Tuesday, April 19, 2011

Bedrest Update

It's day number five of bedrest, and not much has changed, which I guess is a good thing. The urine collection I did on Friday did not show enough protein to qualify me for preeclampsia, but it was quite a bit higher than my baseline level (231 mg vs. 84; the cut-off for preeclampsia is 300 mg), so I'm pretty sure I'm headed that direction in the next few weeks. After discussing things with my doctor/partner, Rachel, we both agree that staying off work is the safest thing. It won't prevent preeclampsia from developing (nothing will), but it keeps my blood pressures more stable, which is safer for me. It seemed like backward logic to try to control my BP with medication while continuing to work if there was an easier option that required less medical intervention. Lifestyle modification is always the first step, as far as I'm concerned (which is why my overweight patients don't like me sometimes--I refuse to prescribe diet pills!). Being off work also prevents my partners from having heart attacks worrying about me; they have all been incredibly supportive and helpful, despite the disruption I have caused to their schedules and workloads. I feel very fortunate to work with such a caring group of people.

We had a follow up appointment yesterday, the first of many in the next few weeks. At that appointment, I had a non-stress test (NST), which is a way of monitoring the baby for any signs of distress, and an ultrasound. Asher wasn't terribly cooperative with any of it. He wouldn't stay in one place long enough during the NST to get a good heart rate tracing, so it took almost an hour to do. One of his grandmothers came for the ultrasound for the first time, and he refused to show his face but instead kept finding new ways to hide it behind his hand and umbilical cord. We were able to see that he has a nice mop of hair on his head. I wonder what color it will be since the Dunns are blond babies and the Marki babies are brunettes.

The good news is that all is well for now. He weighs about 3 lbs 12 oz, which puts him at the 27th percentile. This is a slight drop for him--he had been at 37th for the last three scans--but not particularly surprising given my size and birth weight (my brother and I were both under 6 lbs at term). We are happy with anything above the 10th percentile.

My BP continues to be quite labile, so I have decided to start medication for it. It is still well-controlled at rest, but the slightest activity raises it to worrisome levels. I don't want to have a stroke while getting up to grab a snack! This is particularly concerning to me, given how bad I am at this bedrest thing: I'm constantly finding reasons to run up and down the stairs!

From here on, I will continue to have appointments twice a week for blood pressure checks and NST's. In addition, I will need to do blood tests and a 24 hour urine collection weekly (I have that to look forward to on Thursday). The next ultrasound will be in 2 weeks. So far things are looking good, and I fully expect that Asher will get at least another couple of weeks to grow. If I do develop preeclampsia, the goal for delivery will be 37 weeks (around 5/23), as long as it stays relatively mild, though if there are signs of more severe problems, I will have to deliver sooner. In the unlikely event that I never get preeclampsia, delivery will be at 39 weeks, on 6/6 as we were originally planning.

So, 4 days down, 48 (max) to go! Oh, how I'm looking forward to getting out of the house again on Thursday!

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