Bicornuate Uterus & Ultrasounds - When is enough enough?

[SmittyJ]

I'm hoping you all can help me with your access to resources/personal experiences. :-)

I have a heart shaped (bicornuate) uterus. As a result of being different, I have had a few extra procedures to ensure everything is progressing as normal. By this point, I have had five ultrasounds - 6 weeks, 8 weeks, 12 weeks, 18 weeks, and 22 weeks. As of the last ultrasound, everything was reported as looking great - baby is growing on schedule and they could easily see everything they needed to.

However, despite this ultrasound showing everything was looking perfect, they are asking me to do another one at 28 weeks. To be honest, I want to be done with ultrasounds - they aren't perfect, I've already had an "extra" because they "thought" they saw something on the 18 week ultrasound that turned out to be a non-issue at 22 weeks, and, quite frankly, I feel great! However, they want to make sure there is enough room for baby in my uterus because I am at higher risk for premature delivery. So here's what I'm hoping you can help me with:

* Is there a "typical" number of ultrasounds for someone with a uterine abnormality?

* How accurate are ultrasounds at assessing the amount of room the baby has to grow and develop?

* If the ultrasound indicates that there "isn't" enough room, what exactly can they do about it? Anything? In other words, what is the benefit of knowing for me, my baby, and my doctor?

* How do you strike a balance between seeking the natural birth you want, while respecting your doctor's/CNM's desire as much medical knowledge as possible?

FYI - the external measurements of my uterus today have all been within the normal range - as of 24 weeks it is two fingerwidths above my belly button. 

Looking forward to hearing from all of you. Best of luck with your pregnancies!

[MeepyCat]

Smitty, I don't know much about uterine abnormalities, or how many ultrasounds are normal.  I can, however, speak to what might happen if they identify a potential, or a need, for early delivery.

As I learned with my daughter, there genuinely can be a point where even a premature baby is better of out then in.  The further in advance you can see that point, the better prepared you can be.  With 4-6 hours warning, you might be able to cross town to a hospital with a higher level NICU (doctors agree - the best way to transport a preemie is in utero).  If that hospital with the better NICU is further away (on the other side of the state, or not on the island you live on), you'll need more time.  If you have 24 hours warning, you can do a complete course of steroid shots to improve lung maturity.  With a few days, or a week, you can take the time to consult with the doctors at that better hospital, and let them know what you want in your care, and your baby's care.  You may not be able to salvage your entire birth plan, but the more conversations you can have, the more you can likely get of what you want.  With more then a week, you can go on bed rest or take tocolytics to delay the onset of labor. 

What we're really talking about here is the difference between days or weeks of boredom on the antepartum ward of a hospital with an award-winning NICU, and a panicked rush to a hospital that has to lifeflight your baby out as soon as she's born.  Neither of these options is appealing, but one of them is far, far better then the other.

[amlikam]

Originally Posted by SmittyJ 

I'm hoping you all can help me with your access to resources/personal experiences. :-)

I have a heart shaped (bicornuate) uterus. What is the degree of your setum?
By this point, I have had five ultrasounds - 6 weeks, 8 weeks, 12 weeks, 18 weeks, and 22 weeks.  Wow that is a lot! I have had 2 and will have another next week (though the one next week is to get images of the heart and placenta which is a parital previal.

However, despite this ultrasound showing everything was looking perfect, they are asking me to do another one at 28 weeks. To be honest, I want to be done with ultrasounds - they aren't perfect, I've already had an "extra" because they "thought" they saw something on the 18 week ultrasound that turned out to be a non-issue at 22 weeks, and, quite frankly, I feel great! However, they want to make sure there is enough room for baby in my uterus because I am at higher risk for premature delivery. So here's what I'm hoping you can help me with: 

* Is there a "typical" number of ultrasounds for someone with a uterine abnormality?  I think it all depends. My midwives (I am planning a homebirth) said they would suggest doing most of the u/s the OB recommends especially later on. They said the u/s are more to ensure the baby is growing proprtionally

* How accurate are ultrasounds at assessing the amount of room the baby has to grow and develop? From my understanding they really can't. The uterus is a magical organ that stretchs and even the u/s tech at my 20 week scan said at a certain point the bicornuate uterus looks like everyone elses.....

* If the ultrasound indicates that there "isn't" enough room, what exactly can they do about it? Anything? In other words, what is the benefit of knowing for me, my baby, and my doctor? They could pressure you into a early induction, which would be worse IMO than letting your baby go until it is done. My Midwife said a stitch is sometimes used to help counter the pressure on the cervix for a bicornuate, but that can sometimes be figured out with an internal only.

* How do you strike a balance between seeking the natural birth you want, while respecting your doctor's/CNM's desire as much medical knowledge as possible? I believe as much as you feel is right for you. I wont have another scan until about 32 weeks and then at 36 weeks- but only if recommended by the OB. Actually I might ask for one at 34-35 weeks given my history of preterm labor- but who knows, I feel so different in my body this time around. Doing a lot to decrease my stress.

FYI - the external measurements of my uterus today have all been within the normal range - as of 24 weeks it is two fingerwidths above my belly button. Sounds perfect!

Both my OBs and both my Midwives feel that the bicornuate is a variation of normal and many woman are not diagonosed with it before, during or after pregnancy. It wasn't even an thought when I was pregnant with DD. It was her premature birth that had them looking this time and even then my providers feel that NST later on will be more useful than multiple u/s. My OB's have been great in asking if I want the u/s scans, instead of saying I should. Or sometimes they say "I would recommend one, but it is up to you."

I love that my providers all feel I am able to really know what is right for me. I would suggest you do what feels good for you. With DD I had a scan at 6weeks, 20 weeks, and 30 weeks... no more. Only I knew I was in labor, even my midwife who saw me the day before I have PROM didn't think I was really engaging and told me it was practice... I guess my point is trust yourself. I think you could push the 28 weeks until 32/34 if you want... or not do it at all... you do have a choice.

[SmittyJ]

Hi Meepy - would you mind sharing why your daughter had to be delivered early? In this case, there is no concern for the baby other than the size of my uterus. It's a risk for unexpected preterm labor, they would not induce me early.

[amlikam]

Because my water broke at 36 weeks. Only reason she was early. I realize that too small a uterus is not a reason for induction but I have heard the "baby is too big" rational used for another mom with bicornuate uterus. Baby was 5lbs when he was delivered. Really they cannot tell by u/s if baby is too big or uterus too small. Declarations like that are often guesses. At my 30week scan with DD they said she was 4.5lbs and I would have a big baby. She was 4lbs 9ozs at birth, I doubt she gained just an ounce in 6 weeks during the the time babies gain a lot I their weight. I guess I mean to say is u/s are just tools it is more who is using the information that matters and personally I don't think we need thatany even with the bicornuate unless you have a fused septum or something.

[MeepyCat]

Smitty, I had placenta previa, which is a situation in which labor is really dangerous.

[womenswisdom]

Originally Posted by SmittyJ 

* How accurate are ultrasounds at assessing the amount of room the baby has to grow and develop?
* If the ultrasound indicates that there "isn't" enough room, what exactly can they do about it? Anything? In other words, what is the benefit of knowing for me, my baby, and my doctor?

These two questions are key. You should ask your OB/midwife and see what they say. It's a really important part of being an active participant in your health care. Is there some reason you haven't already had this conversation with them?

If there is nothing they would do differently, then what is the point of the additional information? If the only reason is to see if there is "enough room", is there any way to really tell that (what specific and objective markers would they be looking for?) and what happens if the baby "runs out of room"? If the concern is premature labor, I'm not sure how the ultrasounds are going to help you. You'll either have premature labor or not.