Hello Third Trimester

This week marks the beginning of the third trimester! I can't believe 2/3rds of this pregnancy are over, but I'm not complaining!  This week my little man is the size of a rutabaga.  I'm not super clear of exactly how big that is LOL, but I know he's also probably upwards of 2 lbs now!  He can hear and open his eyes and everything! So multi-talented already!

So yesterday I had my check up and glucose tolerance test.  If I don't get a call by the end of the week I'll know that the glucose test came back fine, which I expect it to.  I'm glad that's over (assuming the test is normal) because I don't enjoy eating a hard boiled egg for breakfast followed by a really sweet orange soda that keeps giving me brain freeze.

I expected the rest of my appointment to be fairly routine--blood pressure check, measure fundal height, and listen to the baby's heartbeat.  My blood pressure was fine and the baby's heartrate came in at a solid 150.  However, I'm still measuring a little big, around 29 weeks as opposed to my 27 weeks.  Most likely, this is due to the stubborn little fibroid that was first mentioned at my 13 weeks first trimester screening.  My OB says that because I'm measuring larger, because I have the fibroid, and because I conceived while taking letrizole (femara--the fertility drug I was using when I got pregnant), they will now consider me high-risk and we'll be doing additional monitoring of the baby.

Basically, this means that I'll have an ultrasound in two weeks to check the size of the fibroid, and then starting at 32 weeks I will be seen weekly.  I will also have bi-weekly non-stress tests and biophysical profiles done.  I had a non-stress test with Tyler, it just involved being hooked up to a fetal monitor that measured his heartbeat and registered movements and any contractions I was having.  The biophysical profile apparently involves a detailed ultrasound that looks at several criteria:  heartrate increases, breathing movements, body movements, muscle tone, and amniotic fluid volume.  The baby will get a score out of 10 in these criteria.  If we get a bad score it could mean there is a problem.  They'll also be watching his growth carefully to make sure that the fibroid isn't restricting weight gain and watching for signs of preterm labor.

My ob emphasized that most of the time these fibroids don't cause any problems at all and that they just want to be extra cautious.  I'm glad that they will be watching things closely, but I can't say I'm not a little surprised.  I anxious to see what the fibroid measures at my next appointment and I guess I can just be happy that I'll get to see my little one on screen again.  I was wondering if I'd have another peek at him before the big day and apparently I'll get a lot more than that!

I am left wondering how this fibroid wasn't detected by my RE's office.  I had monthly ultrasounds with them, as well as an HSG test and an ultrasound when I was 6 weeks pregnant.  My OB even asked if I'd had an HSG and when I told her yes and that it was normal aside from my left tube not filling (which my RE attributed to cramping), she said it could have been that the fibroid is near the tube's opening and that is is actually closing off the tube.  She says it's not always easy to see a fibroid (especially one in the muscle, like mine is), especially in an HSG ultrasound, but she would have thought they would have detected it at some point.  I guess I can't be sure when this little bugger showed up, but it does make me wonder!

I also wonder what kind of concerns my OB has regarding my use of letrizole to conceive. She mentioned it when, but we ended up talking more about the fibroid and I didn't think to ask if she has any specific concerns or has seen anything worrisome in other patient's who have used the drug. I know it's not as widely used in the US as Clomid is (remember I maxed out on Clomid cycles and was using letrizole while we considered other more expensive treatment options), but my RE said it was very safe.  I guess I'll have to ask my OB at my next appointment.  The office is supposed to work on getting me scheduled for the next few appointments and then call me.

After I have the baby, they'll watch to see what the fibroid does and consider what (if anything) to do about it at that point.  Usually if they aren't causing problems, you leave them alone, but they can interfere with fertility, so we may have to address it at some point if we decide to have more children.

So, all in all not exactly what I was expecting, but the bottom line is all is well and baby and I will be watched carefully over the next 12 weeks.

Oh and yes, I believe this little one finally has a name...Alexander Jacob.  We all really like it and it lends itself to lots of possible nicknames: Alex, Xander, AJ...I'm leaning toward AJ personally.

'Til next time!