I had two appointments this week. The first was a (much needed) hair appointment. I got a trim and some highlights, but you’re probably not too interested in that. My hair person is pregnant too and is about a week ahead of me, so it was fun to compare notes.

The second appointment was my follow-up with the perinatalogist. I got some good news and some not as good news. I passed my glucose test with flying colors, so I am glad to not have to worry about that. My blood pressure continues to be good (114/68), and I think my urine sample must have been fine because no one mentioned it to me. (I typically would ask and not assume, but I forgot.) The ultrasound continues to show good blood flow, symmetrical growth, and weight gain. She weighed 2 pounds 5 ounces at 28 weeks 4 days, which is the 12th percentile (according to the chart my doctor uses: I think there may be a few variations). She was in the 8th percentile at 25ish weeks, so this is actually an improvement.

I was very happy with all of this news, but then he told me that my amniotic fluid level was low. There are a few ways to measure amniotic fluid via ultrasound, but my doctor uses the amniotic fluid index (AFI). Her AFI was 8 or 9 at 25 weeks, which was considered normal for her size (smaller babies typically have lower fluid levels, while bigger babies typically have greater fluid levels). At this appointment, her AFI was 5. Anything less than 5 is worrisome and can potentially be dangerous. By the third trimester, amniotic fluid is mostly fetal urine. I am 99.5% sure that I am not leaking fluid, so it is likely that there is a problem with her urine production. I have had three ultrasounds so far and none of them have shown problems with the kidneys, so the reason that she is not producing enough urine is likely that she is not getting enough fluids from the placenta (meaning there is a placenta problem of some sort.) My doctor assured me that I didn’t do anything wrong and also that there’s nothing to do to fix it (No bed rest. I can work. I can exercise.) I will just be monitored closely with weekly appointments from here on out (either with my regular OB or the specialist). If at some point, the baby stops growing or her AFI gets too low, they will deliver early. I really hope that doesn’t happen because I want to have a full-term (albeit small) baby that doesn’t have to go to the NICCU. I want to hold her and nurse her and bring her home (just like all mothers). I am preparing myself for whatever needs to happen to give Baby the best possible start though.

I have read studies (http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000134/abstract) that say that maternal hydration can affect amniotic fluid levels. I don’t think I was dehydrated, but I had forgotten my water bottle a couple days at work that week, so my intake had been lower. I had also gone for a jog the day before the appointment and possibly failed to rehydrate properly. The above study basically says that increasing oral fluid intake or receiving IV fluids can increase amniotic fluid volumes, but that it has not been determined whether doing so improves clinical outcome for the mother/baby. I figure in my case, it would improve the outcome because so far there is not a blood flow problem and she is growing. As long as her AFI stays up, she should be able to stay inside me to develop and grow. Therefore, I have been drinking about four liters of water per day plus a couple cups of other beverages (milk usually). This is not something my doctor asked me to do, but I’m hoping it makes a difference…..

I have also started doing kick counts (which is something I never did in my first pregnancy), but since this one is higher-risk, I decided it would be a good idea. There are a variety of ways to do this, but my doctor’s office recommends laying or sitting quietly for 30 minutes at a time (three times per day) and counting the kicks/movements/rolls/hiccups. If one day’s total is half or less of the previous day, a call to the doctor is warranted. If less than 10 movements are felt in two hours, a call to the doctor is warranted. And obviously, if no movement is felt in 30-60 minutes, a call is warranted. I don’t always have time to do 3-30 minute kick counts, but she has been very active and typically moves 25-35 times in 30 minutes. That is reassuring.

Lastly, we painted her room this weekend. We have an accent wall that is sort of a toned-down lime green, and the other three walls are very, very pale pink. My husband thought it was white until I told him how sweet I thought the room looked. I also got her bedding which is pink and green. We just need to hang the pictures on the wall and we’ll be ready!

Exercise: We had really nice weather this week. I went for a 30-minute jog, a 30-minute walk, and a 60-minute walk. My doctor says it’s fine for me to continue to exercise, but I have decided to stop running partly because of her size/fluid levels and partly because my pelvic bones were sore for a few days after my jog. (This happened with my first pregnancy too, but I think it was a few weeks later…) I will still try to walk or swim and maybe lift a few light weights.

Weight: 139 pounds (up two for the week and 24 for the pregnancy)

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