Oligohydramnios: Chandler's Journey

Today I saw our MFM doctor for the last time related to this pregnancy – it was a mixture of emotions – relief the journey has ended but also sadness because she was amazing to work with. This appointment was not only the typical six week postpartum appointment, but also for her to review with me what the findings were from the placenta pathology to hopefully give us answers as to why my pregnancy ended up the way that it did.

Good news is there is no genetic component contributing to Chandler’s IUGR or the oligohydramnios. A genetic component being a contributing factor would be the least ideal outcome as it could mean that Chandler may need further genetic testing to determine what genetic abnormality she could have, and it could also mean that subsequent pregnancies could be impacted. It was a huge relief to hear that this wasn’t the case for us.

The findings from the pathology indicated that the placenta had a 2cm infarction. An infarction is a fancy medical term for dead tissue. What is interesting is although Chandler was born in the 4th percentile, the placenta was the size of what is expected of a standard sized baby born at 36 weeks gestation [I believe they use the 50th percentile as a standard]. Our doctor was surprised at this finding and was expecting the placenta to be small in size to match Chandler’s small size, however that wasn’t the case.

So why did this happen? Our doctor’s best guess is when I had bleeding the weekend before my anatomy scan (I was 19w5d at the anatomy scan) I had a partial placental abruption. She thinks this is when my bag of water broke due to the trauma of the placental abruption, and why I was having contractions. There is no way to be 100% certain of this, however there really isn’t another explanation. The risk factors for placental infarcts [high blood pressure, gestational diabetes, fetal infection, fetal anemia] were not present in my pregnancy. What is interesting is the 2cm infarct was the same size throughout the pregnancy from the time of the initial trauma – so this helps explain the growth restriction. 2cm is a lot larger portion of a 19w gestation placenta than it is of a 36w gestation placenta, for example [at 36w, 2cm would be ~10% of the placenta]. This also helps explain why Chandler’s growth restriction was so severe when I had hardly any amniotic fluid, and why when my bag of water resealed itself and my amniotic fluid levels were normal again, her growth essentially took off and she caught up quite significantly. With my fluid levels back to normal, my placenta was able to continue to grow with the pregnancy and nourish Chandler as well as it did.

Can this happen again? Technically, yes, it can happen again. Is it likely to happen again? No, it would be highly unlikely. If we choose to have another baby, there is an increased likelihood of having another growth restricted baby once you’ve had one, but it doesn’t guarantee that another baby would be growth restricted. Future pregnancies for me would automatically be placed in the “high risk” category because of the nature of my pregnancy with Chandler [and because I will be “advanced maternal age” but we don’t need to go there :P].

I think one really valuable lesson John and I learned along the journey of this pregnancy and welcoming Chandler into the world is doctors don’t always know everything. They can do their best to predict outcomes given their own professional experiences and research they have consumed, but there is never a guarantee of a positive or negative outcome. For anyone reading this blog who is experiencing a high risk pregnancy with an uncertain outcome, I hope to leave you with a few things I’ve taken away from this experience:

• It’s okay to have faith. Now I’m not talking blind faith or unrealistic faith, but it’s okay to believe in something and have hope. For so long during this journey, John and I only had hope and faith to hold on to because it is what helped keep us going and took us out of the dark place where we started. Writing this blog was a beacon of light for me during that time and helped me hold on to hope – also buying baby clothes online and telling the universe and myself that we would use them [also, who doesn’t love buying baby clothes?] The power of positive thinking is real and I believe in it.
• Question everything. And I mean EVERYTHING. Ask all of the questions, and if you didn’t absorb the information the first time, ask again. And then when you get home, do research to educate yourself on your diagnosis. You have to be your own advocate. If your doctor suggests a procedure you can say no, you can ask for more information, and you can ask to think about it. We were asked countless times to consent to an amnio-dye test so the hospital could “prove” that my water broke. We continued to decline because the risks of pregnancy loss [even though it’s “only” 1 in 500] was too great a risk for us to feel comfortable just so someone could check a box and put my pregnancy in a category.
• Get a second opinion. Or even a third opinion if you need it. If we had listened to the first set of MFM doctors we saw when we initially were counseled after the anatomy scan, our daughter wouldn’t be here. We would have gone ahead and terminated what ended up being a perfectly healthy child. This ties back to questioning everything. Had our outcome been the same and our daughter had an incompatibility with life diagnosis, we would have felt more sure about making that type of decision and would have felt more empowered and prepared.
• Join a support group. Part of why I started this blog was I couldn’t find many stories online of women and families who have navigated an oligohydramnios diagnosis. There were maybe three or four stories I could find, some with a positive outcomes and some not. I was so desperate to know that someone else had gone through this before me and maybe I could read about their experience to prepare myself on what to expect, give myself hope, or at least feel less alone. I was able to connect with some women on a subreddit called r/NICUParents who had similar high risk pregnancies, and that sense of community was extremely positive and uplifting for me.
• Feel your feels. You are allowed to be angry and sad, sometimes at the same time. You are allowed to mourn the pregnancy you envisioned for yourself. You are allowed to feel the pain of what feels like almost losing your child. You are allowed to embrace your pregnancy and/or birth trauma. Just know that this wasn’t fair and it’s shitty and you’re allowed to take as long as you need to be in that place. Don’t be disappointed if your support group says things like “but everything turned out okay!” or try to draw comparisons to their own experiences to provide you comfort – they aren’t trying to negate your experience or minimize what you went through…sometimes people show up for you however they know how.
• Take care of yourself. For a long time, John and I had a really hard time finding joy when we were in the throws of grief during my pregnancy. We would have what we called “a moment” where one of us would start to cry and sometimes it hit us out of the blue and without warning or reason. I wish we would have done a better job of taking care of ourselves and finding joy. I was so focused on the future and the “what ifs” that I really ended up robbing myself of being happy for many months. All I could manage to do was keep living until “next Wednesday” when we would go to the hospital and hope we got positive news that could keep us going to the following Wednesday, and so on and so forth.

I’m not sure what the future of this blog will hold. I go back and forth on whether or not I should sunset this as it feels like a chapter has closed in my life while a new chapter is starting. Sometimes I feel like I should continue to write about Chandler and how she is doing, her development, and how she’s just a precious ray of sunshine. Tomorrow she will be seven weeks old [three weeks adjusted] and she is growing like crazy. She is so incredibly physically strong and has been since she was born, but that is no surprise to me because I could feel that when she was in the womb. I just knew this little girl was going to be a fighter and she has shown that daily. Thanks to all of you who have shown support for me and John during this journey – whether you’ve sent a gift, reached out to us directly, or even just followed this blog and read it as a silent supporter. We appreciate each and every one of you.

Love,

Daniele, John, and little Chandler girl

Hi, everyone! So sorry I have been late in posting an update to the blog – it has been a VERY busy last ten days with giving birth to Chandler, my hospitalization, her hospitalization, and homecoming for us both. I’m looking forward to sharing more about her birth story, as well as how she did in the NICU, and how she is doing now that she is home!

Birth Story:

As noted in earlier posts in the blog, the ultimate goal was making it as far along in pregnancy as possible with the most ideal outcome to deliver at 37 weeks, which is considered early term. My induction was scheduled for 6/21 and we had our normal Wednesday appointment with my MFM doctor on Wednesday, June 14th (35+6). When I met with her I noted reduced fetal movement, and that along with my prior hospitalization the weekend before for contractions (I did not post about this – sorry) and other NST monitoring which was not reassuring, she decided that inducing me that day was the best plan of action. We did not go home after that appointment, but fortunately had brought a hospital bag with us as we had a feeling that this would be the outcome.

John and I headed over to labor and delivery where they put us in a room and we waited to get hooked up to monitors so we could kick off Chandler’s birthday party. John brought me some McDonalds for lunch and a Pitocin drip was started to test to see if Chandler could tolerate contractions and a vaginal birth. After three hours of Pitocin, it was determined she was tolerating contractions to start the induction so it began. By time time, it was already around 5pm, so we knew we were in for a long night. I was approximately 1cm dilated so I was given the first dose of medication to soften my cervix. I was told that we would be checked again in 3-4 hours. After 3-4 hours, there wasn’t much change so I was given another dose of cervical softener and a foley balloon was inserted.

I was allowed to get some sleep after and was advised they would be back again in another 3-4 hours to check me again. Once I was checked again it was time for the foley balloon to come out and I was ~4cm, so the Pitocin was started. I don’t remember a ton of details really after this, other than my water was broken on June 15th in the afternoon and my total labor was 26 hours before I was pulled for an emergency c-section.

I’ll be honest – this birth experience was extremely traumatic for me. My birth plan was an induced vaginal birth with a low threshold for c-section intervention because we knew there was a possibility Chandler was not strong enough to tolerate the stress of labor due to her small size and the issues we had during pregnancy. I don’t know how this happened or if something was missed, but my care team allowed me to labor to a point where Chandler was unable to be safely monitored on the monitors and an intrauterine pressure catheter had to be used to monitor my contractions, and a fetal scalp electrode needed to be attached to Chandler’s scalp to get an accurate read on her heart rate. Once the scalp electrode was attached, her heart rate was extremely low and she was having continued decels. The care team had me alternate laying on my sides to see if her heart rate would improve, but it did not.

Around 8:40pm, it was decided an emergency c-section needed to be performed to get Chandler out as quickly as possible. Fortunately, the OR was across the hall from my room and they disconnected all the monitors and wheeled me across. Meanwhile, John was given the dad outfit so he could join me bedside for her delivery. Fortunately, I already had an epidural so the anesthesiologist started the spinal tap, however I still had sensation. Chandler’s condition continued to deteriorate and there was not time to wait for the spinal to take effect so we had to move to an emergency c-section with anesthesia. Due to this type of c-section being considered a sterile environment, John was not able to be bedside and they removed him from the room. Other things occurred on the operating table before I was put under, but as I mentioned this was a very traumatic birth and for the purposes of this blog details aren’t necessary.

Chandler made her appearance exactly at 9:00pm PST at 2000g. She was sent to the resuss unit where the NICU team was waiting. John was able to meet his daughter there while the team was completing the surgery on me. Due to exposure to anesthesia during delivery, Chandler did have to be placed on CPAP, and also required an IV and a feeding tube. John got to hold her once she was stabilized because when she came out she was not breathing on her own. Once I woke up in the recovery room, John brought her over to meet me however I do not have much if any memory of this due to all of the medication I was on. While I was recovering and getting ready to move to my room on the mother/baby unit, I encouraged John to spend time with Chandler in the NICU and to go home (it was almost midnight) and that I would see him tomorrow.

I was moved to my room and got settled there around 1am. Chandler was in the NICU and I was unable to go see her due to the anesthesia and not being able to walk.

NICU Story:

The next morning, John came to see me and together we went to the NICU to spend time with Chandler. I was really nervous to go to the NICU – something about being a mother who doesn’t know what her own baby looks like is hard to describe. When we entered her unit, I couldn’t have identified my baby if someone asked me to, but once I laid my eyes on her I fell in love with her instantly. She was a 4lb 4oz bundle of perfection – such a beautiful baby with the most perfect features, all ten fingers and ten toes, with a full head of hair. I was afraid to pick her up because not only did she seem so small and fragile, but she had several tubes and wires connected to her which made holding her a little bit difficult.

Chandler was able to come off her feeding tube almost immediately, as she did a really great job with her first bottle. She was able to latch to the bottle right away and learned the suck, swallow, breathe process really quickly. She had to remain on her IV for almost her entire NICU stay to help regulate her blood sugar, as preemies typically struggle with that until their bodies are able to regulate itself which gets easier as they are able to increase their feeds. That was our main focus was continuing to safely increase the volume Chandler ate at every feed to not overwhelm her tiny system, but help her body start to regulate itself so the IV could be removed. She had to have her little heel pricked before every feeding which was really awful, but slowly she was able to be weaned off of the glucose drip and two days before discharge she was able to be weaned fully.

Another reason Chandler was kept in the NICU was her bilirubin levels were high. She had to spend 24 hours on the UV lights to get her levels to where they were safe, and then we needed another 24 hours of her off the lights to show that her body was able to process the bili itself without the assistance of lights.

On Tuesday, June 19th we finally heard the words “discharge” come from her medical team. John and I were chomping at the bit to get her home as soon as possible. Leaving your baby at the hospital by herself was probably one of the hardest things I’ve had to do and I could almost hardly bear to not be with her. Before she could come home, she needed to be fit for her car seat to make sure she could safely be transported in it since she did not meet the weight minimum, and also needed a car seat test to ensure her vitals were not unsafely impacted by her being in the car seat position. She passed the car seat test and fit no problem, so another NICU obstacle was out of the way.

On the morning of Wednesday, June 20th, we started the discharge process to take our baby girl home. She was inspected one last time by the neonatologist to make sure she got a clean bill of health, and had a hearing test which she also passed. Around 10:00am, John and I walked out of the NICU for the last time but this time Chandler was coming home with us. It was an extremely emotional experience holding this precious baby girl that only 17 weeks before we were told might not make it, and if she did would likely be born with serious medical issues and may not be able to breathe outside of the womb.

When being faced with an oligohydramnios diagnosis, John and I felt like the world was crashing around us. This child who was so wanted may not make it, and if she did, our lives might not be “normal” with raising a healthy child and could potentially consist of lots of hospital time and a high level of medical intervention. Now as I write this blog with my baby girl laying next to me, breathing room air with her lungs which we were told may resemble raisins and never fill with air, with arms and legs and fingers and toes which move freely on their own which we were told might have contractures and she may not be able to walk or behave like a normal child, and with all of her organs not only functioning but working perfectly just as intended, we can’t help but be so relieved this journey is over but also to extend the hope to other parents who may be experiencing a similar diagnosis in their pregnancy. While not all outcomes are as fortunate as ours has been, one thing I have learned throughout this process is

1. Always ask for a second opinion. Had John and I only listened to the first two perinatologists who spoke to us after the anatomy scan, Chandler would not be here today. We would have terminated a pregnancy of a child who turned out to be perfectly made.
2. The power of positive thinking is stronger than I ever thought before. Waking up every day, John and I chose to speak about our daughter in the sense that she would someday be here, we planned for her future and our future as a family, and we weren’t willing to accept an outcome where not having her would be a possibility.
3. Find your tribe. We leaned in to support from family and friends who shared our positive mindset of not accepting an outcome which wasn’t favorable. Being able to pick up the phone to call or text an update which wasn’t always ideal, provided comfort to us as we had people we could confide in who may not have been able to fully understand what we were going through, but did their best to be there for us.
4. Trust your medical team. If you can’t trust them with one of the most important things in your life, they aren’t the right fit for you. From my perspective, our doctor saved Chandler’s life. If you don’t feel comfortable with your medical team, find a new one who makes you feel like you are receiving the best care possible and who isn’t afraid to give you the honest truth even when it doesn’t feel good.

Now that my pregnancy journey with Chandler is over, we will be looking to transition this blog to share details about her infancy and milestones for our friends and family. Thank you to everyone who has followed our journey – whether you are a family member, friend, or just a stranger from the internet who happened upon this blog, your support has meant a lot to me and John along the way.

Signing off for now!

-Proud parents of Chandler

John here again, everyone is doing great. Mom and Baby are both fine.

better update to come… Sorry if you have been waiting!

John here – It’s go time! More to come

Hi, everyone! I wanted to drop in and give a quick update after our appointment last week at 32w and this week at 33w.

Last week:

Last week’s appointment (5/17) went well for the most part. We had a growth scan and Chandler measured at 3lbs6oz and is now in the 7th percentile. She passed her biophysical profile with a score of 8/8, however she didn’t want to wake up and show movement which was a bit scary for us. The ultrasound tech jabbed at my belly for several minutes and she finally cooperated and started to move. We let our doctor know and she seemed concerned so I’ve been keeping an eye on her movement. Her Dopplers looked good and her vein varix remains stable, which is also great!

We had a NICU consult on Monday (5/22) to better understand what the post-birth plan will be now that we are in the later stages of pregnancy, compared to how we were counseled initially at the 23 and 27 week mark. It’s relieving to hear that intubation will be unlikely and is considered worst case scenario versus “you should be prepared for this”. It’s most likely if she needed breathing support that we would be looking at CPAP or a cannula. We are very hopeful we will not need a NICU stay for breathing, however we have been advised we may still have a NICU stay for blood sugars, temperature control, or low birth weight – which compared to what we were expecting previously, we are both okay with this being why she needs additional care.

This week:

This week’s appointment on 5/24 was pretty uneventful and Chandler scored another 8/8 on her biophysical profile. This week was not a growth scan week so we didn’t find out how much she has grown, however her Doppler looked good and her vein varix was once again stable. When we met with our doctor this week she advised us she would like to go to twice a week monitoring starting immediately due to her heightened concern of stillbirth. This of course is really scary for us both and one of our biggest concerns at this point, so moving forward until delivery we will continue Wednesday appointments for ultrasound and will start to incorporate Friday appointments for NSTs (non-stress tests), with our first NST being today 5/26. Last night we almost needed to go in to L&D because Chandler hadn’t moved for several hours, and I was finally able to confirm movement which was a relief.

As of now our induction is still scheduled for 6/21, but we are going to speak with the doctor next week to find out if there is any way that can be moved sooner because it is extremely stressful and anxiety inducing to be constantly worried about whether or not our baby is okay and how she is doing.

That is all the updates we have for now – I will write again next week after our appointment on Wednesday. Thanks for everyone’s constant support – it means a lot to us!

Hello, everyone! Sorry for the delayed update – we have had a busy two weeks with doing stuff around the house to prepare for Chandler’s arrival as well as finally getting away from Portland for a bit to visit some family. I’ll give an update as to what happened last week and also what happened at our appointment yesterday!

5/3 Appointment:

Last week’s appointment was a growth scan, biophysical profile, and the normal check of the blood flow from the placenta to the baby. Everything looked great – fluid levels were stable, organs all were presenting as normal, and her vein varix was also stable. She was measuring at 1219g (2lbs11oz) and has now graduated to the 6th percentile from where she was previously at the 5th percentile! She scored a 6/8 for her biophysical profile due to not performing the breathing exercises for long enough, but according to our doctor the breathing exercises are really expected starting at 32w gestation, so nothing to be worried about.

We discussed what the remainder of the pregnancy will look like such as delivery timeline, next steps for my prenatal care, and any additional appointments we need to have. I will be receiving the next betamethasone shots between 31-32w, delivery will be by 37w, and we will have another intake appointment with the NICU team around 33-34w so we can better understand what the care will actually look like compared to what we were counseled on previously.

5/10 Appointment:

Yesterday we went in for our basically 31w appointment. This week’s appointment consisted of a biophysical profile, doppler check which measures the blood flow from baby and placenta, and checking fluid. Her fluid was at the highest we’ve seen at a little over 16cm, which is great according to our doctors. Doppler looked good and she passed her biophysical profile with an 8/8. Overall, it was an excellent appointment and she’s doing a great job in utero! I had the first dose of the second round of betamethasone and will be going in again this afternoon to get the second dose. We have our induction scheduled for 6/21 and will arrive sometime between 8a-8p that day. It’s hard to believe that is six weeks from today! We have so much to get done still to prepare for Chandler’s arrival, including finishing her room, getting her clothes ready, and finalizing needed items off our registry. We still aren’t sure how big she will be when she’s born so we are planning on bringing both preemie and newborn clothing, which fortunately we have a lot to choose from!

Next week we will be going in for another appointment which will include all the regular checks as well as another growth scan. John and I like to guess what her weight will be, and usually he is a lot closer than I am. I think she will definitely join the 3lb club next week!

We’ve had a lot of folks reaching out asking if we are registered and if so where. I’ve linked our registries below! Thanks again to everyone for all the love and support – it has been such a journey and we are so excited to welcome our little girl and hope she comes out as healthy as possible, all things considered.

Amazon

Pottery Barn

Target

It’s been about two weeks since I posted an update so I wanted to jump on the blog and write about how the last two weeks have been going with baby Chandler.

Last week we went in for our growth ultrasound and it was the first ultrasound since I was discharged from the hospital on 3/12. Chandler measured at 930g, which is 2lbs, and my fluid remained stable at ~12.3cm. Our doctor advised us last week that she no longer feels a fetal MRI is recommended as the information we would get from the MRI wouldn’t change the plan of care, so John and I agreed that we were comfortable not moving forward with it. She did however recommend we add in additional monitoring weekly in the form of biophysical profiles because stillbirth is still a concern for growth restricted babies. A biophysical profile is where the baby is observed on the ultrasound for a period of 30 minutes and various things are checked such as the baby practicing breathing exercises, movement, etc.

Yesterday we went in for our weekly ultrasound and our first biophysical profile. During the scan, Chandler was moving around a lot which is pretty normal for her. The fluid remained stable measured at ~13.0cm. One of the fetal radiologists came in towards the end of the scan to look at the Doppler which observes the blood flow through the umbilical cord to ensure baby is receiving the blood flow and nutrition she needs. During this scan we were told that an umbilical vein varix was seen – this was the first we had heard this. An umbilical vein varix essentially is the umbilical vein being larger in size than what is considered standard. It is considered “rare” and is seen in 1/2500 pregnancies. There are some risks associated with it as what can happen is a blood clot could enter the umbilical vein and possibly block blood flow to the baby. Our MFM doctor was not overly concerned with this and since we are already coming in for weekly scans we will continue to keep an eye on it. Right now it is measuring at 14.7mm, which is about double the size it should be. If it continues to get bigger and poses additional risk, we will have to have that conversation with our care team but they will keep checking it weekly.

Now on to the good news. Last week when we discussed the introduction of biophysical profiles, our MFM doctor warned us that due to Chandler’s gestational age we wouldn’t expect to see her perform well. Biophysical profiles normally start around 32 weeks, so Chandler just isn’t as developed as most babies are who are observed and the standards are set for older babies. Our doctor told us she would be satisfied to see Chandler receive a 4 out of 8 and anything below that would be cause for concern. We are excited to share that Chandler not only scored above a 4 out of 8, but she had a perfect score of 8 out of 8. This tells us that the uterine environment is the safest place for her and she is thriving where she is.

Next week we will have another biophysical profile as well as a growth scan. We are hopeful she continues to demonstrate that staying in utero is best for her and we were advised even if her growth were to stall for whatever reason, gestational age is still most important meaning intervention would likely not happen anytime soon. The countdown begins and she can arrive anytime but will for sure be here in eight weeks, which will fly by!

Hey everyone! Sorry I haven’t updated the blog after our last scan on Wednesday (4/12) but we had a lot going on because I was discharged!!! It’s so nice to be writing this blog update from the comfort of home, on my sofa with my dogs, and watching Love is Blind on a screen that isn’t a laptop. Being sent home was a positive thing and I will explain why and what the plan moving forward is.

I believe the last update I posted was after our scan last Wednesday when we found out my AFI (amniotic fluid index) increased from ~2cm to over 10cm. After the MFM team measured the fluid in my hospital room, the plan moving forward was to go to the fetal therapy clinic that Friday (4/7) to have the fetal radiologist involved and another follow up Wednesday 4/12. The scan on Friday went great and the fluid was observed at around 11cm with good Doppler, indicating blood flow through the umbilical cord was good. After Friday’s ultrasound, the plan was to continue with daily non-stress tests (NSTs) until the next ultrasound. On Sunday, Chandler failed the NST due to a large decel which was a concern, however the following NSTs were passing so the doctors weren’t overly concerned with the failed NST. A NST essentially looks to measure the baseline fetal heart rate, and based on gestational age looks to measure at least a 10bpm increase over a measured period (mine were typically 20 minutes). 10-15 increases is considered passing for Chandler. On Sunday, however, she had a large drop in her heart rate where it fell into the low 60s and remained low for a period of six minutes. As to why that happened is really unknown, but some explanations given is she could have rolled onto her cord or possibly grabbed her cord. We had an additional 90 minutes or so of monitoring which all looked normal, and that paired with the monitoring in the days following is why right now intervention isn’t necessary (intervention = delivery).

After that scare on Sunday, I’ve been making sure I keep track of kick counts and ensure she is moving around and she has been. On Wednesday, John came to the hospital for the ultrasound because we had a feeling I would be discharged so he wanted to be there to take me home after. The ultrasound went great and the fluid has been stable in the 10-11cm range and the Doppler looked great.

So what next? Does this mean the pregnancy is no longer high risk? Unfortunately, no, we are not magically cured and there are still concerns that the doctors want to monitor and keep an eye on. Moving forward, we are going back to the weekly visits to make sure my placenta is performing as it should be (there has been talks that a placental issue could be the cause of these problems and not PPROM) as well as biweekly growth measurements to ensure Chandler is thriving in utero. Right now my pregnancy is still considered high risk due to her small size as she’s still in the 3rd percentile, so making sure she continues to receive the nutrition she needs to grow is the focus moving forward. Babies who are SGA/IUGR (small for gestational age/intrauterine growth restriction) and are not monitored sometimes can die in utero when they are no longer thriving, hence why we are going to be watched very closely. Based on the fluid increasing exponentially, the previous diagnosis of PPROM is no longer the case and the doctors either think my water broke and has resealed, or it never was a PPROM case and was the placenta all along, however there is no way to be sure. Due to PPROM and the risks of infection no longer being a concern, delivery at 34 weeks is no longer the plan. The doctors are hopeful to keep Chandler in utero until 37 weeks and have her delivered at that time as long as she continues to thrive.

Over the past six weeks we have had three growth scans, and at each scan she has gained 6oz. At the last growth scan she weighed 672g, which is equivalent to 1lb 7 oz. If she continues to maintain the same weight gain as she has been, at birth she may only weigh a little over three pounds so we are both prepared for intervention (again, intervention=delivery) at any time in the case her growth doesn’t advance past what we’ve seen. Although we can pontificate based on what trends she has shown, we really have no way to predict how her weight will change over the coming weeks, and to take this pregnancy week by week. Although we do not know when the right time for her to come will be, when it happens we will be so excited to meet her! Lung development is still a big concern for our doctors as although her fluid has increased, she had very low fluid at a critical time so we do not know if that was enough. For now I will be taking it easy at home, and we will visit the fetal therapy clinic again next week. I will post another update once we have one. Thanks again for everyone’s support!

Today marks two weeks in the hospital, and tomorrow I will be 26 weeks! It’s crazy how much time has flown by since I got admitted as well as looking back to the day we received the oligohydramnios diagnosis. It’s hard to believe that was over six weeks ago. Today we received some positive news, however we are approaching that positive news with cautious optimism as is our medical team.

This morning I was brought to inpatient radiology to have my weekly ultrasound where they planned on measuring the amniotic fluid levels, look at the umbilical cord and placenta on the Doppler, as well as do a fetal growth assessment on Chandler since it had been two weeks since our last check (on 3/22 she was measuring at 492g). This ultrasound was a bit different than the ones I’ve had previously, as the ones John and I attended outpatient there was a screen where we could see, and the one last week inpatient was performed in my room where I could also see the screen. In case you haven’t checked the blog lately, last week’s ultrasound along with the ultrasound on admission day both measured ~2cm, which is where we have been measuring since my intake appointment at 20w. I asked the tech if she could tell me how big Chandler was or my fluid levels and she told me she could not, but the perinatal team would be able to go over results with me. Yikes – nothing quite like that kind of anxiety.

I got back to my room around 9am and shortly after I got a notification that my results were ready to be viewed in MyChart. I looked at the results and the report showed 9cm….9cm?! This can’t be right. I called John to let him know and that I wasn’t sure if this was something for us to be happy about or if we should worry – a 7cm jump in a week seems really crazy and could this be a sign of something else going on? Around 11, the MFM team came in to go over the results with me and they brought an ultrasound machine with them. As soon as they entered my room they asked if I had seen the MyChart results, and I said yes and asked if I should be happy or worried. They told me I should be happy and this was great news, but they wanted to see this for themselves and ensure there was no error, which is why they brought in the machine.

I laid back and one of the doctors who was with John and I in the room on the day we got the oligohydramnios diagnosis (who had told John that she has never seen a case of oligohydramnios correct itself) performed the ultrasound and to say the doctors were in a state of disbelief is probably an understatement. The MFM doctor was able to measure a total of 11cm of fluid. For anyone who hasn’t spent a bazillion hours learning about AFI pockets like I have, anything from 5-25cm is what is considered standard or “normal” fluid in pregnancy, anything <5cm is considered oligohydramnios, and measurements <2cm is anhydramnios (which is what we were initially diagnosed with). Of course I had a ton of questions for the doctors because I just was blown away at how I could have 2cm of fluid consecutively for weeks on end, and how in a matter of a week it suddenly self-corrected.

Right now the doctors really don’t know why my fluid is miraculously higher. There is still the uncertainty of whether or not I was a PPROM case (ruptured membranes), if this is a placental deficiency, if there is some sort of underlying. genetic explanation, or a combination of the above. In addition to the increase in fluid, Chandler is now measuring 672g (1lb 7oz) and is now out of the “below 3rd percentile” range and is measuring at the 3rd percentile. Another interesting fact to know about fetal measurement is anything below the 3rd percentile is not measured at a granular level – if your baby falls below the 3rd percentile they are grouped in “below 3rd percentile” whether they’re the 2.9 percentile or the 0.1 percentile. Chandler graduating out of the “below 3rd percentile” to the actual third percentile is also really excellent news and may be another indicator that the low fluid was due to placental issues.

So what happens next? I assumed I should start packing my bags and they would be discharging me because now everything is fine, right? Well, not exactly. So although this is amazing and incredible news, the doctors are definitely proceeding with caution and want to ensure things are actually stable and improved. On Friday I will be going back over to the fetal therapy team to have another ultrasound performed by one of the fetal radiologists that we had been seeing prior to my admission. The placental issues that had been observed during the 3/22 scan and prior scans do have to be evaluated by a fetal radiologist just because their expertise is needed to identify the anomalies – so that’s the first step. I will also hopefully get the chance to chat with Dr. Duchovny who has overseen my care to better understand what the care plan looks like moving forward. I will have another scan on Wednesday, 4/l2 as well prior to the team deciding if discharge is the right option for me.

One thing to note is Chandler is still what is considered small for gestational age or SGA, which does still leave me in the high-risk zone. If my fluid stays where it is and Chandler stays in utero where she is supposed to be, the concerns of pulmonary hypoplasia (incomplete/under-developed lungs) can be almost entirely eliminated as a risk factor for her. Also, assuming I did rupture my membranes and assuming my fluid is elevated now because they re-sealed (it can happen but it’s not typical) we also would be looking at a modified delivery plan. We have been told that 34 weeks delivery is the latest that a PPROM patient should carry to reduce risk of infection to the mother, however if that ends up being changed I would not have to deliver possibly until 37 weeks. These are all subject to change though, because ultimately the decision to deliver is going to be based on how Chandler is doing, if she is still thriving in the womb, and how big she is. We are still being told she will be a small baby, but so far she has shown she is healthy and strong.

That’s all the updates for now. John and I are extremely excited to share this positive news with everyone, but we are still prepared for things to change as this pregnancy has demonstrated that things can change day by day. I will post a new update on Friday after the next ultrasound. Until then, thanks to everyone for your thoughts and prayers!

Dropping in to the blog to give everyone a quick update on how things are going. Things are remaining stable week by week and I have now been at the hospital for 12 days. On Wednesday, I had my weekly ultrasound to measure fluid and have a Doppler performed on the umbilical cord. The fluid is still measuring at ~2cm as it has been for the past six weeks, and the Doppler showed an expected level of blood flow between the placenta and baby Chandler. No news is good news in our world right now.

Every day non-stress tests are performed to see how Chandler is doing in the womb and to make sure she’s still thriving. So far she has been outperforming what is expected at her gestational age, which John and I are both really happy to see. Last week one of the perinatologists told me she is performing at the gestational age of what they would expect to see in a 29 weeker, which he translated for me to mean that it shows a strong correlation in her heart and brain development. In his words, “she gets a gold star.”

Tomorrow I have a gestational diabetes test which is typically performed around this time, so that is a business as usual and routine test. I don’t have anything else to share regarding changes at this time. I’m hanging in there in the hospital and taking things day-by-day. My mom sent a care package with a bunch of crafts which I have been keeping busy, along with watching all of the trash TV I can get my hands on – Love is Blind anyone? Thanks to everyone for reaching out and keeping us in your thoughts. I will post hopefully on Wednesday after our next ultrasound.