30 Weeks

It is such a relief to be in the 30s!  Austin is showing more signs of being affected by the Rh disease so we feel better and better as each week passes and 30 weeks feels great.  It has been a busy week so let's get to it.

On Monday we saw my OB for my regular (3 week) appointment.  This appointment went well and our doctor is very pleased with how things are going.  I had my glucose test last time, which came back totally normal, but naturally everything can't be completely right.  My blood work showed that the shape of my red blood cells is just barely above the "normal" range.  I genuinely laughed out loud when he told me.  Seriously?  I don't think I'll ever have blood work that looks like it should.  They measure the shape of your red blood cells by a number and the high end of normal is 36.0 and mine was 36.1.  My doctor said that it's so close to the normal range that he's not even going to re-draw my blood.  We just laughed at the situation more than anything and I'm not worried at all.  Apparently if the shape of your red blood cells gets too abnormal then they start checking for things like Sickle Cell Anemia.  We're not concerned about that being an issue one bit!  Aside from that "slightly off" blood work, everything else looked great.  Austin's heart rate was strong and I was measuring right where I should.  Only one more 3 week appointment and then we'll switch to every 2 weeks! Little things like that are starting to make this feel real!

Wednesday was MCA scan #6 and we had a goal of his level being somewhere between 40 and 46 because that would mean he's still in "C".  When the nurse said "57" that was definitely not what we expected or wanted to hear.  You can see from the chart below that 57 is right below "A" which means a transfusion is near.

On top of his MCA level rising quite a bit, he is also developing fluid around his heart which is another sign of anemia.  If fluid starts developing around two or more areas (like his heart and stomach) it is called Hydrops Fetalis, which is more dangerous.  Fortunately he currently only has fluid around his heart so it's not as severe.  Because of the combination of his high MCA level and the fluid around his heart, they told us to come back on Friday (today) to be re-scanned but had us prepare as if he would be receiving his first blood transfusion this afternoon.  In the beginning we were hoping we would be able to avoid a transfusion but it seems inevitable at this point.  We are just grateful it's an option!

At our appointment on Wednesday they gave me the first of two Betamethasone (steroid) shots.  They describe IUTs (Intrauterine Transfusions) as not being high-risk but also not being risk-free so they like to give the steroids for his lungs in the event something happens during the procedure and he has to be delivered. The second steroid shot came 24 hours later on Thursday afternoon.  **Side note about the steroids.  The injections themselves didn't bother me too much (probably because I'm so used to those awful IVF shots) but they warned me that many women complain about not being able to sleep after getting them.  Boy were they telling the truth!  I was up ALL night that first night but luckily the second night was better.  It doesn't matter though, I would do it again in a heartbeat for out little guy.**

After hearing that we should plan on Austin receiving a transfusion today, we spent the last 48 hours preparing ourselves physically, emotionally, mentally, and in every other way possible.  We felt a bit nervous at times but truly confident in the doctors and peaceful that everything would be okay.  We got to our appointment at 8:00am this morning and the tech was quickly able to get a great MCA reading.  "45" she said.  "Um seriously?" We were all perplexed.  Here's the graph updated with today's number:

We were so prepared for his number to rise or at least stay the same so to hear that it dropped that much was a big surprise.  She ran the scan several times and even got a number in the lower 40s once so we knew it wasn't a fluke.  This kid was definitely throwing us a curve ball!  We were thrilled that his numbers were lower but we were so prepared for a transfusion we didn't know what to think.  Two doctors (an attending and a fellow) came in to talk to us about the new findings from today and we naturally had a million questions. What does this all mean?  The unfortunate thing about a situation like ours is it's not always black and white. There is definitely a gray area where you just have to use your best judgement.  The doctors explained that he still only has fluid around his heart (and no other areas) and that it's a very small amount of fluid.  We have no reason to be worried that the fluid will cause damage to his heart and they even said that if they didn't have a reason to look specifically for the fluid, they likely wouldn't have even noticed it on a non-sensitized baby.  This brought us a lot of comfort.

In the end, Logan and I were given three options and they truly did leave it up to us.  

1. Proceed with the transfusion because he will likely need one soon anyway and we were already planning on it. 
2. Get a non-stress test and make sure he's doing well and then come back every two days to be scanned and wait on the transfusion until his numbers show he truly needs it.
3. Do an amnio today because it is much lower risk than a transfusion but it gives a very good picture of whether or not a baby is anemic. 

We were initially intrigued with the idea of an amnio until they discovered that my placenta is blocking the entire front side of my uterus so they would have to stick the needle through the placenta to even do one. We quickly threw that option out.  As for the first two options, we were truly torn and so were the doctors. There are many pros and cons to both choices that I won't get into here but in the end we decided to do the non-stress test and if all was well, wait for a couple days.  Austin passed the non-stress test with flying colors so we decided to call it a day and go back on Monday morning.

It was difficult coming to a decision we felt was best for Austin but as soon as we made the call we knew it was the right one and the doctors said they would have made that decision for themselves as well.  We will now begin a fun trend of going to the doctor every couple of days, doing an MCA scan and non-stress test, and making a decision at that time whether or not to do a transfusion.  We may go in on Monday and need to do the transfusion but we may also be able to push it back a week even.  Only time will tell!

Despite being a bit surprised at the sudden turn of events this week, Logan and I have felt great peace since the moment we learned a transfusion is likely in the near future.  We are so grateful for the comfort of the many prayers that have been said for our little family and we know they are working miracles!

Fingers crossed that next week is a bit quieter!

Weight: 143.0 (This week: Even | Total: +22.2)

30 weeks down, 7 (hopefully!) to go!