We have had a very busy few days filled with many doctor appointments. I am going to give all the details so I don't have to repeat it to everyone on the phone. Please feel free to skip over it. It began on the 17th with our MFM (Maternal Fetal Medicine, Specialist OBs) appointment. We were going for a sonogram to fill in the missing anatomy from our 20 week sonogram and to make sure Baby C grew. As some of you may know, Baby C is our littlest triplet and has been a source of concern for a number of weeks now. At the last growth check she had fallen from 50th percentile to 26th and we needed to make sure that decline didn't continue. Also, they weren't able to see her stomach on the 20 week check and that is an important structure to visualize.
So, after the 20 week ultrasound they told us that Baby A (girl) was measuring 1 lb 2 oz and was 53rd percentile, Baby B (boy) was measuring 1 lb 4 oz and was 57th percentile and Baby C (girl) was measuring 15 oz (just short of a pound) and was 16th percentile. Statistically, there is no difference between 16th and 26th percentiles so she maintained her growth rate!!! However, after extensive searching they were unable to see any sign of a stomach for her. What that means is that we are working under the assumption that she will be born with something called esophageal atresia. That is a very rare condition were the esophagus doesn't meet up with the stomach.
That led to our Monday appointment with a pediatric surgeon at LIJ Schneider Children's Hospital. We didn't realize it beforehand, but the surgeon we met with was the chief of pediatric surgery there - very reassuring! He made us feel pretty confident that whatever may be in store for Baby C was manageable with surgery. In over 90% of babies born with this diagnosis that have the surgery, they go on to lead normal lives.
Basically, there are two main situations that can lead to what we are seeing. One is more rare (7% of babies with esophageal atresia). In this case, the esophagus ends blindly and the stomach ends blindly and there is no attachment between the lungs and stomach. In this instance, we would probably need to wait longer for them to do the surgery since they would have to either take part of her stomach or part of her intestine for the repair. It also might leave her with other long-term intestinal problems (things like IBS, reflux, diverticulitis, however, nothing too out of the ordinary for our family!). The other, more common case (85%) is when the stomach is attached to a bronchial tube and lungs and the esophagus ends blindly. This is more dangerous immediately, but has a much better outcome. The immediate concern is that the lungs are directly attached to the stomach meaning that the stomach acid can exit the stomach and enter the lungs causing all kinds of problems. However, we are going to notify the surgical team when we head to the hospital for delivery and they will all be present when the babies are born. They can determine what they are dealing with on Baby C within five minutes after she is born and if necessary can take immediate action at North Shore. Also, more likely, she can be stabilized and transferred to LIJ NICU for surgery a few hours later. They will put in a drain to remove the stomach acid and a vent for air (most premies are on a respirator (CPAP) that pushes air into their lungs and in this case into her stomach) and a drain for saliva in the mouth. She will be fed IV until she is near five pounds and then they can do the reconstructive surgery on her. If it becomes necessary they can also go in sooner and sew shut the connection between her lungs and stomach, which would allow her to be fed through her stomach.
All of this, though, should be balanced with the following statistic: in fetuses with no other anatomical or genetic anomalies (our situation) 50% are born completely healthy and in no need of surgery! This means that we have a 50/50 chance of there actually being something wrong with Baby C in regards to her digestive system, and if there is something wrong, we will have a tough first year or so, but after that she should be fine. We are not going to dwell on this and will take things as they come, but we felt that we (and everyone else) should be prepared in the event that Baby C does need surgery and a prolonged hospital stay after birth. It always makes it easier when you are forewarned.
The only other thing we needed to rule out was any anatomical problems with the babies' hearts and circulatory systems. This was particularly important since the surgeon explained that abnormalities of the heart, along with the kidneys, liver and bladder, often appear with a non-visualization of the stomach bubble. We spent four hours at the hospital yesterday, three and a half on the table while they performed fetal echocardiograms on the babies. The good news is that they all have a four chambered heart that leads to the major blood vessels and a normal circulation pattern! The bad news is that I am incredibly sore from all the poking and prodding that it took to get that good news. Mind you, that is not a complaint though. It was absolutely worth it to get that news and was the first time we got good information on Baby A's heart (she is laying right under my c-section scar).
We are very relieved now to have reached 24 weeks and to have all the information that we have on the babies. We feel that we can now just relax and concentrate on keeping them in as long as possible to give them the best chance we can. I am sure that most of you know I am no longer going in to work everyday, but working from home instead and only going in for lab meetings or other important meetings. Dad has been great and has driven me almost every time, sitting in the lobby and reading his paper while I go to meetings, then driving me home again. Harry is getting used to the fact that Mom just can't do much these days and has taken to bopping my stomach and talking to the babies, well mostly just B (that's the boy). The good news about Jon is that they just informed him today at work that, if there are no complications, he should be able to start working at home as of August 1!!!! That means he will be here to shelp me around to appointments and feed me the many meals a day that I need to eat to keep these babies happy. And, most important, he will be able to take care of the babies once they are born and we won't need to hire someone to do that! We figure that eventually we will hire a high school or college student to watch them while he makes dinner and helps Harry with his homework, but that will be pretty cheap compared to paying a nanny to watch three kids for ten hours a day!
Well, that's about it here. Our next doctor appointment is on the 31st so I will try to post again then.
