10pm Monday

Tomorrow is 31 weeks. I am absolutely amazed we've made it this far, there have been many times where I've been fairly certain Little Ellie would be born, but here we are, still together, I am still pregnant.

One thing stuck with me from my chat with the doctor this morning. They still consider her a symmetrical iugr baby. I've been trying to figure out what the ratio is for symmetrical vs asymmetrical, but all I've been able to figure out is that symmetrical usually starts sooner, asymmetrical starts after 30 something weeks.
Traditionally divided into in:
Type I symmetrical 20%
Type II asymmetrical 80%
Symmetrical is the one that's linked primarily to chromosomal abnormalities. High s/d doppler ratios, especially over 30 weeks are linked to both IUGR and chromosomal abnormalities. I really wish we'd had some sort of testing done earlier on, just to know what we're up against, if there's something.

Sometimes I wish I could just ask all my questions, and get all the answers, but the doctors here are busy, and they're rushed, and I feel like unless there's something urgent, I can most likely find out the answers myself. I know that babies with karyotypical anomalies are usually REALLY small, like 0.1percentile, so we're a lot bigger than that, which I'm going to take as a positive.

In the research I've done, it makes a lot of sense to deliver at 35 weeks. Chances are that there's still going to be reduced flow, as there is now. If it goes absent, they'll deliver her at 33 weeks, if it reverses, well, then it'd be go time, whenever that happens. The doctors want to control labor and delivery from start to finish, because IUGR babies do not handle labor well.

They check her heart rate four times a day. If there's any indication on any of those checks (if it's either hovering below 120bpm, or above 160bpm) that something isn't right, they'll do an nst, if that's abnormal, they'll do a biophysical profile and then go from there.

Ah, I'm done for the night with baby checks. Little Miss was not happy to be dopplered this evening, she kept kicking it away :) Fiesty little muffin.

In our weight range, until we reach next Tuesday, according to one place, the action plan should be, at minimum:
US: weekly
Doppler: AED administer steroids, especially < 28 weeks followed by NST and Doppler daily and BPP twice weekly.
Reverse diastolic flow, late deceleration and pulsative venous flow: C/S
*We have two ultrasounds weekly, but and NSTs thrice weekly, they haven't been doing actual BPPs (biophysical profile) since flow and AFI levels have been good (ish).

and after 32 weeks:
US: weekly
Oligo & reverse diastolic flow:C/S
AED: daily CTG, Doppler, weekly BPP, if deterioration, C/S

Survivability is amazing from this point on. The steroids boost her by about a week, although her small size cancels it out. She's got as good a chance of surviving intact as any full term baby would have.

I'm going to go to sleep knowing that she's going to be fine. I want her to stay in for as long as possible, but if she wants to come out, we will most definitely welcome her with open arms.

I can't wait to see how much she weighs on Thursday.
She went from 680g at 25 weeks to 860g at 27 weeks to 1030 at 29 weeks. Up 350g
in 4 weeks. Babies at the 10th percentile would have grown 493g,"Normal" babies would have grown 594g in that time, and BIG babies (at the 90th percentile) would have grown 695g.

Since we're going to hope she sticks with at least the growth expected of a baby at the 10th percentile, the expected growth from 29 to 31 weeks is 308grams. If she were a real go-getter, and aimed for what the average baby gains, the expected gain would be 372g. I'm not even going to hope for what a big baby would gain (436g, if you were wondering).

I'm hoping very much that when I ask on Thursday, how much she weighs, they'll give me a number higher than 1340g. 1340... that's what we need to stick to our curve, it's doable! To clear us of IUGR, she would have to weigh-in at 1454g.

I honestly have no idea what to expect, so I'm going to leave it until Thursday :)

Bonne nuit.