Low Fluid, Decelerations and Sterile Speculums, Oh My!Katie Loeb
I have been blessed with a pretty uncomplicated pregnancy, save for the irritable uterus. I have had the joy of contractions since 26 weeks, but aside from those experiences and the trips to labor and delivery that they repeatedly necessitated, my pregnancy has been blissfully normal.
And then this week happened.
I had my 38 week appointment this morning and was greeted to a nurse practitioner student before my normal OB, who was, as usual, running way late. I don’t mind having students be involved in my care because I just finished my last clinical rotation myself, but her exam was a little…rough. I’m pretty sure I can still feel where she palpated for my fundal height 4 hours ago.
After her exam things went downhill (through no fault of hers, let’s be clear).
It was discovered earlier this week that my fluid levels were lower than they should be. Amniotic fluid does decrease late in pregnancy, but my Amniotic Fluid Index (AFI) was only 6.2cm, when 5cm is the point at which they’ll induce a full term pregnancy for fear of cord compression. And because I’ve been having some, uh, leakage, our worry was that there was a tear and I was leaking amniotic fluid. In case you wondered how they check this, it’s something called a sterile speculum exam and it is unpleasant. They can’t use any lubrication for fear of introducing bacteria into the bag of water/baby, so it’s a speculum, dry, and swabbing. It is not made more pleasant when you have it done by a student.
I currently feel like I’ve been hit in the crotch with a baseball bat. I can safely say I will not be trying to walk myself into labor anytime soon.
After it was determined that I wasn’t currently leaking fluid, I was sent to maternal/fetal medicine for a non-stress test (NST) and another measurement of my AFI. Fortunately, after 3 days of modified bed rest and doing nothing but drinking water, my AFI came up to 10.3, which is fine for this stage of pregnancy. So of course, in light of that positive change, the NST got a little hairy.
At first, the baby wasn’t having any heart rate accelerations, which is one of the major things they’re looking for. They want the baby’s heart rate to be “reactive,” meaning it has periods of acceleration, like when he moves or something happens, and then returns to his baseline. His heart rate was unreactive for quite sometime. His heart was beating fast enough, it just wasn’t changing at all. Eventually he perked up and his heart rate accelerated as it was supposed to.
And then it didn’t. Then it decelerated. This kid, I’m telling you.
Three times in the NST he had a “variable deceleration” where his heart rate dipped from it’s normal 130-140 bpm to about 90 bpm and then popped right back up. I was assured by doctors, including my husband, that because these decels weren’t during contractions (of which I had 3 in the 20 minutes, come on uterus!), they are more than likely just him squishing his own cord. And because he recovered quickly and completely, they are nothing to be worried about.
Yea, okay. That seems likely.
I am now being monitored twice weekly by maternal/fetal medicine with NSTs and repeat AFIs, while we wait for him to decide to come on his own. I feel like I went from an uncomplicated pregnancy, to a baby who is just barely passing all the tests, which makes me very nervous. I know I need to be patient and let him cook for as long as possible, but I feel like we’re starting to reach the point where inside isn’t necessarily safer or better than outside.
I guess that’s why we’re doing the monitoring, and hopefully he’ll come on his own or we’ll figure out quickly when he needs to make his grand appearance. Until then, we wait.
Photo from Wikimedia Commons.