IUGR and another "small" problem

Wikipedia(my new found love) defines Intrauterine growth restriction(IUGR) best(and simply): "IUGR refers to poor growth of a baby while in the mother's womb during pregnancy."  A broader definition would include the fact that an IUGR baby measures below the 10th percentile for its gestational age(and may include the 10th percentile)and whose abdominal circumference is below the 2.5th percentile. 

Of course simply put, there is nothing "simple" about IUGR. There are so many possible contributing factors. Poor Maternal nutrition and lack of oxygen to the fetus are leading factors. Aafp.org(<- click) has a great list of probable causes, ranging from chromosomal abnormalities, diabetic causes, hypertension, infection and our very own blood clotting diseases.   

IUGR does have some unsettling facts that go along with it, it does increase fetal morbidity, in fact it is the 2nd leading cause of infant death. However, as the AAFP stresses, early detection & appropriate management can reduce the risk of infant death.   

Which comes to my next topic, and my clear recommendation. Detection of the problem?  Amniocentesis can help!

Amino-oh no..

Prior to this pregnancy if I was asked if I would like to have a amniocentesis I firmly objected. In my brain Amnio's were only used to rule out down syndrome and to give a person an option to abort. I am pro-life(although I do respect the opinions of others) and it wasn't a consideration of mine, not to mention there are some risks involved..   In fact when I found out my little one was small at 20 weeks, the Specialist threw the amnio word around and I must've had some rancid expression on my face because he said "I'll guess you aren't wild about that idea?"  "No, not at all" Was my response.  When, 2 weeks later, we went back and the baby had barely gained a single ounce he recommended it strongly, and we did it right then and there.  He wanted to check for infections & chromosome abnormalities. By this time we already had our 4G4G explanation, but he wanted to rule anything else out since I have had 2 relatively normal pregnancies that the 4G4G did not have an effect on.    I laid on the table while he did an ultrasound, looking for a good pocket of fluid, he poked around and made sure it is was a good spot(My placenta is anterior, so that complicated things a bit futher)  Finally they told me, "This will hurt a bit"  I am not normally a wuss, but I wasn't looking forward to this at all. There was pressure, and pain. I swear I could feel it through my feet, I tried my best not to tense up, but you do have a long needle in your gut, so you try it.. :-P .  The nurse asked if I was alright, "Yes"*moan* A few seconds later she asked if I was alright again, I Said "yes" once more, then she explained "Oh I meant him" Pointing to my dear husband who was a shade of green I didn't recognize on him.    It was over and done before I knew it, and I was advised to take it easy the rest of the day, no work for me, which was the best news I'd gotten by then.    All of my tests came out alright, and we concluded that the Lovanox was the best bet for me.   He has been growing, so hope is not lost yet.. 

I do recommend the Amnio's now. Its peace of mind.. No wondering about what could be going wrong. Its just not a fun procedure!  As I said before there are some risks involved, so please make sure your Doctor informs you of them.  Complete disclosure is a blessing. The main risk is fetal loss, but recent studies indicate this risk is about 1 in 1,600.  I was pretty comfortable with those stats, and mine went just fine. I was sore for a few days after, it was great sympathy fodder too HUH? I mean.. It shouldn't displace you for too long. If you have any concerns of course you should call your Dr. :)

What next? Oh what the heck lets talk about Blood again..

I've grown to have a love/hate relationship with blood over the last few weeks. I mean on the one hand you depend on the junk, you're not a whole heck of a lot without it, now are you? On the other hand it can cause so much trouble if you don't understand it, whats going on, or how to fix it.  I've got the "whats going on" part down, you can read my previous entry about the dreaded 4g4g Polymorphism if you'd like.   I wanted to write about a few of the other blood troubles that I've met(although not closely dealt with) along the way.  I also want to write about the "How to fix it" part of the above mentioned dilemmas.

First of all, clotting.  When I first started being tested for issues, my original Doc threw our a cluster of probably causes of fetal loss.  Most of them were thrombosis issues(read: clots) And there quite a few to choose from.  First there is "Antiphospholipid syndrome", "Factor V Leiden",  "Lupus Anticoagulant" and then of course there is the 4g4g polymorphism(which he did NOT mention, but its probably because he didn't know), which has no wiki-link. I have become jealous of those of you with wiki-links to go along with your diagnosis.. *SIGH*  All of the above accomplish the same sinister goal, coagulation of blood, in one way or another.  No sorry, not just "coagulation of the blood"; OVER coagulation, unnecessary, and excessive coagulation of the blood.

Why is this problematic, specifically for pregnant women(not only, just specifically)?  Well, when you are pregnant your body naturally produces more clotting factors, making a pregnant woman SIX times more likely to develop a blood clot than normal..  Not only that but your uterus is growing and expanding, Pushing and moving which can compress important vessels in your body, slowing the blood down and creating the potential for clotting.(click for source)   There are actual benefits to your body creating these extra clotting factors, you lose less blood during delivery. I think in a way its a lovely design... Unless of course you have an ugly friend in your body(see list of ugly thrombosis issues above).  There are ways to prevent clots, and to speed up the blood flow, and thats where my next topic of discussion begins.

"The Fix"

i was under the impression when I started taking baby aspirin that I was going to be lucky enough to not need anything but that tart tablet every day.. Boy was I wrong.  At 24 weeks my Dr started me on Lovanox. I got the Non-optimistic, Non-pessimistic, merely REALISTIC speech "This is for your benefit, not the babies since at this point in understanding 4g4g we just don't know if it will benefit HIM at all"  Not exactly a vote of confidence, but I'll take it.  The shots are taken twice daily. I've been on them almost a month and I will say its 70% mental 30% painful which are decent odds if you really think about it.  I've learned to inject in certain spots faster than others, because those hurt the most. So unless you're going for the long slow torture method, you just really wanna go "balls out" for those areas.(IMO the higher you go the more it hurts, just my opinion though ;) ) I've also come to learn the spots that I don't feel at all, but I've abused those spots in the last few weeks, so they're bruised and unpretty.. So I'm going for the fast shots right now.  All in all its pretty simple, make sure you're in a reasonably clean environment, get your hand sanitizer and your alcohol prep pads out.. I pinch the area on my belly that i'm about to "shoot up", then make sure you activate the safety shield once the shot is out of your body and dispose. I use an empty detergent bottle for my leftover goodies, they hold a ton of syringes!   I usually sit still for a moment or two because I have to "reforget" what I just did or I can't go on with my day with shuddering at the thought. lol I am pregnant after all, so dramatics come easy for me!

Anyway take heart if you're going through this with me.. Its not something I'll soon forget but in the end I hope we can all say "It was SO worth it!"