02/12/2021 – 21w5d | No surgery, cardiology appt – another day in the win column

Approx. 22 weeks, they’re eyes are fully formed but their eyelids are closed, they have hair now along with eyelashes and eyebrows, and are beginning to hear sounds. They’re wrinkly now until they gain body fat to add the padding that plumps them into chubby babies ready for the outside world. Technically, they’ll be viable in 4 more weeks if both are >500 grams in weight.
Snow socks are in; chains are so last year! Apparently, my vehicle doesn’t have enough clearance for chains (this is the future of new vehicles) and this nifty new accessory called “snow socks” provide the same traction as chains but like 1% of the hassle! I slid them on the top half of the tires, rolled my swagger wagon forward, then slid the other side on – just like a sock. These socks got me up several icy hills and across an iced overpass in the dark on the way to hospital. My new favorite car accessory. The hospital maintenance people watched in awe as the hugely pregnancy woman did the reverse process in the parking garage in under 4 minutes after my morning appointment. Because like chains, these have a max speed of 30 mph which is a no-go for the freeway which was clear by the afternoon.

Today’s Summary | No surgery equals a win

After staying overnight in a hotel .25 miles from the hospital to make sure I could get there no matter how much snowfall we received overnight, my 2.5 hours + of ultrasound and Doppler studies showed that everything remained approximately the same, so in short – no surgery today! Hoorayyy! We’re making peace with the reality that no action is good, no worsening news is great news, and the longer we can put off any procedures of any kind of poking or surgically going into the womb is a win. “No action” is not intuitive nor does it feel right: never before in our lives when facing a problem has doing nothing made sense. Yet, every day that we do nothing, we cross off the calendar as a win on on our march toward healthy viability (April 1) because it is a success. Onward we march.
Of course, I fully believe that my doing the recommended, as much side-lying horizontal rest and forcing nutrition (it’s actually not very easy to take in 175 g of protein per day and 90 oz of water) along with the support sent by prayers and positive energy coming from you, our tribe of supporters, is making all the difference! Thank you for keeping up the goodness: this is a temporary situation which will all be over before summer, ideally between April 24 – May 09 (if by some incredible stroke of luck and miracle of modern medicine we could keep them in until 32-34 weeks).

More details from today’s Surgical Team/MFM visit

Amniotic fluid is measured via Maximum Vertical Pockets (MVP) which have a small +/- because the uterus isn’t a fixed shape like a sphere. Each time they measure, the uterus shape is slightly different and the measurement is taken by finding the deepest area in a vertical line, without the baby or any of his parts in the line. So the measurement varies a bit day-to-day by nature of the shape.  Today, it was approx. 6-7 cm for our smaller baby, Joshua and approx. 13.5-14.5 cm for our larger baby, Daniel. Total fluid remains at about 20 cm which is right on the line for causing contractions and cervical failure which leads to premature labor.

Doppler flows measured approx. the same, too.

Cervical length (which is discussed because it is the determining factor in all of the above) measured a bit better after two days of almost complete side-lying horizontal rest at approx. 3 cm up from 2.5 which is nearing the shortness that requires cerclage due to it basically failing to hold under the weight of all that fluid plus the babies.

Their Hearts | diagnosis from Seattle Children’s Hospital Cardiology

Our MFM team found some abnormalities with Baby A’s hearts, referring us to Seattle Children’s pediatric cardiology.  After another 2.5 or so hours of ultrasound echo cardio + Dopplers focusing on the babies hearts, we found out that  both of our babies have a relatively common heart defect right now. The “good” news is that these defects do not really affect the growth of the babies while they are in utero, cannot be treated in utero, and if they are still present at birth, the babies will either need no treatment, surgery within 3-6 months of life, or surgery immediately after birth for which they would be transported by ambulance to Seattle’s children and then would recover in Seattle Children’s cardio NICU.  Honestly, with all we have going on, this problem is the least of our worries right now. That’s really saying something when open heart surgery of your preemie newborn(s) is the least of your worries. We’re putting off worry about this: we’ll cross this bridge when we come to it.

More details from today’s cardiology visit on hearts

Baby A has two relatively common heart defects. Both Baby A and B have a small hole in the septum between their left and right ventricles (the part of the hear that squeezes to push the blood through. These holes are called Ventricle Septum Defects VSDs. 1% of all pregnancies have this defect and in some babies, the hole repairs by closing on its own before birth. The location of Baby B’s indicates his might close on its own, but the location of Baby A’s makes it a lot less likely that it will close on its own before birth. Baby A also has a narrow aortic arch or a Coarctation of the Aorta (CoA) assessed as Moderate (not quite mild and not severe).  If both of these issues are still present in Baby A at birth, he’ll likely need open heart surgery the day or few days after he’s born. We, of course, are praying this all resolves with growth and time in utero. One thing is for sure, their hearts aren’t the only heart with a hole in it until they’re born…

The PDA is a fetal vessel that acts as a temporary bypass which allows blood to push to the body if the aortic arch is too thin during pregnancy. This PDA vessel begins closing at birth which is why the heart surgery to correct a thin aortic arch or (CoA) is done after birth.

Thank you all. Remember to play and fill your hearts.

Today was a day of small miracles. So, it goes in the win column. I was able to get home before the snow began to fall in earnest, rather than being snowed in at a hotel 50 miles away from everything that matters to me in this world. Thank you to every single person reading my updates and reaching out to make sure I don’t feel alone. Your cards, notes, texts, and words of kindness (large and small) are helping me find my ‘eye of the storm’ zen every day.  You’re all keeping me sane. I hope you’re filling your own tank during this isolating time: I hope you’re daily finding moments of joy, reminding yourselves to play, and if you’re in the PACNW maybe making a snowman today.

Watching my son and his daddy snowsled today, hearing their laughter, and seeing my dogs (even my 12 year old senior) romp like pups in the deep snow reminds me of what truly matters in life – the small everyday moments are the stuff of dreams.

Hugs to you all,

Pamela

Leave a comment