Maternal-Fetal Specialists- 27 weeks 6 days

Last Thursday was our doctor's appointment with the high risk ob doctors. We are at the Maternal-Fetal Medicine Associates on East Paris. There are two doctors in this practice Dr. Balaskas and Dr. Cumminskey. Our visit started with an in depth ultrasound that looked at everything you can see by ultrasound including all the parts of the baby and the umbilical cord. They took all the babies measurements again to see where it falls size wise on their scales. This took about 30 minutes to complete. At this time the nurse doing the ultrasound told us that everything looked good and was in proper working order as far as she could see. Next Dr. Cumminskey came in and the nurse showed her a few more things on the ultrasound. After the ultrasound was finished we were lead to a conference room where we meet with Dr. Cumminskey to review the findings of the ultrasound and discuss the next step. She agreed that the baby is running on the small size but on their scale it is in the 18-20% range instead of the 13% we had at our regular doctor's office. She next discussed the typical reasons for a smaller baby. The first is a wrong due date which we know is not the case since I had a 9 week ultrasound that confirmed a due date close to Jan. 29th. The next reason for a small baby would be risk factors from the mother including high blood pressure, diabetes, smoking and so on which I fall in to none of those. This just leaves three options left. One is that the baby is just small and there is nothing going on. With Cecelia having been 8lbs 7ozs when she was born it just doesn't quiet fit but it is not impossible. The second option is that the placenta is just not working as well as it should be resulting in not enough nourishment being brought to the baby. The last option is that there is something going on with the baby itself that we just can not see on the ultrasound. The first two options are not something that can be figured out at this time. An ultrasound does not have the ability to look at the workings of a placenta. So that left us with trying to see if maybe the baby itself was causing it to be small. The doctor suggested that we do an amniocentesis to rule out any chromosomal problems. Finding out if the reason for being small is due to the baby or not will determine that course of action for the remaining pregnancy. Once we rule out a problem with the baby we would then just assume, since we can not confirm, that the placenta is not working completely and proceed as such.

The amnio could be performed right in the office and they had time while we were there to do it so we opted to have it done. I will have to say that I was very nervous to have this test performed but in the end it really was nothing at all. After the amnio the baby needed to be monitored with a non stress test for at least 20 minutes so we went to another room for this. Well needless to say the baby did not want to cooperate for the non stress test and after 1 1/2 hours without the results the doctors wanted to see we were back in the ultrasound room. They did another ultrasound checking for 4 different things they wanted the baby to do when they do not cooperate with the non stress test. The nurse has 30 minutes to see all 4 things before the baby is considered to have not completed the test. The baby did the first 3 no problem but when it came to the last one it was no cooperating again. They needed to see the baby's diaphragm move for 30 seconds. The baby got the hiccups but no diaphragm movement so after 30+ minutes the test was completed and the baby did not pass. They said this is pretty normal. The protocol is then to complete the non stress test within 24 hours. So I would be back on Friday for non stress test. With having had an amnio I was also not allowed to do anything for 24 hours in order to allow the puncture would to heal and the amnioc fluid to replenish. So after 5 hours we left the doctors office only to return again Friday morning.

I went in the for another non stress test and after the baby again did not wanting to cooperative they were able to get a read out that looked good and I was let go after 1 1/2 hours on the monitor. This time I meet with Dr. Balaskas who gave me a new set of guidelines. I am to drink a gallon of fluids a day and reduce my activities. He does not want me doing anything unnecessary that would result in pulling extra blood supply to my extremities taking it away from the placenta/baby. So that means no exercising, taking long walks, standing for long amounts of time and such. I am not on bed rest, yet, but it has definitely made me think about the things I do. I basically have to force myself to rest more and not run around the house all day. The reason for the water is to increase blood volume and circulation which will hopefully bring more nourishment to the placenta/baby.

So now we are just waiting for the results of the amniocentesis which should be in on Monday. They have a fast results test that takes 24-48 hours with about a 93% accuracy rate and then they receive a full report in about 1-2 weeks.

I am scheduled to go back to the office on Thursday just for a Doppler ultrasound which will measure the blood flow in the umbilical cord to make sure it is not dropping. My expectations from here on out is week by week. I think I am going to be at a doctors office pretty regularly with ultrasounds quite frequently. There is a possibility of bed rest and taking the baby early. This will all be determined by how the baby is growing and how the blood supply through the umbilical cord to continuing.

We know that the baby is in God's hands and there is not much more that we can do right now then pray. I will try to keep you all updated with how things are going via this blog. We thank everyone who is and continues to pray for us.