Tuesday, April 12, 2011


19 weeks + 3 days, 19 days post rupture

I think the universe hates me. Me and the people of northern Japan whose current nuclear crisis has been increased to the level of Chernobyl. Seriously, we must have done something really terrible in a past life to warrant this level of utter catastrophe and disappointment.

Kidding....well okay not really.

Late yesterday afternoon, around dinner time, I started leaking amniotic fluid again. I had been somewhat unsure over the prior week as to whether I was still leaking (was it coming out in small drips when I went to the washroom?), but I discovered last night that 'No, I can definitely tell when I'm leaking'. I figure I lost about 20 ml-30 mls or so...enough so that it's more difficult to feel the baby move today. My mental state (figuratively) joined my amniotic fluid in the toilet. Honestly, when I feel that fluid come out, it feels as disturbing as if I'm trying to hold in the blood of a gunshot victim, or am at the wheel of a plane going down. My mind starts screaming "WARNING! WARNING! IMPENDING DOOM AHEAD! DO SOMETHING!!!" It feels like I'm leaking away my child's life in slow small drips. It is fucking awful.

And OF COURSE, it had to occur the night before my fetal anatomy scan. You know, the scan that might tell us if we are having a boy or a girl, and the scan that's important to see if in fact our child is developing its parts correctly. Made more difficult or close to impossible WITHOUT FLUID.

We barely slept all night, but managed to make it right on time this morning for 9:45am's scan. It lasted two hours and 3 different people wanted to take a go, including the tech who did most of the measurements, the radiologist who was using me as a teaching tool, and a fellow who was practicing her ability to get uterine blood flow measurements. Even with all that, the report we got afterwards stated that the heart, spine, kidneys and feet need to be 'redone at a later date due to poor visualization due to lack of fluid' (assuming that I even have more fluid at that later date, oh and of course, that I'm still pregnant).

We didn't bother going to see my OB afterwards. We just dropped off the report. He's not going to say anything different and I couldn't take anymore pitying looks today. I was supposed to get an ECHO of my own heart today as well, but we missed our 11:15 appointment time and they were too busy to fit me in later.

Good news from the report is that baby's parts they could see appear normal. There was some fluid left, my amniotic fluid index (AFI) is 5.7 cm, lower than last week's 7.8 cm, but at least not zero. Aidan consistently had 'anhydramnious' meaning that there were no pockets bigger than 1 cm, and 'more than that' is needed for lung development, although I'm not sure how much more. Happily, we also got quite a good profile shot. There was just enough fluid near baby's head to see the outline, so at least it's something for the baby book. Acorn will also remain Acorn for now, as no boy or girl parts could be visualized.

Bad news is, of course, everything else. Placenta looks bad. Still leaking. Cervix length is only 2.7 cm (down from 3.0 cm last Thursday, this makes me VERY nervous). The baby is also measuring behind, so although I'm 'by dates' in my 19th week, the measurements only put us somewhere in the 18th.

It was also disappointing that the e-mail I sent to the placenta specialist Dr. K. was returned with "please make an appointment to discuss". Do doctor's realize how difficult that is? It means another day off work for my husband, another $20 in parking, more moving around, possibly causing more leaking for me, and it's days away until I could see him again and I wanted to ask a few questions about delivery which could, ya know, happen at any moment.

Oh, and just to cap off my day, I saw a woman in the clinic waiting room who I used to work with in the NICU. She's pregnant again with her second. I'm not sure she saw me, but I'm sure she heard when the ultrasound clinic desk yelled out both my first and last name. If she did, it will be all around the NICU soon that "hey, Emily who used to work here is pregnant again!" If I start getting facebook inquiries of "soooo....how are things?", I might just need to punch something.

Today's Bonus Question: Do any pPROM moms know what the 'minimal' fluid index needed for lung development is? 50 points to anyone who knows!


  1. I'll see what I can find out about your question... Continuing to hold you in prayer...

  2. That sounds like a really shitty day. You have made it almost three weeks and that is something to be proud of. I'm so sorry that you are going through this. My thoughts are with you.

  3. Ugh, I hate that the fluid is leaking again. :(

    I hope your prior co-worker STFU and says nothing so that you don't start getting the "how are things" messages.

    Thinking of you and Acorn.

  4. Okay, I just emailed with my favorite NICU nurse. Here's her response:
    "Poor pregnancy outcomes, such as interuterine growth restriction (IUGR), preterm delivery, and fetal distress have been associated with abnormalities in AFI.
    An AFI less than 5 serves as a red flag that requires some type of further assessment or management. The gestational age of the fetus and maternal condition can influence management decisions such as c-section, induction, and additional testing."

    That's all I can find...my guess is she can't get a straight answer because there is no straight answer...every baby/pregnancy is different meaning that minimum number of AFI for a baby to have in order to have a chance is going to be different per case. She clearly needs more tests to get more answers...

    just a few more things from the book...
    The lung maturity can only be evaluates by amniocentesis where concentrations of certain phospholipids (L/S ratio) that are found in mature alveoli in the lungs are measured...
    Early in pregnancy the lecithin ("L") concentration in the amnio fluid which is measured in the amnio is less than of sphingomyelin ("S") with a ratio of 0.5:1 at 20 weeks (needs to be 2:1 for mature lung diagnosis). At 30-32 weeks the ratio reaches 1:1 and at 35 weeks reaches 2:1. If it's less than 2:1, respiratory distress is a big possible outcome. Prolonged rupture of membranes results in acceleration of lung maturity by approx 1 week.

    It's not much, but it's all I can find.."

  5. Gah! This all sounds just horrible. All that I can think of is that you held on for 3 weeks and things improved for Acorn. You can do another 3 more weeks and maybe turn things around again! When I delivered at 21 weeks the nurse told me an encouraging story that I'll pass on to you.... they had just gotten done discharging a girl (and her baby) that had her water broken at 20 weeks and she made it all the way to 29 weeks! I know all this crap is a long shot but you sound like a really strong Momma and if I was in Vegas betting I would bet on you!
    This probably all sounds super corny but I'm rooting so hard for you right now!!

  6. I am really pissed for you. I know it doesn't change anything, but I read everyday and I am hoping for the best. ((HUGS))

  7. Hi Emily,
    I sent you an email to the account listed above. I was wondering about your Dr. K...Is he out of Mount Sinai?

  8. Oh, Emily. This just sucks. Thinking of you and hoping it gets better.

  9. I can only imagine how heartbreakingly frustrating this must be. I am holding much hope for you Emily..

  10. Thinking of you....I remember my AFI was 3 with my girl at 21 wks. I don't know anything about the AFI requirements. We are all HOPING for you.

  11. I was told 2cm pocket, at least one of that amount. I never had that fir my entire 10 weeks after pprom. Under 2cm doesn't mean lungs won't develop satisfactorily just they can't guarantee it. So your afi sounds good to me.i know many pprom mothers who have ruptured as early as you and have babies at home now. Some had little to no fluid the entire time.

    As fr your last post question I got a little pain but didn't realise I was in labour fir a couple hours. Then 15 mins after I realised I was in labour I was 8th dilated. 5 hours later I still hadn't delivered but my son was transverse and at 31 weeks just didn't fit. Think if it wasn't for his position I would have delivered by then. My delivery was very quick because I had an infection, I think it can be a lot slower if you don't have an infection.

    Thinking of you.

  12. Every time I see a new post, I hope it is good news. I hope that things have made a turn for the better. I just ache for what you are going through. It is so unfair and I just want to scream about it.

    I am still hopeful for you. Acorn can still come home with you.

    Everyday must be so scary, every move you make. I hate that the placenta specialist won't just answer your email.

    Thinking of you all the time and holding out hope for the best.

  13. It broke my heart reading this. It was like re living my story all over again. youve done so well for holding on for 3 weeks..... i wish i could have done the same. I had angel a day shy of 20 wks, which was just 3 days after all my waters went completely. They hope that the sac will re seal itself. Are you on daily antibiotics? Thinking of you.... pls feel fee to get in touch x