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.

I Am Powerless (by James)

This morning we are at 6 weeks, 5 days pregnant and I think Amanda has been pregnant forever. In reality, tomorrow will be 3 weeks since the positive HPT.

I must admit that I thought having the bi-weekly blood draws and the extra eyes of an MFM would make this pregnancy easier mentally. And, for the most part, it is very helpful. I would rather know that the HGC and Progesterone numbers are climbing than being left in the unknown. There is something to be said about ease of mind.

All of that can quickly go away though as I learned on Thursday. When I am in a far off land (Green Bay, Wisconsin), the last thing I wanted to hear from Amanda is that she has some spotting and slight abdominal pain. There was nothing I could do except pray. And I prayed heavily that day. The good news is that what she experienced was common and the blood results since Thursday indicate that "by the numbers" the pregnancy is going great so far.

Lesson learned - I'm powerless. All the doctor visits, blood draws, internet research are great indicators of things to come. However, I have to continue to rely on God during this pregnancy. Otherwise, I am going to find myself a nervous wreck, walking on egg shells for the next 7-8 months. I refuse to live in a spirit of fear.

Amanda is doing great. She continues to be exhausted beyond belief, but is really resting more than she typically would for a woman constantly on the go. The kids do not expect anything. They're quite oblivious to the whole situation. Amanda and I have open conversations about the pregnancy with them in the room and so far neither Bub or Gracie expect anything. I'm hoping that is the case and they are not playing dumb. I can't wait until the day we will feel comfortable to tell them "our secret".

Friends, please continue to pray. The next couple of weeks are crucial based on our history of miscarriages. 6-8.5 weeks range seems to be when our early losses have occurred. I can sense your prayers. They are greatly appreciated.

I'm excited to visit the OB tomorrow morning to see how things have progressed. Hopefully, we will also be able to answer the question of "twins or not".

Relief

The spotting from yesterday never changed to the bright red, scary color, and today, it stopped altogether. Also, I just spoke to my nurse about yesterday's blood draw -- my HCg level is at 15,547, and my progesterone level is 22.4. Those values are really good, and I am very grateful. My next scan is on Monday.

Thanks to each of you for your prayers and concern. I'm hoping the next 2-4 weeks pass very quickly so these numbers will no longer matter.

Personal Statistics vs. Common Statistics

Late last night, I began spotting lightly. It stopped this morning, but it just began again, slightly heavier this time (though still considerably lighter than what would normally be considered dangerous). I have a slight twinge of continual pain on the left side.

Spotting -- even bleeding -- isn't uncommon in pregnancies. However, in my five previous pregnancies, I've only had spotting in the three that ended in the first trimester. It's hard not to let personal statistics override common ones.

As for the pain, it's not terrible, and it could just be pelvic tendons beginning to stretch. I remember having a similar pain when pregnant with Gracie, and nothing came of it obviously. I imagine the pain of stretching tendons would be more obvious this time since I have a cerclage buried in among them (which could also cause the spotting). Still, the pain coupled with the spotting cause me to feel concern.

I'm off for my biweekly blood work. If the progesterone level has moved further down, that could cause the spotting and it would hopefully be repairable at this point. If I'm miscarrying, my HCg levels should begin to drop. If everything remains stable and/or increases, I'm probably OK. I should know more tomorrow.

Feeling More Optimistic

After a day of research, I feel much more optimistic. James e-mailed me with article after article that stated from about 6 weeks on, HCg levels aren't accurately predictive of pregnancy health. The increase slows down, and numbers won't double more than every 96 hours or so. The ultrasounds become much more important than the HCg levels after 6 weeks, and what we saw Monday was good.

Randi mentioned praying for my mind to be quiet and sound, and I think that's precisely what I need. Moreover, we need wise, conservative doctors who aren't afraid to do what's necessary to protect my pregnancy and my health. We need God's grace to accept the calls they make, even if they don't make sense.

The Disadvantage of Knowing Too Much

My results from yesterday have just come in: my HCg level is 8510, and my progesterone level is 22.0.

The progesterone, while it has dropped, is still at the top of a safe range, so I'm not extraordinarily concerned about the level at this point. I do feel concerned that it seems to have a downward trend, instead of having a slight upward climb as it should. I still am on a very low dose of a progesterone supplement, so we have a chance to bring it up if necessary, but I have 2-4 weeks before a placenta would be present and capable of taking over, replacing what I take. Thursday's draw should be telling.

As for the HCg levels, I was concerned about the fact that they took 81 hours to double instead of the 48-72 hours I considered normal, but James found this information on several websites:

Look most closely at progression: during the huge majority of early pregnancies (80-90%), the level will double every couple of days, or 72 hours. As your pregnancy progresses, levels rise and that doubling time increases. The expected doubling time for HCG levels:

• Under 1200 mIU/ml: 48-72 hours.

• Between 1200 to 6000 mIU/ml: 72-96 hours.

• Over 6000 mIU/ml: more than 96 hours