Hellobee

At my first child LeLe’s 20 week ultrasound, we found out that we were having a girl and I was beyond excited. And scared. I had a nagging feeling that something was weird, but there was nothing specific that I could identify as what was bothering me. The ultrasound tech was very nice and we got some really great profile photos. We left happy and excited to tell our families that we were having a girl.

We went away for a long weekend the day after our scan to celebrate our anniversary and when we got back on Tuesday, I had a follow up appointment with my midwife to go over the 20 week ultrasound. When we got to the appointment, we waited in a room for over an hour before the midwife finally came in. She glanced at my chart and then asked me, “did anyone call you about the ultrasound?” I replied with no and started to panic. She went on to tell us that LeLe had a single umbilical artery (there are typically 2 arteries) and that it didn’t seem to attach properly to the placenta. She also said that she really didn’t know very much about either condition and that we needed to see a specialist at a larger hospital. I freaked out and was super upset, and I felt like the midwife had done a really poor job of handling the situation, which made it even worse.

We were referred to the specialist, who booked us in for an appointment that Friday, so we had to wait three long days to go see him. Over the course of those three days we googled like crazy and the outcomes for this kind of issue were varied. With just SUA, the outcome was almost always good. It occasionally restricted growth but for the most part, SUA babies are born with little or no issues. But because we had this other issue too, we were pretty lost about what to expect.

When Friday finally rolled around, I was terrified and sick to my stomach. It took us about 45 minutes to drive to the hospital where the specialist was located and our appointment was the first of the morning, so we were up really early. At the specialist’s office, we got all checked in and then a nurse took me back to do my vitals. After that, we met with a genetic counselor to discuss the possibilities of what we might see on the ultrasound we were having that day. She explained that the additional cord issue was sometimes an indicator of trisomy 18, which is fatal in about a third of pregnancies prior to birth. If the child makes it to birth, there are all kinds of medical issues that may arise as a result of the condition. We were given the option for further genetic testing, but we opted to see the specialist first and then decide based on the results of the ultrasound.

We first met with an ultrasound doctor, and she performed the initial ultrasound. This was totally different from the regular 20 week ultrasound because the machine they were using was amazing. The imaging was incredibly clear and we could see everything. She explained everything she was seeing and was calm and kind for the entire time. She located the SUA and the insertion, which she identified as a velamentous cord insertion (VCI). She spent about 25 minutes going over the same spot again and again to get a good idea of the location and the severity of the issue. Then she went out of the room to chat with the specialist and review the images.

After about 20 minutes, the specialist came in. He was a giant man, so soft spoken and sweet. I was immediately comfortable around him and he did another ultrasound and explained what he was seeing. He agreed with the initial diagnosis, and showed us where the cord inserted into the sac instead of the placenta. Once it attached to the sac, it fanned out into about 12 different vessels, and those eventually attached to the placenta. It was basically like a hand spreading out over the sac. The cord was not actually attached to the placenta directly, which is pretty scary. Having both issues together was extremely rare (the specialist said like a one in a million chance), so there was a lot of interest in following our case.

Because the attachment was higher up on the sac, we were at a lower risk than if it were lower on the sac. The risk there is that if and when your water were to break, it could break across the vessels connecting the cord and the baby would suffocate. The reality of our situation was heavy and scary, but I felt confident in the care I was given. The specialist put us on a schedule of ultrasounds to follow growth and make sure that the baby was developing properly. The most common side effect of SUA is IUGR (Intrauterine Growth Restriction), but with our double issues, the likelihood of LeLe being born small was much higher.

We had growth ultrasounds every 2 weeks after that and we went back to the specialist at 33 weeks to check her growth and to ensure that the attachment had not moved lower down on the sac. I had a bag packed in the car because there was a possibility of them deciding to keep me there until I gave birth if the insertion had shifted or if LeLe’s growth had become severely restricted. But we ended up getting great news at that appointment with her growth being right on track and the attachment still high on the sac. We were also cleared to deliver in my regular hospital with a vaginal birth. I was still closely monitored for the remainder of the pregnancy and started going to my regular OB every week at 32 weeks instead of 36 weeks.

After our last appointment with the specialist.  Mr. Cereal took me to look at Christmas decorations to help me unwind from the stress of the appointment.

The actual birth was stressful because of the risk with breaking my water. With the insertion, even though it was high on the sac, there was still an elevated risk if the bag were to break in a weird way. The midwife accidentally broke my water trying to do a different procedure and that put the situation into an almost panic state. With the baby’s cord being so compromised, the contractions made her have heart decelerations and that was pretty scary. The nurses and doctors didn’t really tell me at the time, but her heart was slowing way down with each contraction and they were getting close to the point of having me get a c-section to avoid any medical issues.

The last part of the cord issue that was unique to the VCI was that the cord immediately detached from the placenta when LeLe was born. That left the placenta inside my uterus with no cord to tug on to help it come out. That was a little scary because I bled quite a lot after I gave birth and they couldn’t get the placenta to detach from the uterus wall. It took a manual extraction to remove the placenta. I am a giant nerd and I took a bunch of photos of the placenta, sac, and cord and later I shared them with the specialist, who was also really impressed. He said that he had never seen one with so many vessels connecting the cord to the sac.

We were really lucky. Every good thing that could have happened with these conditions happened and we had an amazing team of doctors, midwives, and nurses. LeLe is perfectly healthy now and has no lasting affects from the cord issues.