So, it's been a very long time since I've posted an update about our little man. Lots of things have been happening recently, so it probably time.
First of all, I'm 25 weeks 1 day today. Hard to believe that, with any luck, he will be here in 3 months. Little man is currently measuring about 1 1/2 weeks ahead and, at last measurement is 1 lb 14 oz. Right on track to be a big boy.
We've been having MCA doppler scans every 2 weeks since about 16 or 17 weeks. These scans measure the blood flow in the middle cerebral artery. It's common in iso pregnancies that babies become anemic, though some not nearly as severe as others. Usually, with a combination of antibodies like I have, the chances of a baby becoming moderate to severely anemic happens more often than not. We were hoping that we would get lucky. Unfortunately, our luck ran out. Prior to the scan we had 10 days ago, little man had been consistently in the normal range or on the low end of the mild anemia category. Our scan on the 13th however, showed a measurement on the low end of the moderate to severe range. This was the first time we had a reading this high. My MFM decided to have us come back 4 days later, which is a normal length of time in cases like mine. So, on Tuesday, we were back in the office. Only, this time, all of the measurements were in the moderate to severe anemia range. Things started moving fast...faster than I thought possible. Dr M, who had always said she wasn't comfortable with performing intrauterine blood transfusions because she had done so few in her career, started researching where to send us. While waiting, her nurse gives me a shot of steroids to help the baby's lungs mature "just in case." After what seems like forever, Dr M comes back and says that she is sending us to the Center for Advanced Fetal Care at the University of Maryland Medical Center in Baltimore. Our appointment is Thursday. In the mean time, we are to come back to see her tomorrow for the second steroid shot and another look at our little guy before we get shipped off.
Fast forward to Thursday. After a 2 hour drive to Baltimore, we arrive at the center which is based right inside the hospital. We have an hour long ultrasound, including a full anatomy scan and MCA. The MCA results are slightly better, which we knew was a possibility. The MCAs aren't perfect and often fluctuate, depending on how well the baby cooperates during the test. Good news is, he's STILL a boy and once again, wasn't shy about showing it. He still continues to measure ahead of his gestational age, and, best of all, he's not showing signs of hydrops. Hydrops is often a side effect of anemia; it's fluid that builds up under the skin, usually signifying heart failure. Dr H, director for the Center comes in to take a look. He looks at the MCAs and does some searching of his own with the ultrasound machine. He then explains that, although not immediate, intrauterine blood transfusions are a must. He is concerned due to the gestational age of the baby. Each transfusion carries a risk of early delivery for several reasons. And, since the MCAs aren't an exact measurement, there's no way to determine just how urgent the situation is. He then explains that a cordocentesis can be done to provide a definitive answer. The cordocentesis is much like an amnio. A needle is inserted into the uterus and, under the direction of an ultrasound, is guided into the umbilical cord. Once in the cord, a small sample of fetal blood is drawn. The blood count is tested from the sample. After a discussion of the risks (contractions, ruptured membranes, emergency csection, etc) a decision was made to do the cordocentesis the same day. This would allow Dr H to make a decision on when the first transfusion would need to take place. Due to the risks, I chose to have the procedure done in the
OR. Though the procedure could be done in the office, if something went wrong and a section was needed, the baby would be our faster if we were already in the OR. Unfortunately, L&D was very busy that day and my procedure got bumped several times for emergencies. Finally, after several long hours, I was prepped and ready. What I though would be a simple procedure definitely was not. I guess I didn't realized just how hard it would be to get that needle in to the cord...plus the fact that the baby was very active didn't help. But eventually the docs got the sample they needed. I was taken back to the L&D for observation (had to be hooked up to monitors to make sure I wasn't having contractions) and to await the results. Dr H comes in to tell us that the baby's blood count is very low, 6.3 in fact. So a transfusion is scheduled for Monday, April 23. He also says that we will probably have to do 5-6 over the next 10 weeks. The second one will be a week after the first and then subsequent transfusions will occur every 2-3 weeks after until the baby can be safely delivered.
As I said before, transfusions carry risks and quite a few. The worst of which, other than the obvious, is early delivery. To say I'm not scared would be a ginormous lie. But, I know that, at this point, he is technically viable and can live outside the womb. Yes, I know the chances of his survival wouldn't be great, but I also know the risks are low. Over 95% of transfusions are successful, without any side effects.
Honestly, it comes down to this...when I first found out I was pregnant, I remember telling myself that I would do anything to make sure I bring home a healthy baby. It sounds selfish, I know, but I want to give my little guy the best chance of survival I can. The fact that it's my body attacking him makes me want to do whatever I can to help him. I know there may come a point where I can't do anymore, but I'm not thinking about that right now. We just need to get through this one day at a time.
So, that's it for now. Tomorrow morning we head off once again to the UMD Medical Center for our first of many transfusions. Hopefully sleep doesn't elude me tonight. I will try to post new sono pics of him soon too!
