Need Input from the Pros

[StressedDad2Be]

First, let me just say that over the last few weeks I've developed a profound appreciation for what nurses do on a daily basis. Whatever your are paid is not enough and all of you are deserving of praise for the sorts of situations you face every day. It didn't take long to realize that neither my wife nor I have the sort of mettle needed to be a member of this profession.

I hope nobody minds this outsider posting to your forum. Here's our situation.

My wife is pregnant with our first. During a routine exam at 24 weeks 0 days, her doctor (who we both really like) discovered she was 1 cm dialated. She was immediately admited to the hospital. Here's what has gone down so far:

Day 1: given steroid shot should baby arrive early, strict bedrest starts.

Day 2: another shot. Ultrasound revealed cervix at 1.7cm with some funneling

Day 4: Ultrasound shows 2.76 cm with minimal funneling

Day 7: ultrasound shows 3.1 cm with almost no funneling. Doctor allows my wife to get up for bathroom breaks and to take 3 minute showers.

Day 14: ultrasound shows 2.74 cm with minor funneling, wife put back on strict bedrest (only allowed up to for BMs)

We are now at 26weeks and 2 days. During this time, there has been no change in dialation, still 1 cm. She has had no contractions other than the occasional Braxton Hicks and those are few and far between. She's pregnant with a girl, which I understand can be a plus.

After the last ultrasound, our doctor decided against sending her home until at least week 28. Her opinion at that time (now 3 days ago) was this:

"...28 weeks is extremely likely at this point and I think 32 weeks is very do-able."

I've done a lot of research and my concerns are what sort of long term problems we can expect depending on how far along we get. My feeling right now is that I don't want to subject a tiny baby to the tortures of heroic, life saving efforts.

I guess my question for those in the know is this:

- given the info I provided, what's your gut feel for a likely outcome, both number of weeks we can hope to get and the sorts of short and long term problems for our little girl?

Thanks so much for your time,

Stressed Daddy to B

[riern]

That's great! Sounds like everything will work out fine for you after all. You'd better start getting that room ready.

Keep us posted!

[ShannonC]

Yay!! Things sound really good for you guys. I myself had my twins at 34 weeks and 3 days... and they came home from the hospital with me. They weighed 4-5 and 4-8. No o2 needed, no IVs, no big problems. Just some difficulty getting them to suck vigourously, but other than that, perfectly healthy little babies! And now, at almost 5 years old, I can't imagine them being more perfect.

I am so happy and touched that you are coming back to give these updates. I only get to come on here periodically but when I get a chance to read your updates, I am so happy.

Keep up the good work!

-Shannon

[StressedDad2Be]

Today marks 1 day shy of 34 weeks, which is great.

We had another ultrasound with the specialist last Friday. They're no longer looking at the cervical length given the number of weeks along my wife is currently at.

The baby is healthy, but underweight...which is a new concern. They calculated her to weigh 3 pounds 12 ounces, which I belive is the 25th percentile for weight. Five weeks prior she was at the 50th percentile.

The doctor said that we don't need to be concerned at this point (of course we are) but we should keep an eye on it, we're scheduled for another ultrasound in 3 weeks.

I guess I shouldn't be too surprised, nothing has been easy with this pregnancy from the start...heavy spotting from 8 weeks to 12 weeks, something with the uterus (maybe it was the placenta don't know) not ascending as high it should around 16 weeks (it since has), then the short and funneling cervix at 24 weeks, than two checks for gestational diabetes at 28 weeks (that was later ruled out), and now underweight.

I just want this whole ordeal over with...

[Jolie, BSN]

Today marks 1 day shy of 34 weeks, which is great.

We had another ultrasound with the specialist last Friday. They're no longer looking at the cervical length given the number of weeks along my wife is currently at.

The baby is healthy, but underweight...which is a new concern. They calculated her to weigh 3 pounds 12 ounces, which I belive is the 25th percentile for weight. Five weeks prior she was at the 50th percentile.

The doctor said that we don't need to be concerned at this point (of course we are) but we should keep an eye on it, we're scheduled for another ultrasound in 3 weeks.

I guess I shouldn't be too surprised, nothing has been easy with this pregnancy from the start...heavy spotting from 8 weeks to 12 weeks, something with the uterus (maybe it was the placenta don't know) not ascending as high it should around 16 weeks (it since has), then the short and funneling cervix at 24 weeks, than two checks for gestational diabetes at 28 weeks (that was later ruled out), and now underweight.

I just want this whole ordeal over with...

Congratulations on another milestone!

I know that you will worry about the baby's weight, but I implore you not to! Ultrasounds at this late stage in pregnancy are notoriously inaccurate in determining fetal weight. At best, it is an estimate with a +/- margin of error of 25%. So your baby may actually weigh almost a full pound more than the estimate given.

If your doctor was critically worried about the weight, he/she would most likely have repeated the ultrasound much sooner than 3 weeks.

You will soon be out of the "high risk" category. Please enjoy these last few weeks, and keep us posted!

[DDRN4me]

hi "Dad" I have been reading your posts with great appreciation for you and your wife, and how hard you have been working to help this little one grow. Dont freak out about the weight, I had a 36 weeker who weighed 5 lbs, they were very concerned at first, IUGR, Small for gest age, etc. but she has always been fine, just thin. as a matter of fact, most people wish they looked like her! :) I'm thrilled you made it this far, and will continue to look forward to your posts. God Bless.

[BETSRN]

Today marks 1 day shy of 34 weeks, which is great.

We had another ultrasound with the specialist last Friday. They're no longer looking at the cervical length given the number of weeks along my wife is currently at.

The baby is healthy, but underweight...which is a new concern. They calculated her to weigh 3 pounds 12 ounces, which I belive is the 25th percentile for weight. Five weeks prior she was at the 50th percentile.

The doctor said that we don't need to be concerned at this point (of course we are) but we should keep an eye on it, we're scheduled for another ultrasound in 3 weeks.

I guess I shouldn't be too surprised, nothing has been easy with this pregnancy from the start...heavy spotting from 8 weeks to 12 weeks, something with the uterus (maybe it was the placenta don't know) not ascending as high it should around 16 weeks (it since has), then the short and funneling cervix at 24 weeks, than two checks for gestational diabetes at 28 weeks (that was later ruled out), and now underweight.

I just want this whole ordeal over with...

Yes, she is small for gestational age. I would also add that with your wife's history and all the level 2 ultrasounds she has already had during this pregnancy, they are probably pretty accurate as to the size of this particular little person! But in the grand scheme of things, this is not of much concern. If she is small all over, that is less of a concern than if her head is much bigger than her abdominal circumference. There is a difference between being symetrically small as opposed to ASYMETRICALLY small. If they decide that her size remains a concern, they may deliver her early, but at her present gestational age, this should no longer be a big problem. Many many babies are born at 34 weeks. Your wife has done a great job keeping that little baby in the oven! You really are over the hump. It's all downhill from here. In my experience in OB, the small ones are often the most mighty because they have been under more stress in the womb.

[StressedDad2Be]

Our specialist said the baby looked perfectly healthy, she's just on the small side weight wise...according to the doc.

How much of this is due to our combined genetics is hard to say. My wife is 5 feet even and weighed in at 100 pounds pre-conception. I'm 5'8". My dad is and both sets of grandfathers were the same height as me. My mom is and both grandmothers were much shorter than I. The same holds true on my wife's side. Neither of us comes from tall/large framed families, which our specialist inquired about and seemed satisfied with.

In addition, my mother-in-law told us yesterday that my wife arrived into the world nearly two weeks over-due and weighing 6 pounds 6 ounces. Extrapolating backwards to 34 weeks...I suppose she could have been as small as our baby is right now. I also found out that one of my cousins on my dad's side was only 5 pounds and change and he was born near term.

So, there seems to be precedent in both our families for this...most notably my wife.

I guess we'll find out soon enough.

[BRANDY LPN]

I don't remember exactly but I have seen a study that shows that the celestone can cause a baby to be small, that while it speeds up the fetal lung maturity it actually can to a small degree arrest growth. But if my memory serves me correctly the typical problems seen in SGA babes were not seen in this group. The paper was written by Stuart Shelton MD MFM, if I remember his name correctly. And this was one of the reasons they stopped giving the steroids every week. Can anyone verify this?

Dad- please continue to keep us updated, and best wishes to you for a happy healthy birth!!

[Jolie, BSN]

I don't remember exactly but I have seen a study that shows that the celestone can cause a baby to be small, that while it speeds up the fetal lung maturity it actually can to a small degree arrest growth. But if my memory serves me correctly the typical problems seen in SGA babes were not seen in this group. The paper was written by Stuart Shelton MD MFM, if I remember his name correctly. And this was one of the reasons they stopped giving the steroids every week. Can anyone verify this?

Brandy, if you can find this article, I would be very eager to read it. I had pre-term labor with both of my girls, beginning at 25 and 22 weeks respectively. I was given weekly Celestone shots, as was the standard practice at the time. They delivered at 37 and 36 weeks, and were both healthy. Neither of my girls has any long term effects (that we are aware of) related to Celestone or any of the myriad of drugs I took for PTL, but I am always curious to read the latest studies. Thanks!

[BRANDY LPN]

http://www.greenjournal.org/cgi/content/abstract/97/2/301

Okay I found the study or rather the abstract I was referring to and I was dead wrong by this study, but if you look at the other study cited at the bottom it contradicts this one, so who knows. I actually worked with Dr. Shelton at one time and I could have sworn he said it DID cause reduced birth weight. I also think he said though that this was not a permanent thing that these kids caught up within a short time after birth, but as you can tell my memory on this subject is foggy at best as this one convo I had with him about this was over 4 yrs ago.

[riern]

Glad to hear you've gotten this far. I agree with everyone else try not to stress about the weight. If the doctor thought it was a dangerous thing he would've scheduled another ultrasound sooner or even delivered the baby at that point. Just try to relax and get some rest. I'm afraid your "ordeal" is just beginning....:) .

Good Luck and keep us posted!

[Jolie, BSN]

http://www.greenjournal.org/cgi/content/abstract/97/2/301

Okay I found the study or rather the abstract I was referring to and I was dead wrong by this study, but if you look at the other study cited at the bottom it contradicts this one, so who knows. I actually worked with Dr. Shelton at one time and I could have sworn he said it DID cause reduced birth weight. I also think he said though that this was not a permanent thing that these kids caught up within a short time after birth, but as you can tell my memory on this subject is foggy at best as this one convo I had with him about this was over 4 yrs ago.

Thanks, Brandy. You're right, it is confusing!