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 :)

14w1d Bleeding at 13w6d weeks pregnant

Last post I wrote Monday morning, expecting to go and have my nuchal translucency scan later that afternoon. We were planning to take a short holiday trip across the island and in the course of packing became a bit late and had to rush to the scan. Turns out the day started as it meant to go on, as I had gotten the times mixed up and our appointment was not 1pm but 4pm! So that would delay our trip (5hr travel time). We went home, double checked the pack-list and grabbed all the things we had forgotten, then hopped around to my parents' place for a cup of tea and a debrief.

In the car on the way there (4pm) the ultrasound clinic called and apologised: the OB/tech (who is the best in our province, but is private = expensive = only using her for some scans) had to rush to the hospital to deal with a woman in labour. So. No way to have the scan. I started to get agitated as I knew that the scan would only be possible up to 13w6d, and although the ultrasound clinic wanted to re-schedule me for the next day we would be out of town by then. Plus Hubby sort of still didn't really want to do the scan at all. I could try and get my midwife to organise to have the scan at our holiday destination (fun). Or the clinic said they would try and swap another patient so I could get a slot on Thursday, which would be the last day I could have the scan by my count - going from the date of conception. Or we could just not do the scan and only do more blood tests later in trimester 2. Then the receptionist was telling me I had my dates all wrong and I was actually not that far along and I could possibly wait even further. She wasn't really listening to me, just telling me I had it all wrong. Not helpful! I know the date of conception down to the hour for crying out loud!

So, with that, we started out trip and I tried to put if out of my mind. We were only really away for a day, but managed to get in some mountain biking and sailing. Both of which freaked me out. The mountain biking was supposed to be a gentle, flat ride along the banks of a beautiful river. Well, it turned out to be a thin gravel track that went UP and DOWN. I have never ridden that sort of track before and couldn't really control my bike well on the multiple down-hill segments with the gravel skidding my bike out from under me. Long story short I had a panic attack as I thought I was about to crash / roll over / tumble into the river. Oh, and I was having a low (hypo) at the same time! What fun! I was unable to stop from panting these really deep fast breaths and wheezing and trying not to cry and feeling sick and my arms and legs just locked up like stone on the bike. Hubby looked after me and got juice and a muesli bar into me. I recovered ok and we were able to bike back slowly. I did feel much better on the way back as I knew what to expect of the terrain, and Hubby showed me a technique with the brakes which helped me control my bike better.

The sailing was fun although at the first turn I thought we were about to tip over and squealed like a mad thing! hehe The lake was a bit choppy and it was just the pair of us on this tiny little yacht. But very cool experience. Boy did I sleep well that afternoon. We cooked a lovely BBQ at the motel that evening and had cheesecake for dessert.

The drive back the next day took a little longer as we headed up to another city to collect youngest-step-son from his friend's place, then drive us all back home. On the way back I got a bad headache that was awful by the time we got home. I managed to eat some dinner then went straight to bed with 2 paracetamol.

At 2.30am that morning (Thursday 9 Jan) the Dexcom woke me up with a noisy beepy alarm: low. I trundled out to the kitchen to get some juice, as has become my custom in the wee hours of the mornings, and took a detour to the loo first. And there it was. Bright red. Bleeding. No pain, just a feeling I can only describe as numbness, like my heart just sank. I knew that if this was going to go badly, there would be nothing anyone could do about it, and that it would hurt a lot. With no baby at the end.

Aware enough to realise that the low could be part of the problem, I drank down some juice and went back to the bedroom to wake Hubby and tell him. After about ten minutes he asked if I was still bleeding so I went back to check, and it seemed to have mostly stopped. We live 5 mins from the hospital so it would have been foolish not to pop up there and get checked out. Yay: A&E in the middle of the night; my favourite :-/

Thankfully the ER waiting room was blissfully empty and quiet. I rang the bell and the triage nurse came out. I gave her my name, how many weeks pregnant I was (13w5/6d) and the fact that I was bleeding. She took us straight through to the triage room behind the automated security doors, and asked me questions while Hubby filled out the paperwork. From my answers the triage nurse was able to determine that I had a "light bleed" but it would be worth checking anyway, and that there was not much they could do except wait in circumstances like these. She slipped a cute little pulse/ox meter on my finger and announced that at 99% oxygen saturation that was a good sign.

The triage nurse took me around the corridor to a private room and a cheerful ER nurse arrived. She was really sweet and gave me "points" for knowing what my blood type was! She took my blood pressure, temperature and pulse and they all came back normal. Next in came the doctor who asked similar questions: when did it start? (2.30am) how many pads? (none!) do you have any pain? (just some mild pressure and ache as I normally have had that I associate as being normal for me being pregnant. Is this your first pregnancy? yes. Any allergies? (no) etc.

Both the doctor and the nurse agreed that the low blood sugar (hypoglycemia) could have maybe had something to do with the bleed, but it could also have to do with the mountain biking or exhaustion. They listed it as a threatened miscarriage and explained gently that the only thing they could do is check for the heartbeat with ultrasound (a strong and healthy heartbeat was present immediately! The most wonderful news in the world!) and do an internal exam to gauge the blood loss and possible cause. They took a urine sample and tested for signs of infection but everything came back negative. Swabs were taken although the results of those won't be available until next week at my GP's office. So in all, it seemed mild, although they noted that it could progress further. They told me to take it very easy for the next four days, and were happy that I had the NT ultrasound that afternoon. We were sent home and I didn't sleep very much for the rest of the night worrying about every little twinge and ache I felt. I was rolling over very carefully!

In the morning I felt fine. Hubby went to work and I tried to do as little as possible. Mainly this consisted of calling all my healthcare providers to get their advice:

First up, the midwife: she listened carefully and asked me more questions. She promised to contact the on-call specialist at the hospital for more advice, but she advised me to get in touch with my diabetes nurse to adjust the pump settings as she suspected the low blood sugar of being a potential cause.

Diabetes nurse: I got her on the phone the second try (a miracle! It sometimes takes days to get through to her as she is soooo busy with patients). She spoke to me for a good 20 mins and we made adjustments to the basal rates of my midnight to 6am rates. In the two days since, I have lowered these rates even further and I am very close to having a night sans-hypos! Yipee!

Midwife again: she called back and advised that the Charge Midwife at the hospital had advised more frequent monitoring (I think that means Doppler?) and I should come in on Sunday (tomorrow) to the Labour and Delivery ward where my midwife was having a clinic. So that will be an experience. I certainly didn't expect to be going there this soon. Oh, and I also have an appointment booked with the hospital OB. Finally.

Later in the day, we went to the ultrasound clinic for the NT ultrasound scan. I told the OB what had happened the night previously and she immediately got to work looking for the baby and any potential problems. She found the baby straight away (it's hard to miss now. I even have a mini-bump!) and found the probable cause of the bleed too: I have a low-lying placenta. It's completely covering the "exit" and she told us that it could easily be disturbed or aggravated by sudden jostling movements. Such as bike riding. Boo. I love bike riding! She went on to say that at 13 weeks it was too early to diagnose placenta previa as it will most likely migrate up higher, however I should have it checked at 20 weeks to make sure.

Knowing what had caused the bleed was such a huge relief, although the OB did say that I can expect more bleeds which freaks me out a bit. I have been being very careful with my movements since then, but I am still active.

Then the checks for the baby began: she did the NT measurement three times throughout the 20 min scan just to triple check, and each time the result came back just slightly over 2mm. If the result is 2.5mm+ then that strongly indicates Down's Syndrome as the likelihood of potential heart defects causing excess fluid is much higher in that case. So, passed that one.

And then she started looking at everything else. I had only really thought to worry about the NT check, but she was looking for the correct number of arms! I hadn't thought about that! It was all fine. We saw two arms, two legs, five fingers on each hand. The spine. The CRL was 7.71cm and this put the fetus at about 13w3d (3 days slower that what I thought from the conception date). She measured the head size and looked at the brain, stomach, bladder, legs, knees, and the mouth which was swallowing. We could see the stomach filling with liquid as the scan went on! She took at few photos for us and seemed much happier and more interested this time, probably because there was so much more to see.

She checked the rest of my uterus and found a fibroid (towards the top, I think?) in the uterine muscle itself. Apparently this is of no cause for concern at the moment.

So overall it has been an absolutely exhausting week. Good news in the end, out little one is still going strong, kicking up a storm in there.

Thanks for reading this far. Here are some pics as your reward:

Our little one dancing and waving and kicking!

Here you can see the brain and the mouth, nose, and the right arm and hand.

My mini-bump. I can just get my pants done up. And those are stretch jeans too! Gone with a blue inset 30 for my Animas pump at the moment.