Back in the Hospital Again
Hello to you all and always, thank you for your prayers.
Sorry to those who follow the blog for your daily updates; I did not have an opportunity to update things in a timely way. Everyone was expecting the growth news and today was a big day. As it turns out, this day offered even more excitement. This blog entry will be split into two parts, this and the one which follows because that's kinda how today has gone: it's been one big blur across two days.
Rebecca and I arrived at the hospital in separate cars. The plan was that I would attend the ultrasound, schedule the June ultrasounds, then head off for work (which is a mere :15 minutes down I-225). Rebecca would head off to Xavier's NST and call me with the results. That was the plan. Here is what actually happened:
Rebecca and I arrived at the hospital in separate cars; I parked in a nearby lot, she used the valet service. Our sonographer was Jean, a petite RN with three and a half to four years experience. Reading the orders, she told us this morning was just a Doppler checkup. "Oh no it's not!" thought I. I'm quite sure Rebecca was thinking similar thoughts. We told Jean that was not correct, so she called the doctor to clear things up.
Coming back, she was not given the go-ahead to do the growth exam (which does extensive probing) and only did the Doppler.
I know I have mentioned the Doppler frequently as it is a vital measurement for the baby's health. I will describe it in more detail. The Doppler is a measure of the blood flow in the two umbilical arteries and the blood flow out through the umbilical vien. Each of the three cords comprising the umbilical are measured. The arteries have a pulsating flow like a pulse, and the vien a more even drain. The arterial measurements are graphically displayed on the machine and appear like a sawtooth wave something like: /\_/\_/\_/\_/. Notice that there is no part of this curve dropping below the "baseline"; dropping below the baseline is not a good thing. A ratio is taken between the peak value and the trough value and that is called the Resistance Index or RI. Xavier's placenta is resisting blood flow when his heart rests (the beat which does not pump blood). An RI ratio approaching 1 means the placenta resistance (which is abnormal in a pregnancy) is strong enough to stop the baby's blood flowing back to the placenta on the "rest" beat. At some point after an RI of 1, blood flow will be in reverse, as if the placenta becomes a competing heart. In essence this means the placenta can no longer deliver to Xavier effectively and at some point further becomes dangerous to him.
Xavier's RI this morning was 0.99. There is no reverse flow yet, but there are what are called absences. In the graph above, that is the flat bottom line. I will note at this point that the absences can persist for days or weeks before any reverse begins; there is no guarantee of this longevity, however. At this point, it is necessary to watch Xavier much closer, with daily Doppler tests and frequent NSTs. That, of course, cannot be done at home. So, the doctor, Dr. Joyce Yong whom we first met at the Platte Parenatal and who sent us to the hospital originally, sent us to the hospital once more. We have been expecting the re-admittance to the hospital because the weekly Dopplers have been trending this way, but we hoped to make it into June.
Dr Yong amended the orders and we did get our growth exam. Here is a summary of this morning's growth exam:
- weight: 1 lb, 13 oz. This is not the 2-2 1/2 we were hoping for, but still Xavier averaged a little more than 2 ounces a week, which has been his growth curve since his 23rd week
- Percentile: 2%. He is still growing at a consistent rate, just behind the curve. He is still on the curve, I will point out!
- S/D blood pressure ratio: 85%
- Amnio fluid: 7.4 cm (had to use the 4 quad method today). This is a little lower than last week; the lower fluid levels made some of the ultrasound measurements difficult, fuzzy or not possible today, but this is no cause for alarm.
- organs: all looking good, heart pumping proudly at 139 bpm; bladder partly full, brain good; stomach OK.
I will continue today's events on tomorrow's entry. To be candid, we feel we are still living one, very long day
Here is today's profile shot from the ultrasound.
Out monographer, Jean, took this 2D of Xavier's face; there was not enough fluid today to get a 3D image. His eyes are to the left.