Last week's hospital appointment - my 24 week visit - was a rollercoaster ride. I started off by having an ultrasound scan to check the baby's growth. S was with me, which was lovely, since we both had the chance to see our little person. The whole thing was over pretty quickly, unlike the anomoly scan, but the news was excellent. Baby's head circumference and abdominal circumference were both at around the 70th percentile, and the length of the femur was around the 50th percentile. The estimated weight of our little fetus was 1lb 9ozs (or 701 grams in 'new money'). It was lovely to see baby's heart beating away, and to know that my placenta's not blocking the exit! My amniotic fluid was normal, and the deepest pool measured 4cm. Finally baby's presentation was cephalic (head down) this time, rather than breech. The midwife doing the ultrasound explained that they're looking for the abdomen to match the head since this suggests that all's going to plan... and our little one isn't suffering from macrosomia, so it seems like my tight control is doing the trick. So far so good. On arrival for the scan I'd been told that they don't do scan photos once you're past 20 weeks, which was a little disappointing, but the midwife who did the scan snuck us a couple of freebies showing the baby's profile. I think they're the best pics yet - here's an example. I love that you can see so much detail of the baby's profile.
Once the scan was complete S headed off to work, and I headed back to the waiting room to wait for my appointments with the diabetes team and obstetricians. When the nurse collected me from the waiting room I was asked to provide a urine sample. Feeling a bit dehydrated, and not really needing the loo, my sample was pretty dark in colour, of which more later. First of the doctors to see me was Dr S, one of the obstetricians, who sat down with me, went through the scan results, and then talked me through some of my questions. I mentioned that I felt I was having to work pretty hard to stay hydrated, and she advised me to keep drinking throughout the day and try not to get too thirsty. We also talked through the fact that I'd had a very peculiar rash on my hands (red, prickly and swollen) on Christmas Day. I showed her the remnants just as Dr I stuck his head round the door to say hi, then came in to join us. Dr S concluded that the rash wasn't pregnancy related, just a bit of dermatitis (probably contact dermatitis) and nothing to worry about, which really put my mind at rest. I also mentioned that I've been getting pins and needles in my hands (fingers and thumbs) in the night, and keep having to change sleeping side and shake like crazy to get the blood flowing again. I was wondering if this was carpal tunnel syndrome. Dr S concurred, and gave me a referral to the physio department, who might be able to help. Apparently they could give me splints to sleep in if they think I need them. We also discussed the fact that I have a work trip coming up in a week or so, and I wanted to hear the team's advice. I'm travelling down to the South of France for a conference, and have decided to take the train rather than flying. In the scheme of things it doesn't seem to make much of a difference time-wise (a couple of hours) and I'm told that the Eurostar is much more comfortable. I've travelled by TGV before and been very impressed with the convenience and level of comfort, and I've had some horrible experiences at Charles de Gaulle airport, so I'll be glad to avoid changing flights there. Dr S agreed that the train might be more civilised, and advised me to keep well hydrated, wear flight socks, and keep mobile throughout the journey. Otherwise she thought it was fine to travel, and reminded me to take my yellow pregnancy notes with me. She also wrote me a prescription for the compression stockings, to save me a bit of money.
Dr I went through my log book with me whilst Dr S went off to find my urine results. He was really pleased with how things have been going - my HbA1C was 6.6% at my last appointment, and I'd managed to get my meter averages down since then, even taking into account the excesses of the Christmas period. I'd been a bit worried about my thyroid results, since I'd been told they were borderline when I called to get my blood results after the last appointment, but Dr I felt that they were still okay, if a little on the low side of normal. Another bit of good news.
At this point my urine results found their way into the room - apparently I was showing +1 for protein, +1 for ketones and +3 for glucose. I'd had a massive hypo in the night, so wondered if I'd overcorrected a bit too much, but it seemed a little strange, since my sugars had been great in the morning at 6.0 mmol/l. Not such good news. Dr S also took my blood pressure, and it was quite a bit higher than it's been at 150/90. Hmmm. Dr S told me I'd need to come back to the hospital two days later (on Saturday) to visit the Day Assessment Unit and have the tests repeated. She explained that she had slight concerns, but that it could just be a blip. She didn't mention the words pre-eclampsia until I did - as a big reader/researcher I knew that this was a possibility based on the symptoms. Dr S explained that it was pretty early in the pregnancy for such a development, and not to worry (but that's easier said than done, of course). Otherwise Dr S and Dr I both thought that everything was going pretty well, and agreed that I wouldn't need to return for another routine appointment for four weeks.
The next stop was to have my bloods taken by S, the diabetes midwife (I've just realised how many S's there are in this post - S my hubby, Dr S the obstetrician, and S the diabetes midwife!) After the usual struggles to find a decent vein (a theme of my hospital appointments, since I have rubbish mobile little veins!) I had blood taken for another HbA1C, as well as electrolytes, kidney function tests and to re-check my thyroid function. Whilst I was having the blood taken S and I had a little gossip and catch up, and I explained about my upcoming visit to the DAU. S explained that I just needed to turn up, as they don't make appointments in advance, and that I might want to consider getting there pretty early (9am) since it can get very busy. She asked if my blood pressure had been taken with the cuff that was in the consulting room, and when I said yes, she mentioned that it was a pretty small cuff for my arm, and that they usually use a larger cuff for me. She explained that might have affected the reading. She was going to try again with a larger cuff, but before she could do so she was called into another room, leaving me to head back to reception in order to book my next visit.
I spent the rest of the day at work, trying not to worry too much, and came home in the evening determined to do a little bit of research. I found out three things of interest:
1) If you're dehydrated and your urine is concentrated, you can have higher levels of protein show in your urine than if you're properly hydrated. (See this factsheet).
2) The wrong size blood pressure cuff can have a significant effect on readings, and can lead to mis-diagnosis of hypertension in larger pregnant ladies: see this website, and this one (for more general information).
3) Pre-eclampsia is scary, but not untreatable. Here are three resources which I found reassuring: patient.co.uk, Mayo Clinic, and NHS Choices.
All of this made me feel a little better. I bought a new home blood pressure monitor that same evening (a clinically validated wrist one, which is perfectly accurate if used properly, and in any case better than the one I currently have, which has a cuff too small for me), and to self-monitor in order to feel more in control of the situation. My BP when I got home was super high - 160/96, but it fell back to 123/76 later that evening, once I'd chilled out a bit, stopped worrying so much, and had a good chat and cuddle with my lovely hubby. It's been at good levels ever since!
Visit Two:
Saturday morning's excursion to the Day Assessment Unit at the hospital was much more reassuring, and in a funny way it was nice to see inside the Maternity Unit and meet some of the people there, even if I did have to go through a little scare first!
We arrived at 9am, and had to wait for security to unlock the door to maternity reception before we could even get in! I'd been scrupulous about drinking plenty of fluids over the prior 24 hours, in order to avoid the possibility of dehydration, and when the admitting nurse checked my pee sample it came up negative for everything - protein, ketones, glucose, the lot! I was shown to a bed, and my temperature and BP were taken. My temperature was up a little (I did feel a tad hot, and since then I've had a bit of a sore throat), and my BP came in at 140/80 - with the large cuff :) The nurses checked my notes, and spoke to the duty obstetrician (Dr M), then came to explain that they'd take some bloods for analysis, and would do serial blood pressures every half an hour (four in all), which meant that I'd be in the unit for a couple of hours at least. Well, we'd come prepared - both S and I had books with us, and my resourceful husband had even brought a flask of coffee (unneccessary, as it turned out, since we were invited to help ourselves to hot drinks from the day room!) My second BP reading was lower than the first, at 134/68, and the midwives were so surprised that they double checked it! Between my second BP reading and the third one of the midwives came and measured the height of my fundus (26cms, about 1-2 cm over the expected reading), and then as a treat let us listen to the baby's heartbeat using the doppler. So exciting, since it was the first time we'd heard baby's little heart chugging away. It was rattling along at 158 beats per minute, which is within the normal range. My third BP was 116/62, at which point Dr M stuck her head round the curtain for a chat. She was happy with my BP results, and told me that all of the blood tests had come back normal, so she was happy for me to go. She agreed that dehydration and a small cuff could have been the problem, and in any case, I was fine according to the DAU's tests. I mentioned my up-coming travel plans, and Dr M thought it was absolutely fine to go ahead with the trip. I asked if I should procure some protein strips for checking my urine at home, and she said they don't usually provide them to ladies unless they've had significant and ongoing problems. (Being a control freak I bought some from Amazon when I got home - they're identical to the NHS ones!) We left the hospital about two and a half hours after we arrived, and both S and I felt much much happier. Definitely better safe than sorry!
Postscript:
Today I had my 25 week appointment with J, the community midwife (and her trainee student K). My BP was 122/64, my urine sample was negative for all the nasties, and my fundal height was 27cm (still 2cm over!) We also listened to baby's heartbeat, which was around 150 bpm. I think I could listen to it all day every day! I also collected my MAT B1, which will allow me to complete the paperwork for my maternity leave at work tomorrow. All in all it was a pretty routine appointment, and I've booked another for four weeks' time. So, I'll be at the hospital next on 3rd February, and then I'll see the midwife again on the 9th.
Last, but not least: fruit and veg. Since my last fruity update my little passenger has graduated a couple of levels...
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