Third trimester: it's complicated

Last weekend, at my friend Liz's baby shower, she asked if I thought I'd go early or late compared to my due date. I replied that I would be entirely confident that like almost all first births (as well as both my sister and I), this baby would show up late.... except for the fact that I had a nagging suspicion I wasn't out of the woods in regards to complications with this pregnancy, so that was the only scenario where I could see me giving birth earlier than August 13th.

I should stop saying crap like that. 

(I've mentioned how 3 of my really close friends were pregnant all at the exact same time, right? Through some ridiculously crazy twists of fate, all four of us got pregnant with due dates within four and a half months of each other. Despite it looking like we engaged in some sort of embarrassing teenage-style pregnancy pact, I assure you that is not easily accomplished with the fickle reproductive systems of one's mid-thirties, and it really did just happen to work out this way.)

At this point, we have one baby who has successfully made it out into the world; our next arrival is due July 4th weekend; #3 is scheduled for the first week of August; and I'm bringing up the rear with my August 13th due date. 

So when we took this photo last weekend at the shower, I was somewhat alarmed to see that I looked not only like the most-pregnant lady remaining, but also like I was giving birth sometime way sooner than mid August: 

Also yes, I'm like 6" taller than all of my friends. 

Everyone assured me it was just the angle, but I remained suspicious of the largeness and in chargeness of that belly. 

Fast forward to Tuesday, when I had a 28 week level II ultrasound scheduled. (Oh yeah: back at my 20 week anatomy scan, they found a few exciting anomalies: some choroid plexus cysts [CPCs] in the brain, and two echogenic foci on the heart. CPCs can be a soft marker for Trisomy 18 [very very bad chromosomal anomaly], but often only when in the presence of other fairly clear anatomical markers like clenched fists due to finger malformations, and anomalies with the heart. While that was quite unlikely for us since the hands and other parts looked fine, the addition of echogenic foci apparently moved us from a possibility of Trisomy 18 to a possibility of Down Syndrome. Counter-however, since we'd had a Verifi test done in the first trimester - a blood test that measures your risk of chromosomal disorders in the fetus - and that came back with really reassuring results, like a 1/10,000 risk, my doctors weren't overly concerned with the findings and urged me not to be either. Easier said than done, naturally, but my only choices were to freak out or to try and put it out of my mind, so I went with #2. Anyway, this 28 week scan was ostensibly to check up on the cysts and foci, but primarily to see if any new markers had presented themselves, since both the continued presence OR the disappearance of either the CPCs or the foci means virtually nothing: if they still presented, it was fine and normal; if they had gone away, that was fine too, but is also a normal outcome even if the baby did have T18 or Downs. So. Very informative screening in other words. Did I mention that only like 1-3% of fetuses have these markers in the first place? Because of course. Also the probability I was going to get OHSS!)

So back to this week: the cysts had disappeared (good slash meaningless!) and the two foci on the heart were still there but so small they have no anatomical implications, so thumbs up to all of that in the sense that nothing got worse / bigger / multiplied. But after doing enough of these, I'm starting to pick up on some cues, so I noticed the technician got a little quiet while measuring the volume of amniotic fluid in my uterus. "Fluid look OK?" I asked. "Oh yes," she replied. "It just looks like there might be a lot of it." 

Then she started measurements on the kid's skull, and began muttering to herself. She redid the measurements about four times, before finally admitting defeat and commenting that our baby had a big head. She measured the femur too, and concluded it's just a big ol' baby overall. She estimated the size at nearly 31 weeks (rather than where I was, 28w 3d) and about 3 lb 6 oz, whereas my weekly baby newsletters were telling me 28 week old fetuses should be about 2lb 4oz. "Do you have diabetes?" she asked me, skeptically. 

I had actually JUST gotten the results from my gestational diabetes test the day before - I passed (meaning no diabetes!), but by the skin of my teeth: you're fine if your score is 135 or below, and I snuck through with a 134.  

So! I talked through all of these results with my ob/gyn. Having a big baby and too much amniotic fluid is indeed most commonly caused by diabetes (gestational or otherwise) so despite technically passing my 1 hour test, I get to go back for the big mama 3 hour test this week where you drink even more of an even glucose-ier drink, then get blood drawn once an hour for three hours to monitor your body's ability to process sugar over time. Apparently the placenta is quite the insulin hog, which is why pregnant women can develop diabetes temporarily - just while the placenta is stealing all your insulin. Plenty of people also just have babies that measure big at some point but "even out" over the course of the pregnancy, or just have big babies in general and it's not a problem, etc. If I do have gestational diabetes, I'll likely just need to make some modifications to my diet, keep up with light exercise, and keep close tabs on my blood sugar level to make sure it remains in check.

It sounds like the more problematic result is the excess fluid levels. Polydramnios - which, you guessed it, is only present in 1% of pregnancies! - can be the result of anatomical abnormalities in the fetus (like an esophageal obstruction, meaning the baby isn't swallowing any fluid; not the case with us); can be diabetes-related; or can just develop for unknown reasons. The problem is that it can lead to some fairly serious complications, like preterm labor, having your water break prematurely, placental abruption, umbilical cord prolapse, hemorrhage post birth, or even stillbirth. Which means I earned myself a referral to a high-risk specialist for a consult, and depending on their assessment, may end up with a higher level of monitoring for the rest of the pregnancy. We'll see though - I have the 3 hour test this week, and the high risk specialist in two weeks, so I'll know more after that. 

As it stands, though, I feel fine right now: I don't have any [other] symptoms of diabetes, and the fluid levels aren't excessive enough to cause shortness of breath or trouble breathing or anything. (Remind anyone of OHSS much!? Apparently if the fluid levels do get too high, one potential treatment is incredibly similar as well: they go in with a needle to drain out fluid to relieve some pressure. Been there done that, baby!) 

I do feel pretty vindicated about that picture up top, though. I have medical proof that I am huge! (The ob/gyn's old school belly-measurement put me at 32 weeks, over THREE weeks ahead. I am definitely bellying it up in here.)