Finding A "Next Step"

Randi checked into Labor and Delivery at 8:30 this morning for more fluids and a new round of fetal heart rate monitoring and ultrasounds. When she got there, the doctor's office had forgotten to send in the admission orders. They went ahead and checked her in but couldn't start fluids until they got the orders from him. Oh, did we mention, that his office isn't open on Wednesday's? So, it took a little bit longer to get going than she wanted. Finally, she got fluids started around 10 a.m., and I was at work this whole time. I arrived to be with Randi at the hospital for the ultrasounds at 1 p.m. The perinatalogist didn't show up until 2:30 p.m. After all, we didn't get home until 4 p.m.

Now, as far as the monitoring, both babies have very good heart rate scans for the hour that Randi was being monitored. She did have a couple large contractions, but they were not frequent enough to be concerning. The ultrasounds on Pooh are still showing absent end diastolic flow with intervals of intermittent diastolic flow. We did not see any reverse flow on him today, happily. What was concerning to us was a decrease in the amount of amniotic fluid surrounding him. He is obviously dehydrated, not from any fault of Randi's. These periods of dehydration in between IV fluids is starting to have an effect. To explain better the role of IV fluids versus oral hydration, the doctor said that it is like telling a person to eat an orange for vitamin C as opposed to telling them to take a hand full of vitamin C pills. Metaphorically, Randi is close to having scurvy. So, we are hyper-hydrating her to attempt to repair deficiencies in hydration, which in turn can stimulate better blood flow and also inrease Pooh's amniotic fluid level.

Tigger's blood flow was completely corrected from the hyper-hydration. He is showing little to no signs of increased blood flow resistance or absent end diastolic flow. Also, we pressed the doctor today about what the "next step" is. This is the gist of what we were told. We will be in this new ho-hum routine of fluids, monitoring, and doctor visits three times a week--it's amazing what you can get used to. At any point if we don't see significant improvement in the blood flow from IV fluids, Randi will be admitted to the hospital for steroid shots to stimulate lung development. We will need 48 hours before delivery for the babies to get the full effect of the steroids. After that time, we will reevaluate whether to deliver Pooh and Tigger, if the situation remains bad, or try to hold off a little longer, if the vitals improve.

"If you will it, it is no dream." Theodore Hertzl