Abby's Pregnancy - Chapter 2

So....first of all, thanks everyone for your warm wishes!

....to pick up where I left off, we went in for another scan around 9 weeks gestation - 2 weeks after the mysterious double sac was discovered. It had been a tense 2 weeks as I continued to bleed on and off, never sure if I was beginning to miscarry the pregnancy or what was going on. The next scan was a huge relief to all of us, as the larger (empty) sac had shrunk considerably and the embryo was growing normally. Dr. Moritz felt it now looked much more like a vanishing twin situation although we never really understood how the other sac had grown to be so large. All in all, it was a reassuring appointment. Things looked to be on their way to a normal pregnancy.

Next, we scheduled an appointment at the hospital for a Nuchal Translucency scan. This prenatal test (also called the NT or nuchal fold scan) can be done between 11-13 weeks and will help assess the baby's risk of having Down syndrome and other chromosomal abnormalities as well as major congenital heart problems. The NT test uses ultrasound to measure the clear (translucent) space in the tissue at the back of the developing baby's neck. Babies with abnormalities tend to accumulate more fluid at the back of their neck during the first trimester, causing this clear space to be larger than average. We had not done any genetic testing during our first pregnancy but I was planning to have an amniocentesis this time around (since I am now such an old bag!) I questioned Dr. Moritz why even bother doing an NT test if we were planning to do an anmio, but his logic was that if something looks clearly abnormal on the NT scan they can actually perform a CVS (Chorionic villus sampling) that same day to determine if the baby has chromosomal abnormalities.

We returned to the hospital a few weeks later for the NT scan and I have to say it was a pretty unpleasant experience. In order to get the baby in the proper position for the measurement of the nuchal fold, the technician kept asking me to cough over and over, turn on my side, etc...This seemed to go on forever as she prodded my belly forcefully and repeatedly to try and rouse the baby or get it to turn. After about 30 min of this, Paulo began to grow quite anxious watching the fetus get jolted about on the screen. The technician was not communicating with us at all and I could feel his tension rising. Paulo asked if I could get up and walk around to try and change the baby's position so that the baby would not have to be poked about and questioned the risks of exposure to excessive sonography. The technician immediately got defensive and responded that this was an "elective procedure" and we didn't have to be doing it. Her implication was that since we were choosing to have the scan, we were giving up our rights to question the safety of the procedure. This seemed completely unfair. It reminded me of how defensive the practice of obstetrics has become.

When the technician finally finished her scans, she left the room silently and returned a few minutes later with the perinatologist. Immediately, I realized that I had met this physician after a screening of "The Business of Being Born" at the hospital and that he was one of the more outspoken critics of the film. Oh, great. This was just getting better by the minute. We chatted amicably about the film and he looked over my scans. (No doubt the technician had informed him we were troublemakers!) He said the blood test results, which they use in combination with the nuchal fold measurement to determine your risk of abnormalities, should really be ignored in my case. He said the presence of a vanishing twin would definitely throw off the blood test results and could create false positives. (So now it seemed the test was even more pointless.) We did ask him if he could see any traces left of the vanishing twin and he took a quick scan of my uterus and pronounced it officially vanished.

Turns out he didn't look very carefully and was wrong...the next week we went back to Dr. Moritz to go over the NT results. I was concerned because there had still been some bleeding over the past week so Dr. Moritz used his ultrasound and found some scattered clots and traces of the vanishing twin near my cervix. I was hugely relieved to hear this because we were about to leave the country for a month and I didn't want to panic every time I saw a drop of blood. Now I had the reassurance to know that any bleeding would be the last traces of the vanishing twin and not the baby. Since we were leaving the country, we scheduled an amnio for week 18. We also scheduled an appointment with a hematologist, as Dr. Moritz wanted to screen for any blood clotting issues that could have caused the placental insufficiency and growth restrictions during my first pregnancy with Matteo.

I feel I should explain somewhat my decision at this point to continue seeing Dr. Moritz as opposed to choosing midwifery care, since most of you know I am a big supporter of midwives. First off, we realized this pregnancy would need to be screened carefully for a recurrence of the Intrauterine Growth Restriction (IUGR) - as you may recall from BOBB Matteo was born at 35.5 weeks weighing 3 pounds and required an extended stay in the NICU. Since my placenta never made it to the lab for a pathology report (seems to have been accidentally lost during the chaos of my birth) we had very few scientific clues as to why the IUGR occurred. This second pregnancy would require more scans to check for growth abnormalities which you really can't detect until 28-34 weeks. So, for me it didn't make sense to start seeing a midwife now who would also need to send me to a perinatologist for ultrasounds on the side. It would mean double the amount of appointments, while Dr. Moritz would be able to perform the ultrasounds at my monthly prenatals. So my feeling is that once we clear the hurdle of the growth restriction, I will be in a position to choose midwifery care for my VBAC either through Dr. Mortiz's practice (he has two midwives that work with him) or finding another midwife in NYC. If I do want to have my VBAC at the hospital, it will be a little trickier for me to switch to a private midwifery practice since none of them (that I can find) are able to accept my HMO and I don't have any out-of-network options. (Dr. Moritz is one of those dying breeds that takes every type of insurance including Medicaid.)
Ahhh...decisions, decision. Much more to come!