9th OB Appointment (35w2d)

I had my 35 week check-up today and first internal cervix check with Dr. Marcus Penn (the final, yet senior OB in the practice, who I had yet to meet). I liked him - he was very friendly, seemed to have a good sense of humor, and took a good amount of time to answer my questions. I gained FOUR pounds since my last appointment on May 6th! However, all is well - my cervix is closed and Dr. Penn could tell that Murtle's head was down! I figured she was positioned feet down based on where I was feeling the majority of her movements (in my lower regions as opposed to up near my ribcage). But darn it - wouldn't you know that Dr. Penn was about to also do the Group B Strep test until I told him that I already tested positive for it and that he had already told me that he was going to put me on anti-biotics at delivery time. I am really not a fan of these large group practices anymore.

Also, my husband and I got to meet with our potential new pediatrician today, Dr. Andre Gvozden of Gvozden Pediatrics. Dr. Gvozden and his staff seemed very nice and friendly and my husband and I liked that the practice consists of just him (as the pediatrician), his wife Cathy (as the pediatric nurse practitioner) and another pediatric nurse practitioner. He also has great credentials (been in practice for over 20 years; training was at the Children's Hospital National Medical Center, Johns Hopkins Hospital and Sinai Hospital; has additional expertise in dermatology and attention disorders; is currently on staff at Anne Arundel Medical Center and Johns Hopkins Hospital; and is an associate professor of pediatrics at the University of Maryland).

We also liked that he does not take transfer patients - his new patients consist of the newborns he meets when they are at the hospital and then he follows their health throughout their youth.

The only issue we may have to consider is that he is very pro vaccination, which is something I was still a bit on the fence about. I am not opposed to vaccines, just the schedule and amount. However, Dr. Gvozden did a good job of allaying our concerns about the alleged vaccine - autism link. We will probably end up going with his practice because I do feel as though he looks out for the best interests of all of his patients and that we can trust him to provide good, quality care.

8th OB Appointment (33w3d) and Non-Stress Test

I had my 8th OB appointment and NST this morning at my OB's Annapolis office. Today's OB, Dr. Margaret Keith (very nice doctor, but she seemed so young), was satisfied with the results of the NST test and even told me that future ones are no longer necessary since my MFM reported that everything from my follow-up growth ultrasound was A-OK.

As for the check-up itself, I learned that I'm holding steady at a 7 pound weight gain. Dr. Keith told me that she would like to see me put on more weight, but I believe Murtle is growing just fine since I've been feeling her move pretty regularly and since my uterus measured 32 cms. Plus, it's hard to gain weight when I just really do not have much of an appetite for anything and since I continue to experience fleeting moments of nausea. Dr. Keith wrote a referral for me to have one more follow-up growth ultrasound with the MFM in two or three weeks. I didn't object, of course! Maybe we'll get some good pictures of Murtle next time. We didn't get any pictures last time because she was facing my spine and the technician could not get a good view of her face.

Oh, and it's a good thing I'm up on my medical issues because I do not have much faith in my OB's practice. I understand how things can fall through the cracks because you never see the same doctor very often since it's a rotating group practice, but why should I as the patient have to remind them of things? I asked Dr. Keith how my TSH was and she said it should have been tested when I had my glucose screening done. She checked my record and learned that it actually had not been checked then, so she set me up to have it tested today. She then told me that I will have the Group B Strep (GBS) test done at my next appointment in two weeks. I told her that I didn't think I needed that since they found that I already had it and she said, "oh, you're right." This lack of attention to detail makes me nervous, but encourages me to simply be more vigilant about my care.

Follow-Up Growth Ultrasound (31w2d)

Things are continuing to go well. I had my follow-up growth ultrasound at the MFM's office on April 22, 2010 (at 31 weeks and 2 days) which showed that Murtle was starting to catch up growth-wise. She was just a week behind - in the 44th percentile (up from the 15th percentile at the previous appointment) - and she weighed almost 4 pounds. My cervix was holding nice and strong at 3.5 cm, the fluid was good, Murtle was active, and my cord was fine. The MFM felt comfortable enough with everything that he told me I had "graduated" and did not need any additional ultrasounds. Yikes! I have a feeling Murtle is going to continue to be on her own (SLOW) schedule, like her father. I hope Dr. Sacks used my egg because as of now, Murtle not only resembles her father, but acts like him, too, LOL!

7th OB Appointment (30w1d) and Non-Stress Test

I think things could be back on track again - hooray! I won't know for sure until my ultrasound next week, but today's Non-Stress Test (NST) and OB appointment(again with Dr. Edwards who I really do like) went very well. To my surprise, Murtle was quite active during the entire NST - she even got the hiccups for a good 5-10 minutes in the middle of the test. At one point during the beginning of the test, she completely shifted positions so her heartbeat fell out of range of the sensor. I didn't know that I could move the sensor during the test, so I just sat there in silence until I got brave and decided to move it. It was a good thing I did because when Dr. Edwards first came in to check on me (after about 10 minutes or so), she told me that if all is quiet for about a minute, I should move the sensor since the minimum length of the test is 20 minutes of active monitoring. So I ended up having to tack on an extra ten minutes for that lost time. Other than feeling a bit bored and uncomfortable because of how I was positioned, the test was a breeze. It was also so wonderful to hear little Murtle's heartbeat and movements for such a substantial amount of time. I didn't have to hit a button every time Murtle moved as I had read that some tests require mothers to do. In addition to the sensor positioned over the heartbeat, the medical assistant also put another sensor right below my breasts to monitor any contractions (which, luckily, never occurred).

After being hooked up for at least another 30 minutes, Dr. Edwards returned and checked the monitor's print-out. She told me that Murtle was "responsive" and quite active during the test. She then measured me and told me that my fundal height was 29 cm. During my last appointment (at 28 weeks), it was 24 cm, so apparently forcing myself to eat more and now drinking 2% milk must be helping Murtle to finally grow. I weighed 160.6 pounds today, so I even gained about a pound within the past two weeks - for a total of about a 7 pound weight gain since my pre-pregnancy weight. My blood pressure was also good at 115/72. Dr. Edwards wants to see how my ultrasound at Dr. Sweeney's office goes next week. If Murtle's growth percentile increases or at least stays the same, she'll see me in two weeks. If it drops (and if Dr. Sweeney won't monitor me weekly), she will want me to return to her office every week so her practice can keep a close watch on everything. I have a good feeling that Murtle will be measuring just fine (even if she is on the smaller size) and that the rest of this pregnancy will be a smooth one. Look at me and my positive attitude! :-)

Regardless, Dr. Edwards wants me to start doing daily kick counts. This consists of me lying on my left side and counting the number of times Murtle kicks in a hour to obtain a baseline reading. She then instructed me to continue to do daily kick counts at the same time each night and if Murtle's activity drops below 70%, I need to contact the office to let them know.

Ah - the final piece of good news is that I passed my three hour glucose challenge test! So, Dr. Edwards told me to keep eating ice cream and milkshakes. :)

One Hour Glucose Challenge Test (GCT) Results

Dr. Edwards (who has really impressed me so far) called to tell me that I failed my one hour glucose screening test, so I have to get a three hour test done. (How in the world could I possibly have gestational diabetes, yet have such a small baby?) She told me that I could have had regular diabetes all along (diabetes can go hand in hand with thyroid problems and I do have a family history of diabetes), which could be affecting the placenta, which could be affecting Murtle's growth. She said they probably should have tested me for this earlier in my pregnancy, but since I was an IVF patient, they probably assumed that I had all of the necessary testing done. Anyway, she's glad that I'm getting extra monitoring at the specialist's office now and encouraged me to ask to be seen by that office frequently to make sure that everything is on track. Hopefully I don't also end up developing pre-eclampsia, too, by the time this is all said and done. I have a strong suspicion that my blood pressure goes out of control when stressed and that happens a LOT, especially during my commute to and from work. So far the only thing that seems to have gone my way during this pregnancy is that my blood type is A+. However, I will hold on to hope that I will pass the three hour test since my one hour test result(147) wasn't too bad.

6th OB Appointment (28w1d)

I had my 28 week OB appointment this morning (including the glucose screen - finally! - the drink wasn't nearly as bad as I thought it was going to taste, especially since I had left it in the fridge for a few nights) and we had a bit of a scare. My OB (Dr. Chasity Edwards) originally thought I was at 24 weeks, so she told me I was measuring perfectly. However, after she checked my chart, she realized I'm actually at 28 weeks. So, since I was measuring behind, she sent me for a growth ultrasound at my MFM's office. As of now, things seem ok - Murtle could just be on the small side (15th percentile), possibly due to my genetics, but we won't know for sure until the next ultrasound when they can see if she remains in that percentile or ends up in an even smaller one. Luckily, everything seems to be ok anatomically and my fluid level is good, so hopefully she's just going to be a small baby. Easier to push out, right? It was great to see Murtle again - while she didn't seem all that active (the time we went for the ultrasound is her nap time, I think), it was wonderful to see and hear her heart beat and we managed to see her drinking a bit, too!

So, now I "graduate" to OB appointments every two weeks (and start non-stress tests soon), but will also need to see the MFM every 3-4 weeks to make sure Murtle continues to progress.

4th (20w2d) and 5th (24w2d) OB Appointment Updates

My 4th OB appointment (20w2d) was pretty uneventful. I had gained in total one pound, my uterus was measuring on track, and Murtle's heartbeat was beating away at about the usual 145 bpm. About two weeks after that appointment, I received a call from Dr. Marcus Penn, one of the senior OBs in the practice. He called to tell me the results of my last urine test (they had sent a sample to the lab because they had noticed trace amounts of blood and protein in my urine for the second month in a row). He told me that I had a slight bladder infection (which I've never known to have had before, but they are pretty common in pregnancy), so he prescribed a five-day course of penicillin / amoxicillin for me to take. He told me that while the bladder infection should not cause any problems for me or the baby, he wants to err on the side of caution and set me up to receive additional anti-biotics administered via an IV immediately prior to delivery because of the type of bacteria I have (Group B Streptococcus, or "GBS" for short). If a newborn were to contract GBS during delivery or shortly after birth, she could develop pneumonia, meningitis, sepsis, or even die. Here is a link to a great article that contains more information on GBS:

March of Dimes GBS Info

So after that minor hiccup, time slowly marched on. I have started to feel Murtle move around a bit more - especially within these past two days, but she stills seem to be a very chill baby. Anyway, lo and behold - we finally (and thankfully) made it to 24 weeks! According to a chart I found, 24 weeks is a HUGE viability milestone. If I were to have a baby at 24 weeks, her chance of survival is between 40-70% (granted, I would never wish for any mother to have to give birth so early due to the medical complications and issues that could arise from being so incredibly premature). However, each day that a baby stays in her mother's womb from 24 weeks means another 3% increase in survival odds each day. Here's the basic break-down:

Up until 21 weeks: 0% survival rate
At 22 weeks: 0-10% survival rate
At 23 weeks: 10-35% survival rate
At 24 weeks: 40-70% survival rate
At 25 weeks: 50-80% survival rate
At 26 weeks: 80-90% survival rate
At 27 weeks: greater than 90% survival rate

Therefore, 28 weeks will be the next huge milestone and one which I'll be anxiously awaiting. At that point, I should be ready to rock and roll with the nursery and other types of baby preparations

So, back to today's 24w2d appointment - it was thankfully uneventful, as well, other than the fact that I am now starting to gain more weight! I gained three pounds since my last OB appointment, which brings the grand total to four pounds! Murtle should weigh about 1.5 pounds by now and should be the length of an ear of corn already! And this is just the beginning of some rapid weight gain for her (and probably for me, too). So I need to keep that stretch mark cream flowing! The doctor I met with today was Dr. Nicole Luecke. I liked her, too, so now I have two OBs in the practice who I would most like to deliver Murtle - Dr. Luecke and Dr. Wells. I was disappointed to find out that Dr. Wells will be out for at least a few weeks (and maybe even a few months), so I might not even get a chance for her to deliver Murtle, which is a shame because she is my favorite so far. Anyway, Dr. Luecke is going to send my urine off to the lab to see if my infection cleared up. Otherwise, she just answered some routine questions I had and then sent me on my way with the orange "glucola" to drink before my next OB appointment. Onwards and upwards!