Monday, March 18, 2013

Low, Moderate or High Risk?

So, we found out several months ago that this baby may have a tiny little heart issue, which is most likely just a derivation off the normal curve, but still within acceptable. At that time we were told that we should go back at 30 weeks to have the heart checked again, and make a game plan from there, depending on what we find.

At our appointment two weeks ago, we found that while the initial heart issue has improved (not gone away entirely though), it seems the heart may be compensating slightly and has some small weaknesses it's presenting on the right side. The perinatologist also found another issue (related, and possibly the cause of the first issue, I believe? You try to ask all the right questions but then walk away with some information gaps) which again, is likely not a huge cause for concern, but could cause more problems which would result in immediate & premature delivery.

While we are choosing not to worry about these issues too much (as our peri said - if they were worried, they'd monitor me even more closely), our more hands-off approach to monitoring this pregnancy has shifted slightly (at least right now it has. If we find out that the problems have resolved, we're back to low-risk), and we're finding ourselves with appointments stacked on top of one another. For example: this week I have another Fetal Echocardiogram with the Perinatologist, yet another (and a consult) with the Pediatric Cardiologist, and a standard checkup with my midwife. It'll be a busy, medical week.

So, here's the rundown, in layman's terms, as best as I can capture it (so there will be some mistakes, I'm sure).

The initial scan found mild Tricuspid Regurgitation. This means that the tricuspid valve, which is located on the right side of the heart and is supposed to be a one-way passage of blood, is leaking a bit of blood in the backwards direction. It was leaking more 10 weeks ago than it is now, but it's still not operating 100%. It could go away entirely by birth, or remain the same. Further (at this time), the perinatologist explained that she saw some "sporadic increasing velocities of blood flowing through the ductus arteriosus" - indicating that the ductus arteriosus may be narrowing. What's the ductus arteriosus, you ask? Good question - it's basically a blood vessell in the heart which only exists in a fetus. It's purpose is to bypass oxygenated blood away from the lungs (lungs don't need oxygen when the baby is in-utero) and back to the heart. It shuts down after birth, once the baby starts breathing, because at that time the lungs require the oxygen. So, to see it narrowing in a fetus indicates a possibility that it could shut early (during pregnancy) and the lungs would start to get too much blood. She gave us a 1% chance of this happening, and assured us that she really isn't concerned, but was being "ultra conservative."

Apparently, this desire to over-diagnose is in line with the national push to diagnose any/all potential fetal heart issues (when there's a big issue which is caught early, obviously the baby has a better chance of survival). We are choosing not to worry about these issues - our doctor seems very confident that both issues are essentially just outside the bell curve, but still within "normal." Of course, we'll be diligent and follow up according to their recommendations. I'm not feeling anxious or nervous about early delivery, but accepting the very slim chance that this could happen (1%. Slim.). If it happens, we'll deal. The good news is the baby is measuring big, just in case we deliver early.

Tomorrow we start the week of appointments, and I'm expecting tomorrow night I'll be back here on my couch, and not recovering from giving birth prematurely. I'm blogging about this now though, on the off chance that things don't go as I expect, and the next post is "surprise, I had a baby!" and everyone wonders what the heck just happened. :) In the meantime, maybe we should get down to getting some names finalized, just in case. I don't want my poor preemie baby hanging out in the hospital as "baby no-name"...

1 comment:

  1. Ah, friend, I'm sorry. Forewarned is forearmed, as they say, and I think you're right about over-diagnosis of potential fetal heart issues. We were warned that Jamie might have a problem due to a calcification spotted at 22 weeks. It hadn't grown at 30 weeks, and obviously, he is fine. Charles had a heart murmur until he was 4. What I'm trying to say is, thank God for modern medicine because while the possibilities are scary, the best thing about all of this is that the problem is understood and there is a solution that can be enacted should your odds change. Until then, mama, your job is love. And you're doing a great job of that!