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a healthy pregnancy. I'm sure it's a girl, although we still have about 2 more months until that can be confirmed. My doctor has scheduled a C-section for me at 39 weeks in March (if I get that far), or baby will be here sooner if the past predicts the future. Our daughter was born at 35 weeks and 1 day due to severe preeclampsia and class III HELLP Syndrome. Her lung collapsed 36 hours after birth, and after a 2 week NICU stay, things started to get better for all of us. She's now 14 months old and doing just fine now, and we know she's looking forward to being a big sister in February or March. Thank you again for all your hard work with the HELLP Syndrome Society!
The following is a series of emails from Donna, one of our members. It follows the progress of her second pregnancy from 22 to 30 weeks.
From Donna
dmmetler@bellsouth.net
(Memphis, TN) 22 weeks - First the good news-the baby is growing as expected, heartbeat is strong, and the average BP readings and protein levels etc don't show any early signs of PE. The bad news is that some of my headaches are demonstrating neurological symptoms which are sometimes seen in severe PE (but also in the migraines that I had in adolescence, which were strongly hormone linked). So, since we don't know exactly what is going on here, we're treating it as a mega warning sign. Fortunately, or not, the conditions in the OB's office were right to trigger one, so he was able to observe what happens. First of all, since I seem to get these worse while out of the house, for the next few weeks we're trying more involved bedrest-no more than an hour up at a time, do not go out for shopping, meals etc. Most of my really bad headaches seem to be linked to locations which have florescent lights, chemical smells or both (which matches my previous migraine history, which is a concern in and of itself since severe migraines could cause me to lose consciousness previously). Secondly, I now am on phenobarbital, both as a seizure preventative and as a more general tranquilizer. Third, I'm supposed to avoid extended visual stimulus-which means no more than 2 hours of TV at a time, and no more than an hour on the computer at any one time. The hope is that in 2 weeks (my next appointment with the OB), things will have stabilized, but for the next few weeks at least, we're erring on the conservative. I'm not completely sure WHAT I'll do with my time, though.
24 weeks - Everything looks good at this point. BP is running a little over normal, but is 10 points lower than 2 weeks ago, with no more headaches. The plan is at this point to continue as we have been doing for the next few weeks at least (we are technically at the point where the baby can survive now, however 28 weeks is the practical point at which it becomes more routine-so that's the next goal). Still on bedrest, but since the headaches aren't a problem, the computer and TV are less of a concern, which should help the boredom thing. The baby is still growing as expected (based on external measurements, and kicking up a storm.
24 week consult - We did the 24 week U/S and peri consult, and things look good- "Cuddles" was in her usual am sleepy mode, and seemed to have decided to sleep with her feet up in front of her face-she got a bit feistier towards the end. And, at 24 weeks, she still appears to be a girl. She's still measuring a bit ahead of her dates. developmentally, which is a very good sign since I'm getting some hypertension. She's breech at this point. but as the technician said, at this stage she could easily decide to flip over while we're watching, so position doesn't mean much.
26 weeks - Based on the OB appointment today, everything looks good-BP is relatively stable still in the borderline levels-not clinically hypertensive, and the reflex signs and headaches with light show haven't returned. No signs of protein. At this point, the plan is to go to weekly appointments to check how things are going, and to continue as is until we either see changes or until about 34 weeks, and to withdraw from the phenobarbital at that time. The feeling now is that the phenobarbital seems to be helping, and that it is less harmful to stay on it than delivery prematurely would be-and the hope is that we can continue as is until at least 34 weeks (and hopefully until 37-38). The Glucose tolerance test and all blood tests are normal. So, unless something turns up on the Biophysical profile, things look good at this point
26 week BPP - We made it through the first Biophysical profile (BPP)-"Cuddles" scored an 8/8-and I must admit, for someone who is as against over assessment of children as I am, I definitely was relieved at the numbers. The test was kind of neat, because one of the student sonographers from Baptist College of Health Sciences was actually manning the machine with the certified sonographer who has been doing the U/S's there to support (and to recheck important readings to verify what the student got)-which meant that there was more detailed explanation of what was going on than even the regular sonographer (who is MUCH better at explaining without my having to ask questions than the Peri) does. The BPP is looking less at the baby's structure and more at the support system around the baby-I did get kind of nervous because when she turned on the audio to hear the blood flow in the umbilical cord, it was rather loud and just sounded bad-I think it scared the student a bit, too. It turned out that the person who had used the machine last had turned the volume up too high, so there was some distortion. Whew! My kidneys and liver (both of which were a concern last pregnancy) aren't showing any signs of problems at this point, either. Anyway, things look great at this point, and they'll be doing these every 2 weeks from this point, just to keep an eye on things. While we'd all prefer to see the BP a bit lower on average, right now it's staying pretty stable in the "borderline" zone, where it's been for the last month, and we'll be pretty content if it stays there. So, except for boredom (I'm creating enough small cutesy crafts to outfit a girl scout troop), things are looking good here.
27 weeks - Things still look good, with no real signs of pre-eclampsia. We're still seeing some labile BP, but overall, it seems to be happily staying in the 120's/80's, which, while a bit high, isn't a concern. The baby is quite active and seems to really dislike the doppler. We did a whole bunch of bloodwork, because I seem to be bruising quite easily, and the fear is that this might be a sign of early HELLP symptoms. However, except for a slightly delayed clotting time (probably due to the aspirin therapy), things came out normal (just got the call from the OB to let me know that, because he didn't want me stressing). Another good development is that since things seem to be staying stable, he feels it would be reasonably safe for me to sign up for the childbirth/new parent classes at Baptist as long as I don't walk too much and my BP stays OK, which is something that I've really wanted to be able to do. He does suggest waiting until we get past 28 weeks just to make sure. One more week down-next week will be the THIRD trimester!!
28 weeks - We made it to 28 weeks! Yay!!! Unfortunately, there are some signs that things may not be staying as stable as we'd hoped. My BP is swinging less, and seems to have settled in the 130/85 average range-which is not officially hypertensive, but is significantly higher than what it was earlier in pregnancy. I also have slight protein, for the first time in this pregnancy, and am starting to have some fluid retention (4 lbs weight gain in a week when I've been averaging less than 1). Nothing too serious, but it definitely has me very nervous-especially since about the only advice is to drink lots of water and spend as much time on my left side as possible, plus keep monitoring at home. Very unsatisfying. We also did a non-stress test today-actually, we ended up doing two. Apparently when the nurse hooked me up the first time, she didn't get things fastened tightly enough, so every time Cuddles would kick (and I think she was aiming for the monitor), she'd knock the monitor out of position, and it would lose her heartbeat. Then, about the time it had picked up her heartbeat again, she'd knock it off. So we ended up doing a second one, with me holding the monitor in place, and things turned out fine. She's definitely on the active side when she wants to be. Anyway, there's no major changes, just enough to make me nervous.
28 week BPP - Basically, I couldn't have gotten a better report had I written one myself-there are no signs of protein, and my BP (after the BPP) was a completely normal 120/78-lower than it has been the last three days. He's tentatively attributing my higher BP levels over the last two days to anxiety. Apparently it isn't all that odd for protein to come and go, and at this point, there is no real sign that I'm developing active PE. My BP is still borderline, but not bad, and I am retaining fluid. He's guessing that the breathlessness has more to do with lungs being squished by growing baby than anything else. My kidneys and liver look normal and appear to be functioning fine. She scored 8/8 on the BPP today, and is measuring 10 days ahead of her original due date, and 5 days ahead of her adjusted due date based on early ultrasounds developmentally-weight estimates are 3 lbs 2 oz at this point, and it doesn't look like a chubby baby, just one developing normally a bit faster than expected, which means she's likely to do well if she comes early. So, at this point, things look good, and I'm feeling much better than I did Tuesday.
29 weeks - Well, based on the exam, everything looks good-blood pressure is normal, no protein, and while I'm still retaining fluid, I'm not increasing fluid rate as fast as I was last week. However, the non-stress test came back as close to non-reactive, and even though we have a definite, very steady heartbeat and definite movements, it's not common to go from being reactive one week to not reactive the next. So, we now have an ultrasound scheduled for Thursday to make sure everything is OK. My OB wanted it sooner, but my perinatologist ended up having to do an emergency delivery of twins this morning, so has a lot of patients to fit in to the schedule this afternoon and tomorrow, and while this is worth checking out, it's not enough of an emergency to send me into labor and delivery to do it. So...more stress.
29 week BPP - The BPP was fine. According to the peri, It's not odd to see babies before about 32 weeks be reactive one time and not reactive the next, even with strong movements, and while it's worth checking, it usually doesn't indicate a problem. (And I suspect that I'm very atypical for my practice in that the plan calls for doing NSTs this early, so the OB's office simply doesn't have very much experience with NSTs at this point). Protein was still negative, and blood pressure in office was good-although it's still all over the place at home. We are moving to weekly BPPs, which also means that BP and protein get officially checked twice a week-and while Braxton-Hicks contractions are normal (and the reason mine may be hurting more than most of the books indicate for this early is likely to be the vertical C-section scar instead of them being overly strong) , because of my physical size and the fact that this baby seems to be growing pretty quickly, it makes sense to keep an eye on me as far as preterm labor goes, too. He agrees with the vitamin K supplements, and doesn't think they're interfering with the aspirin therapy. So, at least for now, everything looks good. I am supposed to continue monitoring kicks, contractions and BP, keep resting, and keep hanging in there for the next couple of months.
30 weeks - Basically, the subject line says it all-the NST was normally reactive today, no protein, BP was within the range it has been (ie-a little high, but nothing to worry about). So, for once, nothing extra to worry about after a Tuesday appointment!
30 week BPP - After the ultrasound, everything looks good-except that Cuddles was not cooperative-we never good a good view of her face or even a nice profile-hopefully she'll do something cute next time. She also has apparently gotten on Mommy's schedule-mommy generally takes naps in the afternoon, and today's appointment was scheduled during Mommy's usual nap time, and apparently it was also baby's nap time-she didn't particularly want to do much today, and while she showed everything they needed to see, she wasn't at all cooperative about it. Going back to first thing in the morning appointments next week!
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