Per R’s post last week, we had an appointment scheduled for Friday morning with Maternal Fetal Medicine to consult with a doctor about R’s abnormal thyroid numbers. We had a routine ultrasound scheduled for 8am and the doctor’s appt. at 9am. At about 2am on Friday, R woke up having some bleeding and cramping. She’s had some spotting off and on since week six, but this was heavier and more like fresh blood than like dried blood (sorry if this is too much information for some readers…pregnancy is a time of lots of information). R tried to just go back to sleep, but was, obviously, very anxious about what this might mean. She woke me up at about 3am, and we both proceeded to turn into total stress-balls. We called the on-call midwife, L, (who was, thank god, an angel with us for waking her up so late) to ask if she thought that we should go to the ER. Her point was two-fold, 1) since we’re 13.5 weeks, a miscarriage this far along is very uncommon, so that was probably not what was happening, and 2) the ER doctors are not OB specialists, whereas we had an 8am appointment with the OB experts, so we should wait and talk to them. I think that was the longest five hour stretch of time in recent memory. R and I just couldn’t sleep, so we watched three back-to-back episodes of tv on the computer and then got ready for our appointment.
When we walked into Maternal Fetal Medicine, they asked R her name to check in, and she proceeded to burst into tears. Apparently, this is a regular occurrence at their clinic (they see a lot of high-risk pregnancies), so they whisked R away to a private hysterical-patient room. I had been parking the car, so I was a little surprised to find R not in the waiting room when I came in. They were very sweet, offered us tissues and water, and told our nurse where we were. About thirty minutes, and a mountain of paper work and urine testing later, we were taken to a different part of the building for our ultrasound. We were so nervous. It’s still too early for R to feel the baby move, so we get afraid that something could be wrong with Baby G and we wouldn’t even know it. The bleeding and cramping had certainly compounded that fear.
Our ultrasound tech, P, was nice, but very matter-of-fact. I think that in her particular line of work, she sees a lot of bad stuff that can happen in pregnancy, so we probably seemed pretty run-of-the-mill with our nervousness and spotting. As soon as Baby G came up on the screen, I could see the heartbeat. It’s like a little black and white flutter in the middle of the chest. I remembered seeing it like that at our 8 week ultrasound. R and I were both flooded with relief. Whatever else was going on physically, we could deal with it, so long as the baby was okay. And, for the record, the baby is great! S/he is measuring 13.5-14 weeks, with a heartbeat rate of 160 (which is nice and strong). We got to see the baby sucking her/his thumb, kicking, and possibly hiccuping. We got to see ten tiny fingers, two arms, two legs, the stomach, spine, bladder, umbilical cord, eyes, ears, mouth, and nose. Our baby actually looks like a little baby now! We also got to see that R’s placenta is intact and in a good position, that her cervix is long and closed (something we were pretty worried about given the surgery she had last January), and that her amniotic fluid is full and clear. We got some really nice pictures, too, which I will now bombard you with!!
This first picture is Little G in profile. Look closely and you can see the ears, eyes, nose, and mouth!
This is Baby G actively sucking his/her thumb…
The next two are from the top looking down onto the head. You can see the hands (with tiny fingers) on the side of the head.
The only downside to all of this good news (which really isn’t a downside at all), is that they can’t tell us where the bleeding is coming from. In all likelihood, it’s the result of all that extra blood in R’s body causing little capillaries to burst, which is no big thing. But it probably means that we’ll experience that bleeding from time-to-time throughout the pregnancy, and we’ll need to learn to not panic about it. So, needless to say, R and I were feeling a rush of emotion and relief by the time we left the ultrasound. Then we were whisked off to our appointment with Dr. F (whose name I wish I could put on here, because it sounds dirty and makes me snicker). As soon as we walked in the room, most of our assumptions about him seemed right on. He’s a very mainstream doctor-type. Older, white, male, very monotone. He spent most of the session fumbling through all of R’s labwork, but he never seemed homophobic or condescending, just very dry and numbers-oriented. His diagnosis is that R has T3 hyperthyroidism (which he considers a condition, not a disease). It’s pretty much impossible to tell at this point if this is a by-product of pregnancy or a previously existing, but undiagnosed, issue for R. His recommendation was to begin a regimine of a drug called PTU twice a day to start. The hope being that this will bring R’s thyroid numbers back into the normal range, and then she can be weaned down to a once-a-day low dosage for the remainder of the pregnancy. He thinks that the thyroid issue is what has been causing R’s heart palpitations (which are unpleasant), and that, if left untreated, hyperthyroidism can cause a life-threatening condition known as “thyroid storm” during labor. You can read more about that terrifying condition here. Fortunately, hyperthyroidism in pregnancy is almost always able to be corrected by taking the PTU.
R (and the baby) will have to consult with an endocrinologist after the birth in order to make a postpartum action plan, but for the time being, R and I will be able to keep seeing our midwives for our regular appointments (as we aren’t considered high-risk at this time), and we’ll meet with Maternal Fetal Medicine once/month for thyroid monitoring (which will include a monthly ultrasound; so much for only one ultrasound during this pregnancy!). Also, fortunately, it looks like we’ll be working with Dr. H for the rest of our MFM appointments (the young, female doctor who first consulted with our midwives). We suspect that will be a better fit for us. After the doctor’s appt., R had to have blood drawn again. Her numbers came back a little better, but still 1/10th of what they should be to be considered for the monitoring, not medication, approach. I picked up her prescription on campus yesterday evening, and she’ll begin taking it today. The medication is generally considered safe during pregnancy and breastfeeding (especially in the low-dose that we are aiming to get down to), but there is the potential for some serious side effects involving R’s liver and/or bone marrow. Hence the frequent monitoring. It’s also possible for Baby G to develop thyroid issues in utero or during the first six months, but they’ll continue to check-up on the baby and any conditions that arise are treatable and almost always correct themselves by six months. So while having a condition like this and having to be medicated is anything but ideal, it’s also very manageable. Sorry this has been such an exhaustive post, but I just really want to remember all of the steps that we took along the way regarding this situation. Our next appointment is with our midwife, L, on February 1st (16 weeks), so we’ll keep you posted! Much much love!