Monday, December 22, 2008

The Good News and The Bad News

We had our follow-up sonogram today, and the doctor came in joking about how many babies we were going to have. We reminded him that we were there to indeed check for multiples, and his joking tone became excited as he remembered my blood results and the report from the perinatologist the week prior.

When the sono began, the doctor had no problem spotting the beautiful baby growing in my uterus. "Just one," he said. I felt a little disappointed, having been so sure that the numbers and my symptoms could not be wrong. "Are you sure?" I asked. "The perinatologist mentioned the other thing was a little high up in the uterus." Just one, he clarified again.

We watched the heartbeat, feeling very excited. After a moment or two, he standardly scanning the rest of my pelvic region. He examined the outside of the uterus, the right ovary, then the left. When he got there, he went round and round, zooming in and out, and I could see what he saw. "There's a gestational sac here," he said, pointing out all the parts. He continued to check and measure and print and document, then agreed with himself that it was indeed a gestational sac, and I had a heterotopic pregnancy.

A heterotopic pregnancy is a pregnancy where there's both a growing intrauterine pregnancy, and a pregnancy outside of the uterus. Most commonly, the baby growing outside of the uterus grows in the fallopian tube. In very rare cases, it grows in the cervix, ovary or abdomen.

Instances of heterotopic pregnancies are on the rise with the increase of frequency of IVF, but spontaneous heterotopic pregnancies are rare. With my baby growing on my left ovary, I find myself in the rarest of rare situations.

During the sonogram, the doctor was unable to find a heartbeat in the heterotopic twin, and the "ring of fire" (bloodflow on the sonogram) was not complete, reaching only the top and bottom of the gestational sac, instead of completely circling it as it should. My doctor is hopeful that the absence of a heartbeat and the incomplete ring of fire means the baby has died, is deteriorating and will eventually be reabsorbed by my body. But, because it's still so early in this pregnancy and not totally unusual to not see a heartbeat at this stage, he's sending me to be scanned again on Wednesday. If there is growth or a heartbeat, he'll want to discuss surgery -- by Friday, if he can make me.

At this point, that's too overwhelming to consider. I've decided unless I'm in actual imminent danger -- like, hemmoraging or something -- I'm delaying surgery for at least a few more days. There are many things to consider, many pros and cons to the various approaches, lots of decisions weighing heavily on our hearts and minds. I'll lay out my thoughts in some posts over the next couple of days. Meanwhile, please keep praying for me and for my babies. (Such a bittersweet thing to say...)

The Cooperative Twin --
in the uterus where it belongs.

The Rebel Baby --
laying low in my left ovary.


Randi said...

I've been thinking about you all afternoon and praying. I'm not even sure exactly what to pray for except for complete clarity for you and James. I'm so happy about the health of the one baby and so disappointed about the situation of the other. This may be the time when an early ultrasound actually causes torment and sadness ... if the one twin isn't viable, a later ultrasound wouldn't even have revealed the presence. As it is, I'm sure you're feeling anxious and able to think about little else. I'll be waiting to see what the scan on Wednesday shows and I'll be praying for peace as you wait.

Amanda said...

The baby is not viable at this point, but because it seems to be developing a little behind the other (which is not necessarily abnormal), a heartbeat may not be present because it merely may not be visible yet.

It's impossible to say right now if the heartbeat hasn't started or if its stopped. Wednesday should be more telling...

Emily said...

Amanda I am praying for you, James, and your babies. I am praying for peace and wisdom. I am not sure what else to say except that I am so sorry you are having to handle yet another hard situation.
I know that you are having to take it easy the next few days and if you can think of anything, really, that I can do for you I am more than willing. The only time I am not available is the 26-28, other than that I am here.
Praying for you friend!

Jenny said...

Wow- I can honestly say I've never heard of a heterotopic pregnancy. I am praying... and have been ever since Amy called me today. I cannot even imagine all the thoughts crossing through your mind (and James's mind) the past several hours. Wednesday will be very telling. I'm sure you will be doing lots of research in the meantime. Can't wait to read about what you're learning. I'll be praying for wisdom and peace! Love you!

Amy said...

You have been on my mind all day. I am glad that I got to spend some time with you after your appointment and am honored that you could open up and share your heart about all of this with me. I know that it is confusing and overwhelming on so many levels. I am so very sorry that you are having to think about it at all and not just 100%, totally bask in the glow of the healthy baby. I know that you love them both, and I am praying for you and your babies. I love you, Bea!

Randi said...

Thinking of you all day ...