Tuesday, September 4, 2012
It's official!
No going back now. My picture frames arrived, my son cooperated, and I got a ridiculously cute series of pictures of him announcing his baby brother's arrival. We put the word up on our family blog and on Facebook this morning. I felt a brief moment of "Oh shit, I can't believe I'm posting this," but it was short lived. And now we have what we hope is a very normal, calm, and uneventful 20 weeks left to enjoy it.
Friday, August 31, 2012
In the mind of a 2 1/2 year old
My 2 1/2 year old is crazy. And not always in a good way. We've been having an extremely difficult time lately with boundaries, discipline, expectations, communication, etc. And I've heard that a lot of this is normal 2-3 year old behavior. But woah. There are days when I just feel like I can't take another moment of his screaming or defiance. Just earlier this week he had his first incident at school where his defiance landed him in the director's office because his teacher couldn't get through to him. Oh yes. It's a fun time. :)
But he's 2 1/2. He's VERY particular about how he wants things done. He's smarter than I ever imagined a child his age could be. And he's testing what he can get away with. I remind myself 5,000 times a day - this is normal, this is normal, this is normal. He will not act this way forever, he will not act this way forever, he will not act this way forever.
And then for every insane, crazy, difficult moment we have, we have moments of sheer joy - when I see what a kind and gentle little boy he really can be, and I wonder how a child could be so wonderful.
(Yes, it's a great big roller coaster.)
We haven't told him much about the baby at all. We certainly told him nothing during the first trimester. Explaining a baby to a child is hard enough without then worrying about un-explaining it. And then we've brought it up here and there a couple of times since our 12 week ultrasound. He has an 8 month old cousin "A" who he has been around several times since she was born and he ADORES her. You have never seen anything sweeter. He is SO gentle an SO compassionate with her. He wants to share toys with her and hug her, and he tells us that he loves her. So every now and then we will say, "Would you mommy and daddy to get you a friend like "A"?" And he always says, "YES!" with so much enthusiasm.
But last night we went further with this story than we've gone before. We told him he has to be careful with my belly (good grief he loves to jump into my lap) because there is a baby brother inside my belly. And one day baby brother will come out and our son will have a little friend just like "A."
And the whole time I'm explaining this I'm feeling like I'm talking to myself and he is not going to comprehend a single solitary word. Let me tell you something . . . don't ever underestimate the mind of an almost 3 year old.
First reaction. "Can I touch baby brother?" Yes. Of course touching through my shirt did not suffice, he wanted to touch my belly. I explained when he was touching that baby brother is safe inside right now.
Second reaction. Runs to grab a matchbox car and jams it in my belly button and says, "It's for baby brother." Cue pregnancy hormones and the tears started coming. Aside from being ridiculously funny that he thought he could share one of his cars with baby brother through my belly button, how much sweeter of a reaction could you ask for from a little boy???
Third reaction. "I want baby brother to come out now." Hahahaha. Oh dear. My son barely understands the concept of tomorrow. We tried to explain that he won't come out for a while longer - and it's going to seem like a long time. How much he understood of that explanation, I have no idea.
And that was pretty much it for the conversation last night. And you never know how much they might remember or forget either. But I will say again, never underestimate the mind of an almost 3 year old.
We were getting ready for school this morning, and as I was getting dressed he came running up to my belly and yelled, "Hi baby brother!" And then proceeded to ask me if I could take baby brother out. LOL.
It's going to be an interesting several months watching him work through what little understanding we could possibly expect him to have of what's really about to happen to his only-child life. And an even more interesting transition once baby brother arrives. (I told my husband last night that I predict baby brother will be here for about 45 minutes before our son asks if we can put him back!)
But one thing I know for sure, our son is going to make one amazingly awesome big brother! :)
Thursday, August 30, 2012
Our BOY looks great!
Where do I even begin?
I would try to explain my anxiety leading up to today's appointment, but I think I'd rather show you my anxiety. Azumio is a company that has several cool iPhone apps. One that can read your heart rate, one that assesses the quality of your sleep, and one that claims to measure stress. The heart rate and sleep apps are very cool and for the most part I've found them surprisingly accurate. The stress app is fun, but I don't know how scientific it is . . . My stress level seems to always fall in the medium range (30ish to 50ish percent). What are the odds my stress level is always in the same range? Well as my appointment was running a few minutes late and I felt more and more sick, I thought I'd check my stress level for a way to pass a few minutes:
My highest reading ever prior to this was 48%!!!
Luckily my appointment started shortly thereafter.
I learned that my second AFP level was 2.8 MoM - worse than the first reading. We had a very long ultrasound (it lasted almost an hour) and the technician was very thorough. We had to stop a couple of times, take a break, have me roll over, move around, etc because baby boy was not exactly wanting to cooperate with all the spine shots that the technician needed. But he finally obliged and she got all the measurements for both the standard anatomy scan and the scan for the elevated AFP.
And yes, it's a he. Obviously and clearly, a he.
To get right to the point, his brain and spine look PERFECT. As does everything else for that matter, with the exception of his left kidney, which has a little bit of extra fluid on it. Not only did they tell us that it's nothing to worry about, but we went through this EXACT same thing with our son (even the same kidney), and know first hand that it's really not a problem.
A couple of other important notes. My cervix - which I had been worried about because of the extremely low pain I've been having . . . 4cm and closed - EXCELLENT. My placenta - so ridiculously anterior that it's hard to believe a random biological event would be that perfect centered in the front . . . but it's already moved up from my 12 week appointment and is not anywhere remotely near my cervix at this point. Fluid levels are normal.
Size. Hahahahahaha. Hahahahahaha. Oh lucky me. Everything, and I mean everything is measuring ahead by almost a week. From the skull to the femur. And a 19 week fetus should weigh ~8.5 ounces and our boy is already estimated to be 10 ounces. He seems to be following in his big brother's footsteps already!
After the ultrasound we got to meet with our MFM doctor (he didn't actually perform the ultrasound). When we were referred to this practice, I of course did my research and found that overall it was a well liked and well trusted practice in our area. They have two locations and doctors bounce back and forth between both locations depending on the day. While all the doctors are well liked, Dr. K. is who you want to see. He's the most senior, and general considered *the* MFM guy. I was freakin ecstatic when I heard he was the doctor there today. I was THRILLED. He reviewed my chart - both the test results sent over by my midwives and the ultrasound images and said he absolutely rules out any neural tube defects with the baby. The absolute only problem he sees is the kidney issue that the tech had already told us about. He made us swear that we understood it was really a non-issue (he was relieved we've been through it before, so he didn't have to sell that point). BUT . . . big BUT . . .
My MoM levels did rise fairly significantly considering there was only 1 week between blood draws. And remember, those aren't absolute levels - those are levels relative to the median adjusted for gestational age. So at 16w6d my levels were 2.56x higher than you would expect them to be and at 17w6d my levels were 2.8x higher than you would expect them to be. So we can not rule out the possibility of placenta problems. Dr. K. highlighted everything I really already knew . . . The possibility of pre-term labor. The possibility of IUGR. The possibility of placental abruption. But he was also very pointed with his words. He said, "You are parents. You are hearing 'pre-term labor' and 'IUGR' and 'placental abruption.' The word I want you to focus on is 'possibility.' You may very likely experience none of these things." But they will be monitored starting in the third trimester with detailed ultrasounds by his staff. So we scheduled our first one in October when I will be 26 weeks.
Needless to say, the appointment was a HUGE PHENOMENAL success. Better than we could have ever hoped. And for whatever brief moments of "oh, we won't get to parent a little girl" we may have had, we are both super excited and actually downright thrilled to fill out our family with another little boy.
And if you made it this far, here are some pictures of our little healthy man.
People always commented on how perfectly symmetrical my son's "softball" head was when he was a bald baby. Looks like little brother will be no different:
And I'm not actually a fan of 3D ultrasounds, but with the elevated risk concerns, they did do several 3D images and measurements. (And yes, I did block out his boy parts out of this picture. Even fetuses deserve a little privacy.)
And one final note. We finally told big brother about all of this tonight. I'll share that story tomorrow. But I teared up on more than one occasion. For as difficult as our 2 1/2 year old can be sometimes, he has moments when I truly can't imagine a more perfect child on the planet. :)
Thank you so much for all your thoughts and prayers over the last week. I can not begin to tell you what it means to me, and I can happily sign off tonight saying I actually feel like we might get to bring this little guy home in January.
I would try to explain my anxiety leading up to today's appointment, but I think I'd rather show you my anxiety. Azumio is a company that has several cool iPhone apps. One that can read your heart rate, one that assesses the quality of your sleep, and one that claims to measure stress. The heart rate and sleep apps are very cool and for the most part I've found them surprisingly accurate. The stress app is fun, but I don't know how scientific it is . . . My stress level seems to always fall in the medium range (30ish to 50ish percent). What are the odds my stress level is always in the same range? Well as my appointment was running a few minutes late and I felt more and more sick, I thought I'd check my stress level for a way to pass a few minutes:
My highest reading ever prior to this was 48%!!!
Luckily my appointment started shortly thereafter.
I learned that my second AFP level was 2.8 MoM - worse than the first reading. We had a very long ultrasound (it lasted almost an hour) and the technician was very thorough. We had to stop a couple of times, take a break, have me roll over, move around, etc because baby boy was not exactly wanting to cooperate with all the spine shots that the technician needed. But he finally obliged and she got all the measurements for both the standard anatomy scan and the scan for the elevated AFP.
And yes, it's a he. Obviously and clearly, a he.
To get right to the point, his brain and spine look PERFECT. As does everything else for that matter, with the exception of his left kidney, which has a little bit of extra fluid on it. Not only did they tell us that it's nothing to worry about, but we went through this EXACT same thing with our son (even the same kidney), and know first hand that it's really not a problem.
A couple of other important notes. My cervix - which I had been worried about because of the extremely low pain I've been having . . . 4cm and closed - EXCELLENT. My placenta - so ridiculously anterior that it's hard to believe a random biological event would be that perfect centered in the front . . . but it's already moved up from my 12 week appointment and is not anywhere remotely near my cervix at this point. Fluid levels are normal.
Size. Hahahahahaha. Hahahahahaha. Oh lucky me. Everything, and I mean everything is measuring ahead by almost a week. From the skull to the femur. And a 19 week fetus should weigh ~8.5 ounces and our boy is already estimated to be 10 ounces. He seems to be following in his big brother's footsteps already!
After the ultrasound we got to meet with our MFM doctor (he didn't actually perform the ultrasound). When we were referred to this practice, I of course did my research and found that overall it was a well liked and well trusted practice in our area. They have two locations and doctors bounce back and forth between both locations depending on the day. While all the doctors are well liked, Dr. K. is who you want to see. He's the most senior, and general considered *the* MFM guy. I was freakin ecstatic when I heard he was the doctor there today. I was THRILLED. He reviewed my chart - both the test results sent over by my midwives and the ultrasound images and said he absolutely rules out any neural tube defects with the baby. The absolute only problem he sees is the kidney issue that the tech had already told us about. He made us swear that we understood it was really a non-issue (he was relieved we've been through it before, so he didn't have to sell that point). BUT . . . big BUT . . .
My MoM levels did rise fairly significantly considering there was only 1 week between blood draws. And remember, those aren't absolute levels - those are levels relative to the median adjusted for gestational age. So at 16w6d my levels were 2.56x higher than you would expect them to be and at 17w6d my levels were 2.8x higher than you would expect them to be. So we can not rule out the possibility of placenta problems. Dr. K. highlighted everything I really already knew . . . The possibility of pre-term labor. The possibility of IUGR. The possibility of placental abruption. But he was also very pointed with his words. He said, "You are parents. You are hearing 'pre-term labor' and 'IUGR' and 'placental abruption.' The word I want you to focus on is 'possibility.' You may very likely experience none of these things." But they will be monitored starting in the third trimester with detailed ultrasounds by his staff. So we scheduled our first one in October when I will be 26 weeks.
Needless to say, the appointment was a HUGE PHENOMENAL success. Better than we could have ever hoped. And for whatever brief moments of "oh, we won't get to parent a little girl" we may have had, we are both super excited and actually downright thrilled to fill out our family with another little boy.
And if you made it this far, here are some pictures of our little healthy man.
People always commented on how perfectly symmetrical my son's "softball" head was when he was a bald baby. Looks like little brother will be no different:
And I'm not actually a fan of 3D ultrasounds, but with the elevated risk concerns, they did do several 3D images and measurements. (And yes, I did block out his boy parts out of this picture. Even fetuses deserve a little privacy.)
And one final note. We finally told big brother about all of this tonight. I'll share that story tomorrow. But I teared up on more than one occasion. For as difficult as our 2 1/2 year old can be sometimes, he has moments when I truly can't imagine a more perfect child on the planet. :)
Thank you so much for all your thoughts and prayers over the last week. I can not begin to tell you what it means to me, and I can happily sign off tonight saying I actually feel like we might get to bring this little guy home in January.
Wednesday, August 29, 2012
There will be an update tomorrow
Just an FYI. I know some people got worried when I didn't get an update up from our last ultrasound quickly. This will probably go down a lot like that one did. Afternoon appointment. Pick the toddler up from school. Dinner. Family time. Toddler bedtime. Call family to relay news. Blog. But I promise I won't leave people hanging until Friday.
Also, if I took a picture of my belly right now after a big dinner and 3 (yes 3) cupcakes, you'd think I was 30 weeks pregnant. I saw myself in the mirror and did a double-take. LOL. Don't judge on the cupcakes please, what I really want is wine.
Also, if I took a picture of my belly right now after a big dinner and 3 (yes 3) cupcakes, you'd think I was 30 weeks pregnant. I saw myself in the mirror and did a double-take. LOL. Don't judge on the cupcakes please, what I really want is wine.
19 Weeks (a day early)
I'm not 19 weeks until tomorrow, but tomorrow is a big day and I want to make a fairly "normal" 19 week update. We'll know a lot more tomorrow than we know today, and that could be either good or bad - and I'd like to at least do one more weekly update in a way that won't be impacted by whatever we learn tomorrow.
So 19 weeks. Really darn close to half way done. Our fruit this week is mango. LOL. Whatever. When we were talking about blueberries and limes I sort of had an idea. Now we go from onion to sweet potato to mango and in my mind, those aren't really a logical growth progression. Anyway. Baby should be about 6 inches long. I'm definitely feeling him/her move a lot more now. Still not big obvious movements, but if I'm quiet and I pay attention, it's happening a lot more frequently. Fetal movement is a wonderful WONDERFUL thing.
I've gained 4 pounds since my last freak out about weight, so in total I'm up 7. Not bad at all. (But don't expect these weight updates to continue when I inevitably blow up and gain 20 pounds in a week.) And my stomach, while still not protruding too much, is starting to fill out and get a bit rounder. When I'm lazy and slouching, I actually think I look almost pregnant and not just fat. When I stand up straight (like I do for my pictures), there still isn't much there, but at least I can see some growth since 17 weeks.
I think that's it for today. I'm just trying to find a way to pass the time until 1:30pm tomorrow. It's going to be a long and difficult couple of days.
So 19 weeks. Really darn close to half way done. Our fruit this week is mango. LOL. Whatever. When we were talking about blueberries and limes I sort of had an idea. Now we go from onion to sweet potato to mango and in my mind, those aren't really a logical growth progression. Anyway. Baby should be about 6 inches long. I'm definitely feeling him/her move a lot more now. Still not big obvious movements, but if I'm quiet and I pay attention, it's happening a lot more frequently. Fetal movement is a wonderful WONDERFUL thing.
I've gained 4 pounds since my last freak out about weight, so in total I'm up 7. Not bad at all. (But don't expect these weight updates to continue when I inevitably blow up and gain 20 pounds in a week.) And my stomach, while still not protruding too much, is starting to fill out and get a bit rounder. When I'm lazy and slouching, I actually think I look almost pregnant and not just fat. When I stand up straight (like I do for my pictures), there still isn't much there, but at least I can see some growth since 17 weeks.
I think that's it for today. I'm just trying to find a way to pass the time until 1:30pm tomorrow. It's going to be a long and difficult couple of days.
Tuesday, August 28, 2012
Let's change the subject. Boy or Girl?
Okay, I need to lighten the mood for the next 48 hours. I'm stressed and worried, but this pregnancy is not doomed and I need to try to stay as focused on the non-scary things as possible.
Since our focused ultrasound will now be combined with our anatomy scan, that means we should find out the sex of the baby in about 48 hours. Based on everything we saw (er, didn't see) and the ultrasound tech's strong opinion from our 12 week ultrasound, we have thought for a while now that we may likely be having a girl. But I'm having some mommy intuition that it's a boy. What do old wive's tales say?
Baby's heart rate? Girl
Maternal food cravings? Boy
Chinese birth chart? Girl
Mayan conception calculator? Boy
First trimester sickness? Girl
Maternal complexion? Boy
Surprise - they seem to split about 50/50?!?!?! (Which is no surprise at all, if you are like me and don't believe in any of these things at all.)
Do I have a preference? I won't lie. I would love to have a little girl. This will be our last child and I always imagined having a family with at least one boy and one girl (there was a time in my life when pregnancy wasn't such a horrifying event and I wanted more than 2 children). I want to experience the joys of parenting both a little boy and a little girl. And honestly, with my husband, my son, and our dog - the testosterone in this house is a little overwhelming at times . . . I need to buy a pink dress - and I don't even like pink.
Then I think about my son, and how much he is "all boy" and how much he would LOVE to have a brother to romp with, get dirty with, wrestle with, etc. And it makes my heart want to explode with joy.
Does it really matter either way? Heck no. If we find out we are having a healthy girl on Thursday, tears of joy will stream down my face. If we find out we are having a healthy boy on Thursday, tears of joy will stream down my face.
Almost everyone I know who has a feeling about this (husband, mom, sister in law, etc) all think it's a girl. I'm going against everyone else and the 12 week ultrasound and saying boy. I suppose we will see how good maternal instinct really is . . .
Since our focused ultrasound will now be combined with our anatomy scan, that means we should find out the sex of the baby in about 48 hours. Based on everything we saw (er, didn't see) and the ultrasound tech's strong opinion from our 12 week ultrasound, we have thought for a while now that we may likely be having a girl. But I'm having some mommy intuition that it's a boy. What do old wive's tales say?
Baby's heart rate? Girl
Maternal food cravings? Boy
Chinese birth chart? Girl
Mayan conception calculator? Boy
First trimester sickness? Girl
Maternal complexion? Boy
Surprise - they seem to split about 50/50?!?!?! (Which is no surprise at all, if you are like me and don't believe in any of these things at all.)
Do I have a preference? I won't lie. I would love to have a little girl. This will be our last child and I always imagined having a family with at least one boy and one girl (there was a time in my life when pregnancy wasn't such a horrifying event and I wanted more than 2 children). I want to experience the joys of parenting both a little boy and a little girl. And honestly, with my husband, my son, and our dog - the testosterone in this house is a little overwhelming at times . . . I need to buy a pink dress - and I don't even like pink.
Then I think about my son, and how much he is "all boy" and how much he would LOVE to have a brother to romp with, get dirty with, wrestle with, etc. And it makes my heart want to explode with joy.
Does it really matter either way? Heck no. If we find out we are having a healthy girl on Thursday, tears of joy will stream down my face. If we find out we are having a healthy boy on Thursday, tears of joy will stream down my face.
Almost everyone I know who has a feeling about this (husband, mom, sister in law, etc) all think it's a girl. I'm going against everyone else and the 12 week ultrasound and saying boy. I suppose we will see how good maternal instinct really is . . .
2 Days
I can wait 2 more days, right?
I have a Level 2 ultrasound scheduled with a specialist on Thursday at 1:30pm. Because my overall anatomy scan was scheduled for next week, they are going to try to combine the 2 and get all the measurements they need, so this should be the most detailed ultrasound I've ever had.
Unfortunately, the ultrasound will likely be as stressful as the wait between now and then, because the results won't be interpreted fully until after the ultrasound is complete.
Who wants to drink some alcohol for me between now and Thursday afternoon?????????
I have a Level 2 ultrasound scheduled with a specialist on Thursday at 1:30pm. Because my overall anatomy scan was scheduled for next week, they are going to try to combine the 2 and get all the measurements they need, so this should be the most detailed ultrasound I've ever had.
Unfortunately, the ultrasound will likely be as stressful as the wait between now and then, because the results won't be interpreted fully until after the ultrasound is complete.
Who wants to drink some alcohol for me between now and Thursday afternoon?????????
Monday, August 27, 2012
First AFP result confirmed
Not much else to say right now. Part of me feels sick. Part of me feels numb. But at least there is no question that I need to be seen by MFM. My office faxed the referral this evening and I will call in the morning to try to get an appointment ASAP.
Sunday, August 26, 2012
At some point, I just laugh . . .
Because there is nothing else to do. In the latest news, I have been bitten by another deer tick. It was successfully removed at home, and it was small enough that I'm fairly certain it had not been attached long enough to transmit Lyme Disease.
Seriously? I've been in the yard twice in the last week. My husband takes our dog out at least 4 times a day, mows the grass, does all the yard work and has never been bitten by a tick in the 10 years he has lived here. I've lived here for 4 years, been bitten 3 times, all 3 times when pregnant.
You can't make shit like this up.
Seriously? I've been in the yard twice in the last week. My husband takes our dog out at least 4 times a day, mows the grass, does all the yard work and has never been bitten by a tick in the 10 years he has lived here. I've lived here for 4 years, been bitten 3 times, all 3 times when pregnant.
You can't make shit like this up.
Friday, August 24, 2012
The science behind maternal AFP
I am a nerd. An over-researching knowledge-seeking math and science minded nerd.
Knowing that my AFP is elevated and that elevates my risk for birth defects or placenta problems is scary. But what is AFP? What is a normal level? What exactly does all of this mean? How are neural tube defects or placenta problems indicated by this one measurement? (They don't exactly seem like related complications.)
Yes, sometimes google is a scary place to look for answers. But if you know to stick to the science and avoid the more informal sources - you can really get great information.
AFP (alpha-fetoprotein) is produced by the liver of a fetus. Its not something produced by a healthy adult liver so in non-pregnant adults, AFP should be found in trace amounts. AFP produced by the fetus is excreted into the amniotic fluid and then some of this protein crosses the placenta and is then found in the mother's blood. All pregnant women should have AFP in their blood - in fact too little AFP in maternal serum can be an indicator of Down Syndrome. The question is - why are my levels elevated? And exactly how elevated are my levels?
Let's start with that second question first. AFP levels are reported as "multiples of the median" or MoM. As gestational age and maternal weight change throughout pregnancy, AFP levels vary widely. So they are not reported as absolute values tested from maternal serum. Rather they are reported as how much they deviate from what is considered normal for a particular gestational age and maternal weight (and a few other factors including race and diabetic status). So an AFP level of 1.0 is considered "perfect" - exactly the median. An AFP of 0.5 means the mother has half as much AFP as you would expect. And an AFP of 2.0 means the mother has 2 times more AFP than you would expect. On the low end, anything below 0.5 is considered too low. On the high end, there is some controversy. Some labs use 2.0 as their cutoff. While other labs use 2.5 - stating that 2.0 increases false positives significantly without a marked increase in effectively detecting more birth defects. My lab uses 2.5. What was my level? 2.56. Severe defects are usually seen when MoM values are above 7.0 and my lab recommends a repeat draw for anyone between 2.5 and 3.5. So, in some ways, that's comforting. My level is not grossly abnormal. That being said, I'd obviously feel much MUCH better if that number was a helluva lot closer to 1.0.
So what causes elevated levels in mothers? There are 2 known causes and then there is the "it's not necessarily a problem" explanation so I'll start with that first.
This is the most common outcome. I have to keep telling myself this. Some babies make more AFP than others. Some completely healthy placentas let more of the protein cross into the mother's blood. It is not necessarily an abnormality (particularly at my level) and does not necessarily indicate a problem. These are the "false positives" with this test and 90% (YES NINETY PERCENT) of mothers with elevated AFP fall into this category.
Now let's go into the concerns with elevated AFP that apply to the remaining 10%.
1). Neural tube defects. These are defects where the baby's brain and/or spine do not close properly and part of this system remains literally open. These disorders range from things as serious as anencephaly (if you google it, don't look at pictures) to more minor cases of spina bifida and everything in between.
The opening in this system allows much higher amount of AFP to be leaked into the amniotic fluid than would normally be excreted by a baby with a closed system. More AFP in the amniotic fluid means more passes the placenta and more gets into mom's blood.
While NTDs are the most common defects associated with elevated AFP, it can be caused by any abnormal opening in the baby. So it's important to rule out other problems like an open abdominal wall.
The second concern?
2). Abnormal placenta. It is possible for the baby to be fine, for the AFP levels in the amniotic fluid to be normal, and for the levels in my blood to be elevated due to problems with the flow back and forth between the placenta. (It seems that "leaky placenta" is the jargon for this.) A placenta that is not allowing proper flow back and forth has been linked to many complicated and very serious third trimester problems. These include: intra-uterine growth restriction (IUGR), preterm labor, premature placental deterioration, placental abruption, and still birth. All of those things life threatening for the baby.
So what can be done about any of this?
1). Ultrasounds to rule out birth defects. Technology has come a LONG way. With specialized equipment, extremely trained specialist, and most recently the addition of 3D and 4D ultrasounds, I've read that ultrasounds are now almost 99% effective at identifying birth defects when using a specialist trained to look for specific problems.
2). Amniocentesis. This is a little more controversial and not used as much as it used to be for this problem. Many things can be determined from sampling the amniotic fluid. A full chromosomal analysis of the fetus can be done, but an open abdominal wall is not necessarily a chromosomal problem. So while amniocentesis can be used to definitively (100%) diagnose something like Down's Syndrome, it is not 100% in identifying all birth defects - specifically the ones we are concerned about here. The other thing amnio could tell us here is how much AFP is in the amniotic fluid. If the AFP in the fluid is elevated, that points more towards problems with the baby. If the AFP in the amniotic fluid is normal, that points towards problems with my placenta.
So what's the controversy with amnio? It requires sampling the amniotic fluid. That is insertion of an insanely long needle through my abdominal wall and uterus, and into the baby's sac to withdraw the fluid (while watching via ultrasound so as to not go too far and stick the baby). Invasive is an understatement. And it does come with an small elevated risk of miscarriage after the procedure.
Given that amnio isn't a definite answer for this problem, it carries some risks, and ultrasounds have become so amazingly advanced, amnio isn't likely something we would consider.
3). Ultrasounds and non-stress tests to monitor possible placenta problems. Let's say we are fortunate enough that ultrasounds rule out birth defects with the baby. How on Earth do you rule out problems with the placenta? Unfortunately, you don't. You just monitor them very very closely. This is done with ultrasounds and non-stress tests done frequently (every 2-3 weeks) to try to stay ahead of possible problems like growth restriction, preterm labor, etc . . . BEFORE you ever get to the concerns of placental abruption or still birth.
So that is where we are. As much as I know that my levels aren't *that* high and as much as I know that 90% of people flagged by these tests have no problems, I really don't care how this re-test comes out. I NEED the high risk consult. I need someone who knows what they are looking for to tell me that my baby and my placenta are okay and monitor them with a trained eye. I KNOW my previous losses are completely unrelated to this. But in 2 weeks we cross over from being in the miscarriage category to the stillbirth category, should something go wrong. And I can not take any chances, no matter how slim, that we could possibly be adding a late second trimester or third trimester still birth to my fucked up obstetric history.
Knowing that my AFP is elevated and that elevates my risk for birth defects or placenta problems is scary. But what is AFP? What is a normal level? What exactly does all of this mean? How are neural tube defects or placenta problems indicated by this one measurement? (They don't exactly seem like related complications.)
Yes, sometimes google is a scary place to look for answers. But if you know to stick to the science and avoid the more informal sources - you can really get great information.
AFP (alpha-fetoprotein) is produced by the liver of a fetus. Its not something produced by a healthy adult liver so in non-pregnant adults, AFP should be found in trace amounts. AFP produced by the fetus is excreted into the amniotic fluid and then some of this protein crosses the placenta and is then found in the mother's blood. All pregnant women should have AFP in their blood - in fact too little AFP in maternal serum can be an indicator of Down Syndrome. The question is - why are my levels elevated? And exactly how elevated are my levels?
Let's start with that second question first. AFP levels are reported as "multiples of the median" or MoM. As gestational age and maternal weight change throughout pregnancy, AFP levels vary widely. So they are not reported as absolute values tested from maternal serum. Rather they are reported as how much they deviate from what is considered normal for a particular gestational age and maternal weight (and a few other factors including race and diabetic status). So an AFP level of 1.0 is considered "perfect" - exactly the median. An AFP of 0.5 means the mother has half as much AFP as you would expect. And an AFP of 2.0 means the mother has 2 times more AFP than you would expect. On the low end, anything below 0.5 is considered too low. On the high end, there is some controversy. Some labs use 2.0 as their cutoff. While other labs use 2.5 - stating that 2.0 increases false positives significantly without a marked increase in effectively detecting more birth defects. My lab uses 2.5. What was my level? 2.56. Severe defects are usually seen when MoM values are above 7.0 and my lab recommends a repeat draw for anyone between 2.5 and 3.5. So, in some ways, that's comforting. My level is not grossly abnormal. That being said, I'd obviously feel much MUCH better if that number was a helluva lot closer to 1.0.
So what causes elevated levels in mothers? There are 2 known causes and then there is the "it's not necessarily a problem" explanation so I'll start with that first.
This is the most common outcome. I have to keep telling myself this. Some babies make more AFP than others. Some completely healthy placentas let more of the protein cross into the mother's blood. It is not necessarily an abnormality (particularly at my level) and does not necessarily indicate a problem. These are the "false positives" with this test and 90% (YES NINETY PERCENT) of mothers with elevated AFP fall into this category.
Now let's go into the concerns with elevated AFP that apply to the remaining 10%.
1). Neural tube defects. These are defects where the baby's brain and/or spine do not close properly and part of this system remains literally open. These disorders range from things as serious as anencephaly (if you google it, don't look at pictures) to more minor cases of spina bifida and everything in between.
The opening in this system allows much higher amount of AFP to be leaked into the amniotic fluid than would normally be excreted by a baby with a closed system. More AFP in the amniotic fluid means more passes the placenta and more gets into mom's blood.
While NTDs are the most common defects associated with elevated AFP, it can be caused by any abnormal opening in the baby. So it's important to rule out other problems like an open abdominal wall.
The second concern?
2). Abnormal placenta. It is possible for the baby to be fine, for the AFP levels in the amniotic fluid to be normal, and for the levels in my blood to be elevated due to problems with the flow back and forth between the placenta. (It seems that "leaky placenta" is the jargon for this.) A placenta that is not allowing proper flow back and forth has been linked to many complicated and very serious third trimester problems. These include: intra-uterine growth restriction (IUGR), preterm labor, premature placental deterioration, placental abruption, and still birth. All of those things life threatening for the baby.
So what can be done about any of this?
1). Ultrasounds to rule out birth defects. Technology has come a LONG way. With specialized equipment, extremely trained specialist, and most recently the addition of 3D and 4D ultrasounds, I've read that ultrasounds are now almost 99% effective at identifying birth defects when using a specialist trained to look for specific problems.
2). Amniocentesis. This is a little more controversial and not used as much as it used to be for this problem. Many things can be determined from sampling the amniotic fluid. A full chromosomal analysis of the fetus can be done, but an open abdominal wall is not necessarily a chromosomal problem. So while amniocentesis can be used to definitively (100%) diagnose something like Down's Syndrome, it is not 100% in identifying all birth defects - specifically the ones we are concerned about here. The other thing amnio could tell us here is how much AFP is in the amniotic fluid. If the AFP in the fluid is elevated, that points more towards problems with the baby. If the AFP in the amniotic fluid is normal, that points towards problems with my placenta.
So what's the controversy with amnio? It requires sampling the amniotic fluid. That is insertion of an insanely long needle through my abdominal wall and uterus, and into the baby's sac to withdraw the fluid (while watching via ultrasound so as to not go too far and stick the baby). Invasive is an understatement. And it does come with an small elevated risk of miscarriage after the procedure.
Given that amnio isn't a definite answer for this problem, it carries some risks, and ultrasounds have become so amazingly advanced, amnio isn't likely something we would consider.
3). Ultrasounds and non-stress tests to monitor possible placenta problems. Let's say we are fortunate enough that ultrasounds rule out birth defects with the baby. How on Earth do you rule out problems with the placenta? Unfortunately, you don't. You just monitor them very very closely. This is done with ultrasounds and non-stress tests done frequently (every 2-3 weeks) to try to stay ahead of possible problems like growth restriction, preterm labor, etc . . . BEFORE you ever get to the concerns of placental abruption or still birth.
So that is where we are. As much as I know that my levels aren't *that* high and as much as I know that 90% of people flagged by these tests have no problems, I really don't care how this re-test comes out. I NEED the high risk consult. I need someone who knows what they are looking for to tell me that my baby and my placenta are okay and monitor them with a trained eye. I KNOW my previous losses are completely unrelated to this. But in 2 weeks we cross over from being in the miscarriage category to the stillbirth category, should something go wrong. And I can not take any chances, no matter how slim, that we could possibly be adding a late second trimester or third trimester still birth to my fucked up obstetric history.
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