Tuesday, October 12, 2010

Perinatologist

At our last appointment with the fertility doc, he suggested that we look into having a fetal echocardiogram done around Week 18.

Backstory: Our first daughter, Ainsleigh Brynn, was born with a "constellation" of heart defects that ultimately combined to kill her. There's about a 5% recurrence rate for congenital heart defects. That's not a lot, and there's little to be done about it in utero anyway. However, we live in a small town; our hospital doesn't have a NICU and the nearest pediatric cardiologist is at LeBonheur in Memphis. So, the thinking is: find out if there are any problems, so that we can be prepared --- where in this context "prepared" means, crucially, that we'd arrange to have the baby in Memphis at a hospital that can support the baby.

Our OB agreed with the fertility doc, and so referred us to a perinatologist in Memphis. We had that appointment yesterday, October 11th. It went very well.

The ultrasound itself lasted about an hour and a half. The tech told us baby is a girl first thing.


Then she checked out the baby in every dimension.  For instance, she counted all the fingers and toes.


There were lots of other checks, too.  She confirmed that baby has two umbilical arteries (this is the correct number; Ainsleigh only had one), that her kidneys are in place a supplied with blood (she can watch blood flow through the renal arteries), that her spine is properly formed, and more. 

One thing they do is estimate the baby's size.  The tech takes three measures: the circumference of the head, the circumference of the abdomen, and the length of the femur.  Each measurement is used to form an independent estimate of baby's weight.  These estimates are averaged; the average comes to 10 oz.  This figure is looked up on a chart ; it corresponds to the average size of a baby at a gestational age of 19 weeks.  Given that baby was 18 weeks 5 days at the time of the ultrasound, she's right on time.

In addition to the 2-D images taken at a particular depth, they can rapidly scan through depths and use the computer to construct a 3-D portrait of baby:


It's imperfect, of course, but you can see her pretty well here.

As to the purpose of the visit: her heart looks great.  They spend a great deal of time on this.  There are a number of techniques involved.  A simple ultrasound can show the heart moving as it beats, and the valves opening and closing.  The machine can also detect the movement of blood through the major blood vessels as well as between the chambers of the hearts.  Finally, they can zero in on and listen to the various components of the heartbeat: this or that valve opening and closing in rhythm.  The amount of detail that can be gleaned is really impressive, given baby's heart is about the size of a quarter.

Put all these approaches together and you get the result you want: baby is healthy, and her heart is in perfect working order.

Movement

Sarah started feeling the first movement about three weeks ago, during Week 15. (This writing is at the end of week Week 18.) Since then the movement has gotten more frequent and more noticeable. Now Sarah can feel movement several times a day. Frankly she enjoys the Hell out of it.

I think I felt the baby move very early on, in Week 16 or so. I had my hand on Sarah's stomach and felt a soft but definite rolling --- sort of like baby had been under my hand and then rolled out from under it. Since then, I haven't been able to feel anything. Occasionally Sarah will say "come her, the baby is kicking" and I'll run over and put my hands on her belly, but then baby always immediately stops kicking. Oh, well; it will come in time.

Sonogram, 23 August 2010



Some Limited Excitement

The sonogram on 17 August really wasn't supposed to happen. As previously discussed, we 'graduated' from the fertility doctor on Monday, August ninth. Thereafter we immediately made an appointment with Sarah's regular OB here in Oxford. That appointment was on August seventeenth.

This appointment was meant to be a meeting. But halfway through the meeting, the doc was called away to do a delivery. So, he had his tech do an ultrasound to keep us amused while he was gone. There was nothing terribly informative about the resulting pictures, but it was nice to see the baby, as it always is.

Five days later, on Sunday the 22nd, Sarah had some bleeding. There wasn't a terribly huge amount, and she didn't have any cramping or pain with it. Nevertheless, Sarah was very scared and called the doc. He told her not to stress out about it, to take it easy the rest of the day and come in first thing Monday morning.

By then, the bleeding had stopped and we were starting to settle down. But, they did an ultrasound to peek in on baby anyway. As expected, all was in order.

Sonogram, 17 August 2010





Catching Up

Apologies are in order.  I started a new job last month, and I've been extremely busy.  Since the last posting, we've had three sonograms. In the last (no use trying to build suspense when I've already colored the blog pink) we found out: baby is a girl.  Now, in order, pictures from each sonogram, and some other stuff.