As I'm sure you can imagine, today has not been one of my better days.
I thank all of you for your thoughts and prayers and grow-baby dances and whatever else you have to throw my way.
Despite being exhausted, I can't sleep. My mind is racing. So I, being an obsessive idiot, turned to the internet.
First, since my last post was incoherent, here's more detail. I belong to an online moms of multiples forum, and I asked them about this, and because my mind is racing, I'm just doing a cut+paste job. Sorry if that's weird. Anyway:
I have di/di boys. Baby A has always been smaller than Baby B, right from our very first scan at 5w3d (IVF babies). He usually measures about a week behind and in the 20th percentile. Baby B usually measures right on target and in about the 50th percentile. Today, at 23w1d, I was told that Baby A is not growing properly.
They would not give me all the details I asked for (just one reason why I am switching providers!), but apparently he went from the 20th to the 4th percentile in a course of 2 weeks. I know he went from 13oz to 1lb even, so he did grow. His femur measured at 22w, I do not know what his abdomen and head measurements were, but I was told his overall is 21w4d, and that he is symmetrically small. His fluid levels are normal, and a cord doppler showed good flow.
I am/was seen by a peri group--different doctor every time, different tech every time. I really did not like this tech or this doctor, even before they gave me the bad news. The doctor was very old, did not know how to do a transvaginal cervical exam!, and did not recheck any of the measurements done by the tech, who only took one measurement and recorded it instead of 3 to average them, which is what my other techs have all done. She also told me she was "new to this". (I didn't question her at the time, because I didn't think it was a big deal.) Anyway, the doctor informed me that A obviously has some very serious problem(s) going on. His anatomy scan was "perfect" and his nuchal measurement at 12 weeks was ideal, so I was a bit surprised by this.
The doctor presented me with 3 scenarios:
(1) Chromosomal abnormalities. Can be checked by amnio, which I am willing to do to guide decision making.
(2) Virus such as CMV or toxoplasmosis. I am being tested for these tomorrow, but I have to say, it doesn't make sense that only one baby would be affected. Better to rule it out, of course.
(3) Placental abnormalities. But growth is symmetric, has been symmetric since they began measuring more than just CRL, and the doppler and fluid levels don't suggest reduced blood flow, so i just don't know.
He recommended steroid shots and delivery at 26 weeks. I am extremely uncomfortable with this, so I called my regular OB as well as my sister, who is a 4th year OB resident. My OB is transferring my care to the University hospital, as she doesn't feel qualified. My sister does not have access to my charts, but discussed the measurements I knew with the peri's at her hospital, and they all advised AGAINST early delivery based off just this ultrasound.
I should have an appointment at the U soon. I am going to insist on another ultrasound to check these measurements. Are there any other questions I should ask? Tests to have run?
Do you have any stories, happy or sad, about experiences with this? Thanks.
ANYWAY.
I was just now googling (I know, very bad) and I discovered two important facts: the U will take my insurance (something I didn't think to check before gladly accepting the referral and my OB's offer to schedule the appointment herself, with the doctor she studied under), and this website:
http://www.baby2see.com/medical/charts.html#Fetal_Weight_Percentile
Now, I realize this is just an online website, but...Atticus weighs an estimated 1lb even, which is 16 oz, which is 454 grams. Which, according to this calculator, puts him in the fourTEENth percentile.
Let me say that again.
FOURTEEN.
That is not four.
Fourteen is small. Fourteen is smaller than twenty. BUT. Fourteen is not pathologic, it is not SGA or IUGR. It's not as worrisome to drop from 20 to 14 as it is to go from 20 to 4. It's possible it was a measurement error, a bad day, or maybe yes, he's slowed down a touch.
But I will absolutely murder someone if all of this stress and fear and tears and doubt was caused by someone misreading the computer screen or my chart.
I realize 1am is not the best time to be making decisions, and the internet is not the best guide, and there is such a thing as denial and of course I would sell my soul to have both of my boys be ok so it's possible I'm reaching here...
But holy fucking shit, if it's 14 and not 4, if things are not ideal but not grave...I can't even begin to think what I'll do.
Please please please, let this be true.
12 comments:
Oh I do hope that it is an error and Atticus is not doing as badly as what was first thought. I am sending lots of positive thoughts your way. xx
I would try really hard to wait for the second opinion (and a lot more data) to start freaking out. If you have confirmation that the placenta is doing its placenta thing in terms of providing blood flow, that is great. At the very least, it's too early to start scheduling a 26 week delivery like it's mandatory.
I would want to have a whole lot of evidence that things are going pear-shaped for Atticus in utero before taking him out so prematurely. Doubly so if it also means taking Damien out way before his time.
Fetal size estimates from ultrasound are notoriously screwy and extremely variable, so a new technician and a lack of multiple measurements and averaging are likely to give you a data point that is inconsistent, without there being anything unusual or different about the baby's growth rate.
Also, here is a more legitimate source of growth percentiles that requires reading the graph but also should be reassuring:
http://www.aafp.org/afp/980800ap/peleg.html
Praying that is true for you! Glad you are investigating this!!!!
Oh Marissa, how terrifying! I think you should definitely try to hang on and get that second opinion before panicking (as if that were possible) -- it looks like there was a lot about that ultrasound that wasn't ideal, and I'm so glad you are able to step outside of the situation to get another opinion at the U. I'm thinking of you and the babies!
a second opinion with a maternal fetal medicine specialist, an expert look at what is going on with your babies, potentially a fetal MRI scan [this has no radiation] and then consider what is best for your babies.
good luck from australia. your babies have held in there this far and grown at the same steady rate. there were too many variables with your last scan to make rash decisions at this stage. good luck.
Get another ultrasound! I had a VERY similar scare with my twins, but since it was very near the end where I was getting a scan done every two weeks or so, I knew the tech was full of shit. My boys had always measured exactly the same, and the tech had baby B measuring 3 weeks behind. She freaked and called in the doc, who basically gave her a dressing down right in front of me. The computer on the machine does the calculations automatically, but the dip had measured his femur length incorrectly, and hadn't bothered to re do the measurements. An ultrasound is such a simple thing to do, but so much weighs upon it, and it is SO easy for a tech or doctor to make a big mistake. So, go to the best hospital you can, get the best ultrasound machine you can, and the best person to read it that you can. Hoping and praying with you that a bad measurement was all it was.
My u/s tech told me just yesterday that when you get into 20-30 weeks of pregnancy, the margin of error for measuring is ELEVEN DAYS. (seriously, how have they not figured this out yet).
SO glad you're getting a second opinion.
I can feel the anxiety wafting off the screen at me, I wish I was there to hug you! Everything's going to be okay.
Thank god you 1) have some medical know how 2) know how to advocate for yourself. Of course you should get a second opinion and the doctor himself should have recommended that you do just that given how important this decision is. Sending you hugs and positive grow baby grow thoughts.
um that old fart of a doctor and "i'm not that good at this u/s tech" just stressed ME out andit's not even my baby they are discussing trying to evict super early.
Please waiton your second opinion. and please sue somebody ANYBODY if it turns out that they were super wrong and caused you all of this angst over misreadings and incompetence.
I stumbled upon your blog today, and wanted to echo the others who have suggested a second opinion and no freaking out. I had a similar experience with my twin pregnancy at 28 weeks. The peri looked looked over the ultrasound notes and told me to head upstairs for a NICU tour because he predicted I would deliver within a week but didn't explain why. I refused the tour and delivered at 36 weeks. To hell with sloppy doctors. Trust your gut and hang in there.
My second baby was notoriously small the entire pregnancy, leading to restricted activity for me, growth checks every other week, and non-stress tests about 3 days a week. She is perfect, healthy, and just a teeny girl today at nearly 9 years old:) All this to say, try not to panic, get your second opinion for sure because somethings are not adding up right, and love your boys:) Still praying for all of you.
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