Dearest Bunny,
It's 4:24 a.m. and your mommy is having a bit of pregnancy insomnia ... so I'm putting it to good use by writing you an overdue letter about our ultrasound last week. Life has been so busy here lately, and sitting down to write has taken a back seat to homeschooling, laundry, birthday parties and errands. So even if I wouldn't normally appreciate being wide awake several hours before I need to be - if it means a free window of time to write to my bunny, I'll take it :)
Last Monday, Daddy and I returned to the hospital we've traveled to many times before, to have our 20 week level two ultrasound. The doctors there specialize in high risk pregnancies, especially when they involve mommies of "advanced maternal age." The technicians (as well as the ultrasound machines themselves) are the best there are in our area. It is amazing to me how far technology has come in maternal/fetal medicine even in the last five years. I know sometimes technology can be a double edged sword - there have been times in previous pregnancies when I have felt that knowing "too much" as far as risks go, was not necessarily a great thing. But now that we have moved beyond risks and are dealing with some very real possible health concerns, I am grateful for any knowledge that can help our doctors be better prepared to take care of both you and me. I know many babies' lives have been saved because of advance knowledge of certain medical conditions and issues, and we want to be as best prepared as we can to face those and get you any help you need.
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| cutest little bunny ever !! |
So ... here is how the ultrasound went ...
We arrived at our destination early last Monday morning, eager to get a peek at our beautiful baby girl again. After a few minutes of waiting (that always feel like forever !) the nurse called us back to check weight gain, blood pressure, etc. before moving into the room where our ultrasound would be done.
I have to say here, that Daddy and I decided early in this pregnancy to agree on something : we were not going to let fear or worry rob us of any of the joy we would experience during our last pregnancy together. We knew the possibilities going into this, that there might be chromosomal or health issues related to our age, but we prayed for months before conceiving you, that God would give us the desire of our hearts for one last baby. And when that second little line appeared on my pregnancy test, the morning of our 28th wedding anniversary, we made a pact to enjoy this precious gift of life without any fear. That's not to say there aren't moments when the "what-ifs" don't try to creep in and dominate my brain. But when they do, I remind myself of our decision to - in your daddy's words - "war against worry". And I turn my worries into prayers for your health and safety and mine, and fix my thoughts on what is good and true. And that is this, little bunny : you are a miracle. My odds of getting pregnant at 47 were one percent every month. I've read enough articles and statistics on women getting pregnant at my age to know what a gift and miracle I've been given, and I'm not going to let any fear or doubt steal that gift from me. I'm so thankful for this amazing little present I carry inside of me, and I'm not letting anything stand in the way of enjoying this final season of my life - you are a blessing straight from Heaven, and I am so grateful to be your mama.
And I said all that to say, that even though we knew we were at a specialist to look for potential problems with this pregnancy, we could not get away from the excitement we felt at seeing you again. Several people who have walked this way before have shared that they've had the same feelings we did: the nice thing about high risk pregnancies is that you have LOTS of opportunities to "see" your little one before they are born !
The technician who did our scan last week was one who has seen us in the past ... she is extremely thorough and communicates everything as she sees it. Daddy asked her why she is allowed to share everything so freely - there have been some technicians in our history of ultrasounds who were so tight lipped during things that we had no idea what they were measuring or looking at . This technician explained that there were several factors involved in her openness - the main one being that this is a clinic that deals specifically with potential health issues, one where the doctor comes in immediately afterwards to do her own scan and discuss the results. There is no waiting period, where pictures are sent to the doctor - she is right there to talk to us about what things they are seeing, and she is relying primarily on what the technician sees initially, to tell her what is going on with our baby.
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| sweet little profile |
During last week's scan we saw the same soft markers for Down syndrome we had seen before - one of your kidneys is enlarged, which the doctor said will probably resolve itself and not be a problem at birth. Your leg and arm bones are lagging by one week - every other measurement corresponded exactly to your gestational age at the time, of 19 weeks and six days.
The tech got a very good look at your heart this time- she saw four distinct chambers, as well as a number of other details that told us everything looks very good at this point. The blood flow was going in the right direction, there were no major evident holes, and the nuchal fluid at the back of your head was within normal range, meaning your heart is pumping as it should. The tech noted that it is a bit elevated however- at the high end of "normal", so we are going to keep an eye on that. I looked up this information online that explains everything- this really made me thankful that the technician who saw us is actually a Fetal Echocardiographer.
When serious heart defects are identified before birth, studies have demonstrated that the outcome of the newborn may be improved, especially for defects involving the left side of the heart and those of the outflow tracts. One of the problems, however, is the identification of the fetus with a congenital heart defect. At the present time over 90% of fetuses with serious heart defects may go undetected because of the limited experience of the physician or sonographer performing the screening examination of the heart. However, when the fetal heart is examined by specialists, known as Fetal Echocardiographers, the detection rate for congenital heart defects exceeds 90%. Therefore, the problem is the following: “How can the fetus with a heart defect be identified so that a cardiac examination can be performed by a Fetal Echocardiographer?”
There are several solutions to this problem which are as follows:
1. First-trimester Nuchal Translucency Screening
Investigators have reported an association between an increased nuchal translucency measurement and the increased risk for congenital heart defects. One explanation for this association is that as the blood flow patterns are altered by the cardiac defect, congestion or other changes occur that manifests as an increase in size of the measured nuchal translucency.
2. Second-Trimester Genetic Ultrasound
This study is performed between 17 and 20 weeks of pregnancy and detects over 90% of fetuses with heart defects.
3. Third-Trimester 4D Fetal Heart and Face Screening Program
This examination of the heart occurs in the third trimester, between 24 and 32 weeks of pregnancy. This is a new program created by Dr. DeVore and is useful, especially for patients that cannot be referred for 1st trimester nuchal translucency screening or 2nd trimester Genetic Ultrasound, because it can identify defects of the heart, face, and abnormal growth.
When the tech switched to the color mode on the ultrasound, which shows the direction of the blood flow, there was a brief moment when the red color seemed to cross both sections of the heart, rather than remaining distinctly separate. It was only for a second, and the tech said that this could just be what is referred to as a "color flash"... meaning that you may have moved and the blood flow appeared to be crossing where it shouldn't, when in reality it is only a flash of color on the screen because of that movement. However, she told us she would let the doctor know, and that this is something they are going to make note of for our next appointment, when we have a full echo done on your heart. This will happen in four weeks, when your heart is more fully developed - that ultrasound will exclusively look at your heart in detail, to see if there are any holes or defects that were too small to be noticed previously.
After looking at and measuring everything else she needed to, our tech noted that the placenta had moved a fraction of a centimeter away from my cervix, which was an improvement. I asked her if this was placenta previa, and she said yes, and hadn't they told me about this last visit ? I answered no, and said it was probably a good thing ! (I'm doing great in my war against worry, and I probably didn't need that news at that point in time;)) She went on to explain that this is not full placenta previa- the placement is just slightly covering my cervix right now, but they fully expect it to shift upwards as my uterus grows throughout the rest of my pregnancy. Whew !
When the scan was finished, our doctor came in to discuss the results and do her own brief scan. We talked about the placenta, and she explained that they like it to be at least 1.7 centimeters away from the cervix at delivery - if it is not, then a c-section is required. However, there is still plenty of time for my uterus to grow and stretch, which would (hopefully) move the placenta with it. I have never had this before, but the doctor said that most of the time it does move enough - unless it is completely covering the cervix, which mine is not. Just something else for us to pray about, but I really am not worried ... we've seen God do much bigger miracles than moving a placenta over a few centimeters ;)
The rest of the ultrasound was spent discussing where I am going to deliver you, little bunny... but it was a lengthy discussion, and this letter is already getting to be long, so I will save it for another post.
Rest assured though, Daddy and the doctors and I are going to do everything we can to make the best decisions we can for your health and safety. We are SO in love with you already, Bunny, and we haven't even held you yet- I can't wait to see this beautiful face in person in just a few months ...
Love you to the moon and back, Madison Faith.
All my love,
Mama xoxoxo
The tech got a very good look at your heart this time- she saw four distinct chambers, as well as a number of other details that told us everything looks very good at this point. The blood flow was going in the right direction, there were no major evident holes, and the nuchal fluid at the back of your head was within normal range, meaning your heart is pumping as it should. The tech noted that it is a bit elevated however- at the high end of "normal", so we are going to keep an eye on that. I looked up this information online that explains everything- this really made me thankful that the technician who saw us is actually a Fetal Echocardiographer.
When serious heart defects are identified before birth, studies have demonstrated that the outcome of the newborn may be improved, especially for defects involving the left side of the heart and those of the outflow tracts. One of the problems, however, is the identification of the fetus with a congenital heart defect. At the present time over 90% of fetuses with serious heart defects may go undetected because of the limited experience of the physician or sonographer performing the screening examination of the heart. However, when the fetal heart is examined by specialists, known as Fetal Echocardiographers, the detection rate for congenital heart defects exceeds 90%. Therefore, the problem is the following: “How can the fetus with a heart defect be identified so that a cardiac examination can be performed by a Fetal Echocardiographer?”
There are several solutions to this problem which are as follows:
1. First-trimester Nuchal Translucency Screening
Investigators have reported an association between an increased nuchal translucency measurement and the increased risk for congenital heart defects. One explanation for this association is that as the blood flow patterns are altered by the cardiac defect, congestion or other changes occur that manifests as an increase in size of the measured nuchal translucency.
2. Second-Trimester Genetic Ultrasound
This study is performed between 17 and 20 weeks of pregnancy and detects over 90% of fetuses with heart defects.
3. Third-Trimester 4D Fetal Heart and Face Screening Program
This examination of the heart occurs in the third trimester, between 24 and 32 weeks of pregnancy. This is a new program created by Dr. DeVore and is useful, especially for patients that cannot be referred for 1st trimester nuchal translucency screening or 2nd trimester Genetic Ultrasound, because it can identify defects of the heart, face, and abnormal growth.
What Percentage of Serious Heart Defects are Identified as the Result of an Increased Nuchal Translucency?
In 2005 Makrydimas et al published their results from a pooled database in which the nuchal translucency was measured during the first-trimester in 637 fetuses with congenital heart defects. The fetuses were divided into two groups; those with abnormal chromosomes and those with normal chromosomes. When the nuchal translucency was 3.5 mm or greater, 59% of fetuses with heart defects and abnormal chromosomes were identified. Similarly, of fetuses with normal chromosomes, 23% with heart defects were identified because of an increased nuchal translucency measurement. |
| umbilical cord mustache, and your tiny fist by your face :) |
When the tech switched to the color mode on the ultrasound, which shows the direction of the blood flow, there was a brief moment when the red color seemed to cross both sections of the heart, rather than remaining distinctly separate. It was only for a second, and the tech said that this could just be what is referred to as a "color flash"... meaning that you may have moved and the blood flow appeared to be crossing where it shouldn't, when in reality it is only a flash of color on the screen because of that movement. However, she told us she would let the doctor know, and that this is something they are going to make note of for our next appointment, when we have a full echo done on your heart. This will happen in four weeks, when your heart is more fully developed - that ultrasound will exclusively look at your heart in detail, to see if there are any holes or defects that were too small to be noticed previously.
After looking at and measuring everything else she needed to, our tech noted that the placenta had moved a fraction of a centimeter away from my cervix, which was an improvement. I asked her if this was placenta previa, and she said yes, and hadn't they told me about this last visit ? I answered no, and said it was probably a good thing ! (I'm doing great in my war against worry, and I probably didn't need that news at that point in time;)) She went on to explain that this is not full placenta previa- the placement is just slightly covering my cervix right now, but they fully expect it to shift upwards as my uterus grows throughout the rest of my pregnancy. Whew !
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| smiling or laughing ? |
When the scan was finished, our doctor came in to discuss the results and do her own brief scan. We talked about the placenta, and she explained that they like it to be at least 1.7 centimeters away from the cervix at delivery - if it is not, then a c-section is required. However, there is still plenty of time for my uterus to grow and stretch, which would (hopefully) move the placenta with it. I have never had this before, but the doctor said that most of the time it does move enough - unless it is completely covering the cervix, which mine is not. Just something else for us to pray about, but I really am not worried ... we've seen God do much bigger miracles than moving a placenta over a few centimeters ;)
The rest of the ultrasound was spent discussing where I am going to deliver you, little bunny... but it was a lengthy discussion, and this letter is already getting to be long, so I will save it for another post.
Rest assured though, Daddy and the doctors and I are going to do everything we can to make the best decisions we can for your health and safety. We are SO in love with you already, Bunny, and we haven't even held you yet- I can't wait to see this beautiful face in person in just a few months ...
Love you to the moon and back, Madison Faith.
All my love,
Mama xoxoxo
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