February 18, 2004

Elizabeth Update, 2/18 night

I'm going to try to use my blog (which I haven't used much at all to date) to post updates on the status of Elizabeth and the baby. This way, I don't need to remember to email a billion people. I'll just email you all the blog URL, and you can keep checking back in for details.

OK, for those of you just joining the game: The baby is at 33 weeks as of today. Full term is nominally 40 weeks (based on the way they count). Starting a few weeks ago (maybe right before 30 weeks?), they noticed that Elizabeth's blood pressure had jumped up, as had her weight (which means she's retaining water). Those are signs of pre-eclampsia/toxemia/PIH (same thing, different names), which can be a major concern. They put her on more frequent exams, to keep an eye on her. The blood pressure seemed to be fluctuating up and down, but staying mostly reasonable. She'd never had more than traces of protein in her urine; if there are more than traces, then that's another, more serious, sign of toxemia. Some of her tests had been slightly trending in the wrong direction, and so her doctor started talking about needing to induce her early (but how early wasn't clear).

Given that things seemed to be stabilizing, we'd been hoping she could make it most of the way through the pregnancy, perhaps to 38 weeks. Well, on Tuesday (2/17), she went in for her twice-weekly exam, and they said that she'd gained 9 pounds in 4 days -- ie. she was retaining more water. The urine test also seemed to indicate some protein. They gave her an injection of steroids which help the baby's lungs to finish developing, and to give a surfactant effect (?) in the lungs so that if they do need to induce her real soon, then the baby would be better able to breathe on her own.

They told her she needed to get a second injection of the steroid in 24 hours, i.e. at 4pm today (2/18). They also were waiting on the results of some blood tests. Today, they decided that they wanted her to go into the hospital, probably to be admitted, because her platelet count was down to 135 (maybe 135,000?), plus all the other stuff. So we took her to Brigham & Women's hospital. They checked her in, gave her the 2nd steroid shot, drew blood for more tests, did a non-stress test (NST - where they monitor the baby's heart), etc. They then decided to admit her.

The baby looks to be doing great according to the NST, and according to an ultrasound from a week ago. Elizabeth also feels fine. She says the whole thing is annoying because she feels OK, it's just some machines that are telling her there's a problem. But they're doing a 24-hour urine test, which gives them a better profile of the proteins her kidneys might be spilling out, and to enforce bed rest on her.

So I left her at the hospital around 9:30pm tonight. I'll be heading back sometime on Thursday. We probably won't hear anything back on the 24-hour test until Friday morning. So we don't know what's going to happen. Maybe they'll send her home for strict bed rest. Maybe they'll induce her right away. Maybe they'll leave her in the hospital for a few weeks. Keep checking back every day or two to this spot for more details.

Posted by Tom Nugent at February 18, 2004 10:35 PM
Comments

Prayers and fingers crossed.

if it matters, michelle (my best friends wife) is going through much the same thing, but is further along week 38. its a headache but thsi stuff is befoming more and more common. i know its gotta be making you crazy, but the docs typically know what they are doing. and B&W is one of the best places in the country...

talk to you soon, take care. mjl

Posted by: Michael Laine at February 19, 2004 12:20 AM

Hi, Tom! I'll be praying for you guys.

I don't know if you got any more info on the surfactant effect and your baby's lungs... If you did, disregard the following and just know that I'm thinking about you.

Basically, in order to exchange gases, the alveoli (little tiny sacs) of your lungs need to be opened up like, well, little sacs. Surfactant is what coats your alveoli and allows them to open up (it's a lipid molecule, and the hydrophobic forces repel each other and the little sac opens). Normally, surfactant isn't produced until the last few weeks of gestation, at which point it hangs around inside the cells lining the alveoli. When the baby cries and takes its first breath, the oxygen induces the surfactant to be released from the cells, the alveoli open, and the baby can breathe on its own. Steroids (specifically glucocorticoids, like dexamethasone) can cause surfactant to be produced a little earlier in gestation, so that if Elizabeth needed to be induced, your baby will be a little better off breathing.

The guy who did a lot of work on surfactant is actually at my med school, which seems to be teaching me things.

It sounds like Elizabeth's doing okay, as long as she's lying down. And if it makes you feel any better, I was three and a half weeks early and they didn't even know anything about surfactant then.

Posted by: Adora at February 19, 2004 01:19 PM
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