OB Appointment Yesterday

Um that's a lot of extra monitoring for something that isn't supposed to be a problem ... maybe I'm wrong but it sounds like your OB is going a little over-board... how do you feel about it?

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I'm really not sure how I feel about all of the testing. When we talked before about the testing she'd be doing, I'm almost positive she said it would only be twice and now she wants to do it every week, which would mean four times total until delivery. I know there's nothing else going on or the perinatologist I saw for it would've told me. Everything has checked out okay with the baby, other than the two vessel cord, of course. I mean, her weight at 30 weeks was almost 4 pounds and in the 75th percentile for gestational age. I really feel like this testing is a little excessive, though. I know she wants to stay on top of things because she is concerned about the baby becoming distressed in the event the placenta starts to have problems because of the cord issue, but I would think there would be signs of the baby distressing, such as decreased movement. But is all of this testing par for the course for a two vessel cord baby?

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I'm certainly not an expert, but here's the testing that I've had/am expecting, for comparison purposes:

-20 weeks u/s showed the two-vessel cord
-fetal echo and growth scan around 24 weeks (both fine, with size well above average, which is typical for my kids )
-growth scan around 28 weeks (growth was fine; scan showed mild polyhydramnios (excess amniotic fluid))
-AFI to check fluid level around 30 weeks (back down into high normal range)
-growth scan around 34 weeks (growth fine -- weight estimated 7lbs2oz, on track with ds1's birth weight and also similar to m/w's estimate through palpation; fluid levels back up and higher than first high reading -- I think I might have gotten into the low end of severe polyhydramnios this time)
-I start weekly NSTs next week (around 36 weeks)
-I'll be having another AFI to check the fluid level around 36 weeks, and I don't know if they'll do another at 38 weeks

The green scans/tests have been/will be due to the two-vessel cord. The blue ones I've only had/will have because of the polyhydramnios.

The perinatologist did mention that the excess fluid could theoretically be due to cardiac or kidney problems, which are sometimes associated with the 2VC, but since they've looked at the heart and kidneys repeatedly, he doesn't think that's the issue here. In any case, I wasn't told to expect extra AFIs ahead of time, so they don't seem to be part of the standard of care for 2VC here. (But they do seem to be built into the growth scans. Oh, and in terms of time, they're very, very quick. I think the one I had by itself was maybe 5 minutes long.)

So, it seems like we've got the NSTs in common, but I wouldn't be having repeated AFIs if it weren't for the additional issue of excess fluid, and I'm done with growth scans/non-AFI ultrasounds (unless growth/activity problems become apparent, of course). Oh, and actually, in terms of checking the baby's size every week (which is what I'm assuming the ultrasound after the AFI is intended to do), my perinatologist doesn't even like to do growth scans 2 weeks apart. He prefers 4 weeks, because the margin of error is around 2 weeks in either direction, so with 2 (or fewer) weeks apart, he feels it's too easy to have a situation where it looks like the baby isn't growing, but really is.

I don't know. It's so hard to figure out what's reasonable, what's over the top, and what's not enough. Yesterday I talked with my m/w, and she told me her intuition has been bugging her about my homebirth plans. She's been feeling like this baby keeps giving us reasons to be concerned (even though nothing ever really shows up in the follow-up testing), and maybe it's all leading to a baby who really needs to be born in the hospital. I'm sad to lose my chance at a second (and last) homebirth, but I had to say that I've been thinking the same thing. (Fortunately, my m/ws have hospital privileges as well, so I'll still be with them.) It's just tough when there are these potential problems which may not be problems, but could be, and then you have to decide if the prevention/avoidance/detection of the problems is more or less risky than the chance of actually having the problem, yk? I really think that both of us will end up with healthy happy babies in a few weeks, and that the whole 2VC thing will become a vague memory with no impact on them after birth, but it's a challenge getting to that point without going a little nuts.

Sounds like what I had when my dd had a 2 vessel cord. My appts went like this: I went in had the regular urine dip, weight, and bp check. Then back to the exam room to be hooked up to the monitor for the NST. It is a good idea to eat *right* before this (I always ate a granola bar as the nurse was hooking me up). This way the baby will most likely be awake and the test won't take too long (if baby isn't active it takes longer to get a reactive strip). Once the baby does it's thing (can't remember, but it is so many movements and they want to see the heartrate jump for a period of time), then it is a quick u/s to do the AFI (amniotic fluid index).

If it is possible to have someone watch your toddler I would suggest you do that. When you are hooked up for the NST you will likely be left alone and you can't really get up so it would be hard to control a toddler. My DD#1 is a pretty easy going kid and was about 2.5 when her sister was born but I still left her with my friend during those weekly visits. It was hard because I had never ever left her with anyone, but we did a trial run the week before to make sure she would be ok and she totally was.

Good luck!

Beth