Sara and Chloe "behaved" last night and there has been no new bleeding, but after the OBs discussed Sara's condition this morning, they think it is in our best interest to keep her here until next Monday (at the earliest). After a brief discussion with the doctor, here's what we just learned...
1. Some of the OBs think that after a third "bleed" that the patient should be on bed rest at the hospital until delivery. Chloe continues to show no stress, so the compromise is to let Sara go home next week if there is no more bleeding and the next growth scan looks good.
2. Chloe's growth has slowed and after her next growth scan, she is probably going to be considered a "growth restricted" baby (anything in the bottom 10% is labeled as growth restricted). At the first growth scan, she was measuring in the 30th percentile, the next was 19th and the last one was in the 11th percentile. Based on her original "curve" she is now "off the line" and will more than likely be sub-10% next week.
3. As long as Chloe continues to grow, she will stay inside the womb. If she stops growing inside, they will induce labor, so that Sara can continue with her chemo treatments sooner. There is limited benefit to keeping a non-growing baby in the womb...or at least the benefits of getting chemo started sooner outweigh any small benefits of keeping Chloe in utero.
4. Our new goal is for Sara to get to 35 weeks prior to delivery. The 35 week milestone is important for a few reasons. If Chloe is born prior to 35 weeks, she will definitely spend some time in the NICU. If she makes it past 35 weeks, the NICU will only be utilized on an as needed basis. The NICU is well aware of our "situation" and is ready for Chloe if she decides to surprise us in the next few weeks. If she continues to grow, they won't induce labor prior to 37 or 38 weeks.
5. If Sara's tests indicate that she might need to deliver within the next 14 days, the doctors will administer another round of steroids to further develop Chloe's lungs (currently, this is not the plan).
6. The doctors will start doing biweekly doppler tests to continue to measure development. The doppler will be the quickest way for them to note any potential problems.
She was very happy to get out of her room, even though it was in a wheelchair. One of the potential side effects of the Adriamycin (chemo drug) is cardiotoxicity. Prior to her starting chemo, the docs got a baseline reading on her heart. The echo results will probably be back tomorrow, showing if there has been any damage to her cardiac muscle. The OB also wants to know how her heart is functioning, as labor tends to be very stressful on the heart. We anticipate that there has been no damage. Even though Sara received over 1/2 of the allowable life time dose of Adriamycin, the amount she received is less than what typically causes heart issues (based on my research).
Sara and I had a small outing in the hospital this afternoon. We went and got her post-chemo echocardiogram a few floors down. Who knew a trip to the cardiology department would bring Sara such joy?
Thanks for checking up on us.