The most complicated pregnancy ever?

Well, it feels like the most complicated pregnancy ever but I'm sure there's worse ones than this :-)

Today we had the 27 week ultrasound to check on the foetal vein situation. We had two pieces of good news and one piece of bad news. First the good news.

E3 is doing very well. It was so sweet. He was lying there with his feet around his ears!!! The sonographer said a doctor at her u/s conferences always shows a baby sucking its big toe but none of them believe its real because they've never seen it before. She was therefore very chuffed to see E3 with its feet near its mouth.

E3 is growing really well and in the 64th growth percentile. That means that 64% of babies are smaller than E3 at this age. If he was at the 50th percentile, he would be exactly average. So having him a bit bigger than normal is just great.

She was also able to estimate the weight, which is about 1.2 kg - the expected weight of a 29 week old baby, so I was very happy about that.

But the best news is that the vein running across the cervix has moved out of the way a bit! I hadn't dared to hope for this but its happened. The two parts of the placenta have now moved quite a long distance from the edge of the cervix and have taken the vein with them. There is no placenta previa at all. The doctor and sonographer had a really good look at the vein and traced exactly where it was going so I feel confident that they have assessed it well.

Although the vein is still dangerous, its not nearly as scary as when it was lying directly across the cervix. The doctor said it may move even further away as we go on through the pregnancy. He said it can still rupture but not until the baby pushes down hard to be born and creates a big tear.

He was councelling us that a caesarian section is still the way forward because the vein can still rupture when the membranes rupture. He needn't have bothered - no way are we going to take a chance on risking a natural birth.

So we are now faced with a slightly less chance of the vein rupturing before the elective caesarian, which is good news.

And now for the bad news.

My cervix, which was measuring 34 mm at 19 weeks has now shortened to somewhere between 14 and 19 mm. There's a range because I have what's called a 'dynamic' cervix (yes, there's just no end to the abnormalities with this pregnancy!). That means the cervix lengthens and shortens over minutes. So one minute it could be 14 mm and the next 19 mm.

Under 15 mm is not a good sign and really increases the chance of pre-term labour. I am seeing my obstetrician on Monday to discuss it in more detail but for now we have a plan:

1. Another ultrasound in one week to see if the cervix is still shortening or holding steady

2. Progesterone pessaries (same as for IVF cycle), which are proven to help with cervical shortening

3. A big reduction in activity. This means really cutting back on any exercise ie. I need to really restrict walking around as much as possible.

I can still go to work (for now) since this involves sitting at a desk all day but we will see what happens when I see the obs on Monday and with the ultrasound next week.

So all in all, LH and I both feel more positive about things, despite the 'cervical' setback. E3 is now much less likely to die within minutes if my membranes rupture, although it can still happen. Before, it was almost a certainty. That was more terrifying for us than the shortened cervix.

Things still aren't great because we've got a good chance of having a premature baby, but less chance of it not surviving. As usual, I've been digging up clinical papers to look at the chances of preterm birth and found a very good one that relates cervical length, gestational age it is found and chances of preterm birth.

A 15 mm cervix at 27 weeks gives us a 14% chance of having E3 arrive before 32 weeks, so that's not too scary. Its only a 4.7% chance of preterm delivery before 28 weeks. There's only 4 days to go to 28 weeks so I think we are pretty good on that one.

And finally, if E3 is born now, he has more than an 80% chance of survival.

So all in all, we are coping with these new developments quite well. Its back to one day at a time and next milestone is next week's ultrasound. I'm determined to keep the 'why me' line of thought at bay. Things could be far worse and we've coped with everything mother nature has thrown at us so far, so we will deal with this as well.