it would happen to me (of course ;).  Currently, I am thinking my past SCH is one increased risk factor of several for my current cervical issues (another being the fact that I have a multiple gestation).  Ah, the fun!  lol

    BTW, I am still working several hours per day from home, but always while lying on my side as instructed.  Which is doable, but not exactly ergonomic, lol.  My staff have been quite good about it all, and people at the office in general have continued to contact me as usual, which is what I had asked them to do.  So that has been going pretty well.  I have some more things to finish up remotely before I truly go on leave.  I imagine this will take a few more weeks.

    Last but not least, I'd like to give a shoutout to my DH, who has been doing virtually all of our homecare and childcare duties while I've been on bedrest.  He's been a real trooper about it, and is very supportive of us doing whatever it takes to keep these babies growing safely inside.  So Glossup - thank you!  xox  Heart  (Our DS has been really understanding and even helpful too!  He's 4 so can generally understand what is going on.)

     

  • 26w3d - Premature cervical shortening + funnelling = Instant BEDREST!!

    Oh darn!!

    I went for a routine fetal growth u/s this Monday and was shocked to be told my previously long and healthy cervix had shortened quite drastically!  It measured 1.9 cm (they want to see it at least 2.5 for twins at this gestation).  Also, the cervix had begun funnelling from the inside.  BAD!!

    I was put on immediate bedrest, which I promptly disobeyed by going into the office for 2 more days to frantically wind down / handoff my work as best I could.  I also had IT set me up with a home laptop, VPN and IP Phone so I could finish a few more things from here.  Whew!!

    At first, I was just annoyed I couldn't finish Jan and Feb at work as planned, and that I still had so much to do to prepare for the babies.  But the more I researched, the more I realized it is just way too early for the girls to arrive, so really I need to do what it takes to keep them baking!!

    So now I am officially on "strict bedrest", but am allowed short periods to get up for the bathroom, eating or a quick shower.  The idea is to stay horizontal as much as possible, to keep the weight of the uterus off the cervix.  The goal is to prevent preterm labor/delivery.  I am now also on progesterone.  The OB said it is supposed to help curb Braxton-Hicks contractions (which I've been having tons of lately, especially when stressed or doing physical labor).

    If I go to term, I'm looking at 10 weeks of this!!  Arg!!  lol  DH has been great so far, he is willing to do all the care work for DS so I don't have to worry about it.

    My next checkup is Jan 20.  Let's see how my cervix is doing then.  The OB I saw this week said it is "possible" I could still go to term.  So I don't really know what to expect.  But here's to hoping!!  (BTW, during that same u/s, the sonographer showed us the girls' faces.  So cute!  They measured well for their dates, although are each still under 2 pounds.)  Keeping baking, babies!!

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