Yep, I'm still here. Good times.
Fortunately, my pre-eclampsia is now pretty much under control. My blood pressures are back to a normal range, my labs have remained normal, my second 24-hour urine came back with less than half the protein levels as the first, and I've now lost over 10 pounds of water weight ... which means my swelling has substantially decreased and my feet, hands, and face look normal again!
Unfortunately, that is no longer the reason I am being kept in the hospital. On Monday night, J's fetal heart tracing started to look decidedly non-reassuring. Up until that point, his heart rate would vary just as it was supposed to with accelerations with each movement. Completely healthy and normal. All of a sudden he became tachycardic averaging about 170 bpm and his variability all but disappeared - it looked nearly like a flat line. For babies in utero this normally means there is some sort of problem with their oxygenation. The doctor ordered a stat Biophysical Profile (BPP) to check his breathing, muscle tone, fluid levels, etc. J scored a perfect 8 out of 8. So in spite of the crummy looking strip, he was healthy and happy in there. This went on for four days. The boys were getting monitored twice a day and each time J's strip looked the same - flat and tachy. Every day I got a BPP with a reassuring perfect score, but the mystery continued.
Finally, yesterday Dr. C - another of our amazing perinatologists - decided to do the BPP herself so she could check for abnormalities the ultrasound techs wouldn't usually look for (i.e., possible placental abruption, cysts on the umbilical cord, cardiac regurgitation). That's when she discovered that J's umbilical cord did not insert into the middle of his placenta like it should. Instead he has a condition called Velamentous Cord Insertion (VCI) in which the umbilical cord inserts into the fetal membranes before it makes it to the placenta - and his is also a marginal insertion. Dr. C likened it to the umbilical cord typically being protected by Tupperware, but the weak spot in the membranes is only protected by Saran Wrap. Add to that, the extra fluid he has in his sac due to the pre-eclampsia and the resulting pressure exerted on his cord was too much for the weak spot to handle, thus making his heart work overtime to compensate for the lack of circulation. She gave me Lasix to decrease the fluid levels and, hopefully, the pressure on J's umbilical weak spot.
Well, it worked! I lost 2 pounds of water weight overnight and the next monitoring J looked like an entirely different baby! His heart rate was in the 120s, perfect variability and tons of accelerations with each movement. I couldn't help it. I started crying out of relief and joy. Though I trusted my doctors - esp Dr. C! - I couldn't help but worry if this was going to have any long-term affects and it was driving me crazy not knowing why. Having a solid reason for his crummy strip and then to see it change back to happy and normal all in one day was simply more than this momma's fragile emotions could handle.
There are risks involved, obviously. We have to closely monitor my weight, J's fluid levels and his fetal heart tracings to ensure everything stays happy and normal. I will probably keep getting doses of Lasix occasionally as the pre-eclampsia is still there and will continue to cause me to retain fluids. We have to also closely monitor J's weight gain because this can cause him to lag behind his brother, especially now in the third trimester when they're running out of room and their main job is to gain weight. As any of this can change within a matter of days, they will not be sending me home until after I deliver these boys. And we're definitely going to have a cesarean section - 1) because PB refuses to get out of breech position and 2) because with VCI there is a risk of hemorrhage when the water breaks.
Honestly, I'm fine with a c-section. With twins, it was always a possibility and I made peace with it long ago. I firmly believe it will not effect my bonding or breastfeeding abilities. As long as these boys are safe and sound, then I will welcome them however they come!
Personally, I think J was sending a signal to us all that his momma needed to be watched carefully. The docs were thinking of sending me home when he started acting up. If he hadn't, we might not have found out about the VCI until it was too late. Who knows? Our little J is one smart cookie!