Category Archives: IUGR

The “What Ifs” are Hard to Carry

First of all I want to thank you all for your comments on my last few blog posts. I have not made time, nor have I had the energy to respond. I feel like I’m just going through the motions with a lot of things in life right now, and I’m ok with that.

Now onto the point of this post. Last Tuesday I met with my MFM to go over his thoughts on what the heck happened. He is a fabulous doctor, and he answered about 98% of my questions without me having to ask them. I wonder if that’s because he’s extra awesome or if that’s pretty standard for most people. Of course we don’t really know what happened. However, his best guess is that something was wrong with the placenta given that the placenta was on the smaller side and I had growth restriction in my pregnancy with A. But even with him saying that, he reiterated that we don’t know if Colton was growth restricted based on his weight (2lb 1oz, which was on the lower side of normal for gestational age) since we did not have a growth scan scheduled until 30 weeks.

There were no signs of infection, no blood clotting issues, no maternal fetal hemorrhage, or signs of a cord accident (there was a loose nuchal cord noted when I delivered him but this is very unlikely to be the cause of his death according to my MFM). I honestly wish there was a concrete answer, even if it was that my uterus sucks, because that would make it a whole lot easier.

Then we moved into the (scary) realm of trying again. If this is our decision, we should wait at least six months from the delivery, which puts us at late August. Getting pregnant too quickly increases the risk for growth restriction and pre-term labor, both of which I’m at risk for in general with my unicornuate uterus. Then we talked about what kind of monitoring I would need, and he basically said he wanted to meet with me early in my next pregnancy to come up with a plan I’m comfortable with. He offered to manage my entire pregnancy if I want, or we can co-manage with my OB, or I can just be managed by my OB (HA, yeah right!!). His recommendation is a growth scan around 23-26 weeks at least, and if I feel I need more frequent monitoring then he is happy to do it. He also said he would be happy to meet up and talk again before I am actually pregnant to go over any other questions I may have.

I asked the ever so important question of what is our risk of having another stillbirth, and both my husband and I were pretty shocked by the answer. He did the statistics in his head based on his knowledge of studies and experience and came up with 5-10%, but likely closer to 5%. His reasoning is that I will be monitored much more closely in any future pregnancy. That does not necessarily mean that I will have a term baby, but a 95% chance to deliver a live baby (meaning it’s possible that I may be induced early and have a premature baby). We both were surprised that the recurrent stillbirth prediction is so low (not 1% low like most people who have an “unexplained” stillbirth, but still low). He also calculated that my risk is about 50% to have another growth restricted pregnancy. This is way lower than my husband and I would have thought. Another related thing I wanted to know is how many times he’s seen someone have two stillbirths in a row and he said once, and both of this person’s babies had genetic defects as the reason for stillbirth.

Overall, this makes me reassured that if we do decide to try again, I will be monitored much more closely than with both Colton and A.

Something I asked him is if he thinks I’m crazy for wanting to try again. He said based on my risk factors and his analysis, he does not think it’s crazy at all for me to try for another pregnancy. I just have to make sure I can cope with the worst happening again.

My last questions was about using lovenox in a subsequent pregnancy. He does not think it’ll do anything (and he also does not think the aspirin does anything) but if I want to try it and can’t find someone to prescribe it, he would be happy to prescribe it for me. My husband does not want me to use this medicine and says it’s a deal breaker for trying again. I would like to try it if we do try again so I’ll have to figure out if I can convince him to let me do it.

I just wanted to add that my D&C showed that I had an infection in my uterus (endometritis) and no retained placenta was noted. The mass my OB saw could be a small fibroid (which has never been noted on any ultrasound or other test I’ve had so I’m guessing it’s a recent growth). We will follow up on this later, especially if I have long periods or bleeding and cramping in between periods. I finished a 5 day course of doxycycline and I am taking a 2 week course of Augmentin to hopefully get rid of it. My MFM says that endometritis is something the pathologist writes when they don’t have anything else to put down so it’s possible I’m taking the antibiotics for nothing. Awesome…

I don’t think I’ve actually written much about the events surrounding us finding out that Colton died, but I only noticed reduced fetal movement about 2 days before he died, and I have major regrets that I did not go in on Friday night after noticing the reduced movement. I was super concerned that night and I will always wonder if I would have gotten checked out if he would be here today. I am well aware that a 28 week delivery would likely have had some bad outcomes (including him dying anyway) but it’s hard to not wonder if he would be coming home soon (since this past Saturday I would have been 37 weeks). Both my OB, MFM and husband all say to not beat myself up over this, and I’m not, but the what ifs are hard to carry. I’ll leave it at that.

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16 weeks and the cervix checks begin…

I had my 16 week appointment yesterday and everything looks good so far! My cervix is measuring 5.15cm which is fabulous. Thank goodness! (Side note, I went in around 14 weeks for intense pelvic pressure and my cervix measured 3.2cm so I am very happy with the longer measurement). My uterus is also measuring on track for 16 weeks.

I asked if she could try and estimate the baby’s gestational age and he is measuring right at 16 weeks 3 days, so perfect growth. I am super concerned about IUGR after last time. It didn’t show up until sometime between my 20 week ultrasound and my growth scan around 28-29 weeks. So I’m reassured that things are fine now but not entirely convinced it won’t happen again. Baby A was somewhere in the 30th percentile at 20 weeks and <3rd percentile at the growth scan so we shall see.

I’m still taking the vaginal progesterone twice a day which is messy and not my favorite thing but I have no interest in seeing what happens if I stop. I took it though the entire pregnancy last time and will be doing the same this time. The new pack of pills are red, which is lovely because it looks like blood when it comes out. I was reading about this on google and someone pointed out that if it was real blood, it would turn brownish on your pad, while the red progesterone stays a bright red. That was extremely comforting and so far only bright on the pads!

I’m also still on the baby aspirin. I’m not sure when I will stop that. Last time I stopped at 28 weeks. I have my doubts that the aspirin actually helped the blood flow later in pregnancy because of when A was diagnosed with IUGR relative to when I stopped the aspirin. We shall see.

I’ve been feeling flutters since 15 weeks which is amazing! I never had flutters with baby A because of my anterior placenta. Only pokes. This time my placenta is partially anterior so better for movement. I’ve also been having some intense round ligament pain. Feels like really bad period cramps only on the right side (the side my uterus is on). It’s not daily thank goodness but several times a week. Very uncomfortable. Otherwise feeling good!

Lastly I’ve already put on 12 pounds so not good! I blame the holidays and needing to eat when I felt crappy. Hopefully it gets a bit better now that I’m feeling better. But I really have to watch it.

Hope everyone is well!

A Cause for the IUGR

I had my 6 week postpartum appointment yesterday. Baby A came with me and screamed a lot. I ended up breastfeeding her while walking into the appointment room and during my pelvic exam…surreal. Everything looks good on my end!

We discussed several things throughout the appointment. 

•I expressed to her that I do not wish to be on birth control. Firstly, I am not convinced that it didn’t contribute to our difficulties TTC. Secondly, we plan to try again (although I cannot imagine that right now…more on that in another post). Lastly, I have switched to all natural products and I am not interested in introducing hormones into my body at this point. 

•She said that since I had an uncomplicated vaginal delivery we could try again as early as 6 months (I think that’s crazy).

•When my cycle returns and is regular, she can order a follow up FSH, AMH, and E2 so I don’t have to go back to my HMO fertility clinic right away. I am relieved about that (even though I had a pretty great experience with our RE). I’m wondering how those numbers will have changed a year or so after having them drawn. I also hope it will give us an idea of what to expect. 

•And now the main point of this post. The results of my placental pathology. It was small (as we already knew from looking at it after delivery). This could have been due to the UU (meaning the smaller size of my uterus) or uteroplacental insufficiency. The placenta showed signs of chronic uteroplacental insufficiency. Basically this means that the blood flow from my uterus to the placenta was insufficient for a good chunk of the pregnancy. Thus the IUGR diagnosis. I have lots of thoughts about this. 

Firstly, the baby was in the 38th percentile at the 20 week anatomy scan. That is normal. Then, right before 30 weeks at our growth scan, she was less than 3rd percentile. So things went wrong somewhere between 20-30 weeks. I stopped taking the baby aspirin at 28 weeks (which I was taking to hypothetically increase blood flow to my uterus…who knows if it helped. I feel it did help). I don’t think that would have affected growth that drastically in 2 weeks but I can’t help but wonder if I had stayed on it (or restarted it) if her growth would have been less restricted. 

Secondly, I wonder if the less than ideal blood flow had anything to do with my 3 miscarriages. I did not take aspirin until before the 4th pregnancy (which actually worked). I do have signs of poor egg quality with high FSH and boarderline AMH. All the miscarriages were missed, with no growth each time past 6-6.5 weeks. Could that have been due to poor blood flow and not egg quality? My gut says its egg quality. I guess we will never know but I wish we could. Too bad we were unable to test the embryos that miscarried.  

Thirdly, I wonder if the pregnancy being successful is because the embryo implanted in an area of the uterus that had better blood flow and the majority of my uterus has poorer blood flow. Those with a unicornuate uterus can have poor blood flow due to the abnormal formation of the uterus. Am I doomed to have tons of miscarriages? That remains to be seen.

Lastly, I wonder if I am lucky enough to get pregnant for a second time (and not miscarry) if this will happen again. And if not, how much more will my uterus grow? Can I make a bigger baby in my half uterus? It obviously stretched a ton this time but not like a normal sized uterus did. 

I made my OB cookies and wrote her a thank you note because she was so incredibly kind and supportive throughout the entire pregnancy. I know I was a high needs patient (for good reasons I think) and I wanted to let her know how thankful I am for her care. I ended the card saying “I am so thankful for my beautiful baby”, and I teared up as I wrote that. The gratitude I feel toward having her is immense and I don’t think I could put it into words. 

She grew!!!

I had my growth scan at 34 weeks 5 days and baby girl put on 1 lb 3 oz in the past 2 weeks! Now she’s estimated to be 4 lbs 3 oz. still tiny but up to the 3rd percentile. I’m hoping she can break the 5 lb mark by our induction at 37 weeks. Blood flow through the cord still looks good, as do my fluid levels, and she’s still passing her NSTs. My BP was slightly higher than my normal but still ok (128/88), and I had trace protein in my urine. My MFM wasn’t concerned so I guess I’m not either. 

My MFM scheduled our induction for October 1! That’s 37 weeks exactly. Less than 2 weeks from today. For some reason having this scheduled finally got me excited! The hospital will call us sometime after 4pm to let us know what time to come in to get started. I’m assuming this is because they do the scheduled c-sections earlier in the day and then the scheduled inductions happen afterward. From what I understand, they will give me medicine to ripen my cervix, and possibly use a foley balloon to help dilate me. Then I’ll probably get some pitocin. I’m not super excited about the possibility of a balloon to dilate my cervix or pitocin as I hear both can be painful, but I guess we do what we gotta do to get the baby out safely. I know the nerves about being induced will hit eventually but for now I’m just going to enjoy this incredible feeling of excitement! 

Now I’m nesting like a mad woman. My hubby set up the crib and changing table yesterday, and I bought the rest of the necessities off of our registery. Tomorrow is baby laundry day and then I’ll put everything away in its rightful place. I am a terrible decorator and I’m not into themed things but I had a ton of fun picking out cute crib and changing table sheets. Nothing is matchy but I love them all. Once I’m finished getting everything together I’ll try to remember to post pictures so you can all see my valiant attempts at nesting!

I had my friend-thrown baby shower yesterday, and it was so fun to celebrate the baby with my girlfriends and family. My aunt (who is an artist) gave me some incredible illustrations that I’m going to frame and hang by her bed. Everyone gave her a book to add to her library. My husband and I love to read so it’s great to have so many books now. Some of the books we got are from our friend’s childhood collections (used) and I think that’s so cool!

I also had my last day of work this past Wednesday and yesterday was my first official day of maternity leave. I’m so happy to be off now, as it was getting really hard to be at work on my feet all day, and sitting in the car for long periods of time commuting has been torture!

I hope everyone is doing well!

IUGR Update

I had my growth scan yesterday at the MFM’s office. Baby girl only gained 5oz and now weighs 3lb 1oz. Now she’s less than the 1st percentile. It’s great that she gained some weight, however tiny the amount, but I’m just so sad at how tiny she is. If she gains 5oz every two weeks and we are being induced at 37 weeks, I’m on track to have a baby who weighs around 3lb 11oz. That’s a TINY baby. I really hope the scan is off and she’s actually going to be bigger (not smaller). I also hope we can make it to 37 weeks without any issues. My MFM keeps telling me that it’s the gestational age that determines outcome, not weight. He’s glad we made it this far already (33 weeks tomorrow) and we are hoping everything continues to look good until induction. I’m still incredibly scared and sad that my body cannot nourish my baby appropriately. I’m so scared to have made it this far and then she doesn’t make it. My MFM also reassured me that with the close monitoring the risk of a still birth is quite low. I’m still scared, though. 

Thankfully, she’s still passing all of her NST’s, blood flow to the baby looks good, and the fluid levels are good. You could see her practice breathing on the ultrasound. It was really cool! 

We are looking at induction at 37 weeks, which we will schedule at my next appointment in 2 weeks. I’m scared of the induction itself, as I know labor that is induced has a higher risk of c-section. That, coupled with the fact that IUGR babies tend to tolerate induction poorly, makes me think I will end up with a c-section regardless. Ugh, I was really hoping for an unmedicated vaginal delivery but obviously whatever is best for the baby is what I want. I just know that pitocin contractions are supposed to hurt more and if I need a c-section right away for a problem it may be better to just have the epidural in place so I can be awake for the birth. So many things to consider. 

I’m really struggling with feelings of guilt and sadness. There has been lots of tears and I am really feeling blue. I know we all have our battles to fight but I just wish this wasn’t mine. I feel like my body sucks in general, with the poor egg quality, recurrent miscarriages, and the unicornuate uterus, and now it’s potentially contributing to lifelong issues for my little girl. 

In other news, I had my first baby shower, thrown by my husbands family. It was a joint baby shower as my SIL is expecting in December so we figured it made sense to combine them. It was wonderful to celebrate our baby, no matter what the outcome. I only got one “you’re so small” comment that I just brushed off. My SIL was 26 weeks to my 32 weeks and her bump is the same size as mine. Really great for my self esteem. We got a ton of clothes, and a lot of the stuff off of our registery. 

Speaking of the “you’re so small” comments, I really struggle hearing them. It just makes me feel bad about myself. I am also concerned about getting the “your baby is so tiny” comments after she is born, so much so that I don’t want any visitors after she is born. I’m sure this is unrealistic but it’s just how I feel. I don’t want to be judged as a poor mother because my baby is tiny. I already feel horrible about myself. These feelings concern me in general because I am concerned about post partum depression and anxiety and I feel like this may put me at a greater risk. I guess it’s good that I’m aware of the feelings already but it’s still scary. 

Thank you for reading if you made it this far. I hope everyone is doing well.

First MFM Appointment

This past Thursday was my first meeting with the MFM. I had a full on anatomy scan to go with the growth scan, and they also checked my cord flow from the placenta to the baby, and my amniotic fluid levels. 

Dr. C is awesome. He says that the most likely cause for the IUGR is my unicornuate uterus (as expected). My fluid levels are normal, blood flow to baby looks good, no markers for TORCH infections, no hypertension or diabetes, and completely normal-looking anatomy (so low risk for a chromosomal issue). I am relieved that everything looks good, but at 30w4d she weighs 2lb 12oz, which is the 3rd percentile. She’s incredibly small. The biggest risk here is stillbirth, which he says is a very small risk since I will be monitored so closely. I hope that’s true. 

The plan is for me to have twice weekly non-stress tests (NST), once weekly ultrasounds to measure the flow to the baby from the umbilical cord, and to check my amniotic fluid levels, and every other week growth scans/appointments with him. He says even if she doesn’t grow, as long as everything still looks normal we plan for an induction at 37 weeks. He also said that if things still look good at 37 weeks we can discuss pro-longing the pregnancy. I am also able to try delivering vaginally if the baby stays head down (I think she will stay head down since I’m pretty sure she had no room to turn). However, IUGR babies tend to get stressed during labor so I may end up needing a c-section anyway. 

I have had 2 scheduled NST’s so far and she passed both of them. For the first one I had contractions registering every 1-5 minutes the whole time, and I could even feel them all. I also went into labor and delivery last night because the baby had reduced movements all day. Luckily everything looked great on the NST there and she is moving back to normal today. I also had a few mild contractions I couldn’t feel. Apparently that’s my new normal. 

So how am I feeling after all of this? Honestly, I’ve been a bit of a mess. I’m incredibly scared that my body will be unable to continue growing her and I’ll give birth to a tiny baby with a whole host of problems. I don’t think I could forgive myself if that happens. I just keep wondering if it was selfish for me to try carrying a pregnancy with this known uterine anomaly. But then I have to remind myself that we don’t know the outcome, and we took a calculated risk. I am just hoping for the best. 

Thank you to everyone for your support. If all goes well I get to meet my little girl in about 6 weeks. I am so excited (and scared). A year ago, I could have never fathomed that. 

IUGR

I had my growth scan yesterday and my baby girl is measuring about a week behind at only 2.5lbs at 29w5d. That’s less than the 4th percentile, and we have officially been diagnosed with IUGR. Other than the low weight, everything else looks normal. 

I have been incredibly sad about this, even after talking to my OB, who seems fairly confident that everything will be ok. She wants me to have twice weekly non-stress tests where they will measure the baby’s heart rate and check my amniotic fluid levels. I start this on Monday as I am currently on a plane to Colorado for one of my husbands best friends weddings.

As of my scan yesterday, my fluid levels are normal and the blood flow from the placenta through the cord to the baby looks normal. So the most likely cause of the IUGR is my unicornuate uterus. I wonder if my uterus will continue to grow or if we have reached our maximum size. I will also have a more detailed growth scan this upcoming Wednesday with a maternal-fetal medicine Doctor to double check the baby. Then I think I get followed up there in addition to my OB. I will have more answers on Wednesday.

My husband is my rock, he is so optimistic that everything will be fine, and she’ll just be small. I’m so lucky that he thinks that way. On the other hand, I am trying to stay calm and positive, as I know what IUGR looks like in premature and term babies. I am really hoping to avoid a NICU stay, but even if we can make it close to term, we may be stuck in the NICU anyway so she can gain weight, we know she can maintain her temperature and breathe correctly. Sometimes ignorance is bliss, and my job can be a curse. But at least I’m prepared for what the NICU entails (although it’ll be so strange to be on the patient/parent side).

I am so sad that my body can’t grow my baby correctly. While I know I did nothing to cause this, it’s still hard not to feel incredibly guilty. My poor baby did nothing to deserve this and I am so sorry to be putting her through this. I really hope she continues to grow and develop inside me and there are no lasting long term problems from the IUGR.

She is always moving and reminding me she’s there and I am so grateful for that. I never thought I would get the opportunity to be pregnant and now I am almost 30 weeks. It’s amazing how you can love something so much that you haven’t ever met.

On the ultrasound you could see little tufts of hair on the back of her head. She was also super stubborn like her Daddy and wouldn’t move into a position where we could get a full profile shot. She’s super deep in my pelvis (head down) and my hip was in the way. But we got a cute picture of her. She seems to have a small nose and big lips (those are probably from me). I can’t wait to meet her, and I hope I have the opportunity to be her Mommy for a long time.