Sunday, June 8, 2014

35w2d CTG monitoring for suspected placental failure

Yes yes I know, there has been a major gap in my posting on here. Sorry to have worried anyone! I appreciate those of you who have given me a poke with the comment stick hehe. Basically all is fine. But third trimester exhaustion hit me and I've been dealing with insulin resistance (blood sugars kept creeping upwards). Every evening I thought of posting I would fall asleep!

Here are some pictures of what happened yesterday:

Hi Interwebs! Check out my belly!
Oh it hasn't been all napping and falling asleep in the armchair around here. Or struggling to make it through the last several weeks of work (only 5 working days left, folks!!!) Oh no! In fact yesterday things got all interesting again as I found myself back up in Labour and Delivery having the baby's heart rate checked out, to check for placental failure. Fun times. Don't let that smile fool you.

From about 24 weeks onwards I started to get insulin resistance meaning that my blood sugars would be slightly higher each day, and a dose of insulin which worked one day, would no longer be enough. The treatment is not difficult, but it takes a huge amount of observation and dedication and trial and error to get right. Especially since it has to be done at least once a week, more likely every 3 days or so: adjusting insulin basal rates up, making insulin:carb ratios stronger, and giving more corrections throughout the day (and night) when those two prior things weren't doing the trick.

Cut to Friday, my 6th to last day at work, and I was feeling like crap. Had an awful night with barely any sleep due to almost constant low blood glucose alarms going off. I must have drunk nearly 750ml of juice throughout the night! Plus now that I'm so huge, reflux/heartburn and belly/back aches have made my nights a bit of a living hell. If I could get away with just staying awake for the rest of this pregnancy, I think I'd take it as lying down can be most uncomfortable if I'm overtired.

I checked back over my blood glucose logs and noticed that my blood sugars had been dropping more and more from Wednesday through to Friday. This set off some mild alarm bells. It could be that because I was mid-34w that my insulin resistance was starting to wane, and that would be, from what I read, somewhat normal for the increases in blood glucose to plateau out a bit. But this was a drop. I was running -30% temp basals and still getting lows. I was drinking juice by the glass and needing more in half and hour. Not normal. Plus I felt like arse. So tired, so achy, got cankles. Boo.

After scouring the interwebs on Friday night and getting help from some lovely FB ppl, I decided to give things one more night and see if they would fix themselves. Nope. So Saturday morning I messaged my Diabetes Nurse Educator who promptly phoned my OB and they both wanted me in immediately for CTG monitoring just to check for placental failure (where the placenta has started to degrade and so the baby isn't getting the blood supply it needs). I once again felt like a silly fool traipsing up the road to the hospital when by all outward appearances I was well and good. But there are no maternal symptoms of placental failure so for once I was actually quite thankful to have diabetes - my blood sugar drop being a potential early warning sign! Yay for the silver lining! :)

A lovely little British nurse got me setup on the monitor at about 11.30am, and since I had told Hubby there was no real need for him to come and sit and be bored with me in hospital, I was left alone with the wonderful sound of Tiny Fish's heartbeat.

30 mins later she came back to check on me, and kinda hummed and hawed at the graph. She said that the heart rate was good, but there wasn't really much variability. It showed one "tightening" of the uterus, but didn't capture any braxton hicks contractions in the entire time I was there. She decided to leave the monitors on for another 30 mins. I rolled to my left side at her suggestion to try and wake Tiny Fish up, even though I thought baby was already awake with some gentle movement happening. This helped to increase the variability of the heart rate which was what the midwife was looking for. She said that normally this would be a perfectly acceptable graph, but with my diabetes and the low blood she wanted to see a "perfect" graph before letting me go.

It was really nice, one of the first things she said when she came in was "I've read your notes" (Wow!!!) and I see you are Type 1, I don't know much about Type 1 as most women we get through here are Type 2 or gestational. Tell me about it" Just, wow!!! That's so awesome to have a healthcare professional being so open and friendly, and genuinely wanting to know all about Type 1 and how I manage it. She was fascinated by the CGM, and kept asking me interesting and intelligent questions about how I deal with different aspects of my diabetes. She even wanted to check with me who she should call if there was a problem with the heart rate! (It was awesome that my OB was scheduled on shift that morning. I didn't get to see him, but I believe she checked the graph with him).

At one point I was on my own again, and I noticed that Tiny Fish's heart rate that had been sitting at about 144 - 146bpm was suddenly going 140, 139, 138, 137... I felt fine, but I checked my Dexcom graph and saw that I was indeed slipping ever so slowly low:

I had been in hospital for an hour and a quarter, right across lunchtime, and had no food. Lucky I packed a banana, muesli bar, mandarin, juice... My blood glucose meter was, as normal, slacking and only showed 5.5mmol (a no-drama number), and no alarms had gone off on the dex. So I decided to see what would happen for a minute. Not long, but it intrigued me greatly that the baby's heart rate would start dropping noticeably before I felt symptoms or got low alarms. Shortly after that, the midwife came back in and by that stage I felt it necessary to eat the banana. She too was interested, and of course insisted that I stay a further 30 mins. Gah. She also threatened me with a hospital lunch but I said no thanks I have plenty!

Another goodly wait and Tiny Fish got the hiccups. The were strong enough to be seen moving my belly, and through the CTG monitor they were very loud! They were so strong the monitor kept slipping to the point that I couldn't keep it lined up with my hand, and the CTG alarm started going loudly. So that, plus loud hiccups, plus dexcom alarms, plus my phone buzzing with incoming text messages (hey, I was bored!) and soon another midwife came quickly in to sort me out. She looked at the graph and decided it was pretty good. My midwife came back in and ripped off the paper print out and took it out to get checked, and then I was released!

I packed up and got all the jelly wiped off my belly. Walking back up the corridor I started bumping into folks from my antenatal class, another and another. What was going on? Oh riiiiiiight, this was the antenatal class tour of the labour ward! lol. I was starving (hey, a banana and muesli bar is NOT enough at this stage ok) and hubby was on his way to pick me up so I decided to flag the tour. But they were all like "oh is this where we meet?" "um, yeah, I've just been in here for monitoring, I'm not staying for the tour" "Oh! Are you ok???!" "Yep, got the all clear".

So it was the result I expected, no problems, and next scan is on Thursday. But since we live so close to the hospital it is worth getting checked out anytime I see something unusual. This week is my last week of work with handovers to all the new tutors (5 replacements!) and I have 4 official medical appointments, with a recommendation from the midwife to go for another CTG monitoring session after the scan on Thursday. Current thinking is that I will talk to my boss about working shorter hours this week as the exhaustion is just getting too much for me. Hopefully I can just work mornings??? We will see :)

Thanks for reading :)

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