Saturday, January 18, 2014

25 weeks...and a shocker

First, thank you all, all the people who "derlurked." I've saved the blog addresses of those who were not on already my reading list, and I look forward to reading your stories.

Apparently, there is an ultrasound every month from this point on. I was pretty darned happy to hear this, and I went back to Mediscan, where I've had all ultrasounds done so far. This is a lab chain that specializes in fetal testing, and the doctor here is one that I absolutely have come to like and respect. Her name is Vandana Bhansal, and I highly recommend this place (and her) for antenatal testing.

The ultrasound was going well. Dr. Bhansal then casually asked J what her blood type was. Both my mother and I were shocked out of our wits when she replied "B negative." Negative?!?! That means she does not express the Rh antigen. I do express it, as does my donor.

Rh- moms need specialized attention when they are carrying an Rh+ baby, because if there is is mixing of fetal and maternal blood, the mother will make antibodies against the fetal Rh antigen. Those antibodies can then cross the placenta and can cause fetal anemia and jaundice. Severe anemia can even result in fetal demise. If the mother is sensitized to the Rh antigen in one pregnancy, then all the later pregnancies are at risk. To prevent this, the mother should be given the Rhogam shot at 2 points: at 28 weeks of pregnancy when the chance of fetal blood mixing is 1%, and at delivery, when it goes up to 10%. If an Rh- mother has a miscarriage or trauma during pregnancy, the Rhogam shot is administered at that point as well.

Now, Rh negativity is sort of rare. It is high in the native American population, and rare amongst Caucasians. I thought it was rare amongst Indians as as well...I found out that it was more common than I thought, coming in at about 10%.
  
I never dreamed that a Rh- surrogate would be selected, especially given the masses of women available for surrogacy in this country that are Rh+. I never got the surrogates initial  screening tests (I had to literally  badger my RE for the initial thyroid testing results); had I seen this, I would have gone with somebody else. I'm shocked that I had to find out by accident, and I am so grateful that I got Dr. Bhansal; had I not, this may have never come to light, and I'm not sure if my RE told the OB specifically about this, or was aware of it. 

So here I am, having to live with this wrinkle as well. We immediately had her tested...as of now, she does not have antibodies against the Rh antigen; she has received one of the two mandated injections (the one given at the time of birth) following all her pregnancies. Not being the sort to take chances, we will have to administer the Rhogam shot during pregnancy as well. Now, Rhogam used to contain thimerosol (ethyl mercury) as a preservative. It was recently removed in the version administered in the US, but I don't know whether the older version is still in use in India. I'm stuck with the headache of ensuring that a thimerosal-free version is given. 

All was well in the ultrasound too: the thing that made me slightly worried is that the head circumference growth is lagging--it went from above the 50th percentile at 19 weeks to the 12th percentile at 25 weeks. The one thing that is absolutely ahead is femur length, coming in at the 84th percentile.

 I'm trying not to think about microcephaly, and I'm trying to remind myself that I have an absolutely tiny skull as well, and was apparently incredibly low birth weight (under 4 pounds at 41 weeks!!), and I turned out to be perfectly healthy. This baby is sort of like how I've been all my life---small head, long legs, so worrying is stupid,right?

12 comments:

  1. That looks like a very big miss. I am so glad ur doing this on ur blog....many couples might totally rely on the agency and drs...cant thank u enough. I am so happy that u found out in time...grt going baby :)

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  2. I am glad that you found out about the RH negative status and can get the first shot as needed.

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  3. Congrats on another good ultrasound! Seems to be me that it would be very reassuring to remember that you also have a small head and long legs. Yes, I would say that you could let go on worrying about those stats for now!

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  4. You also need to remember that just a slight variation in where the position the ultrasound monitor on the baby's skull can make the measurements off slightly. That is why doctors watch for trends over two or more ultrasound readings and will dismiss one reading that just seems totally out of whack.

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  5. yowza! Your heart must have stopped when she said her blood type! So glad she hasn't expressed antibodies against the antigen. and sorry to hear about the head circ lagging. I'm sure it's fine, but I also know how hard it is not to worry. You are getting so close! You will be a mama soon! Thrilled for you!

    Mo

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  6. I'm so relieved for you that she doesn't have the antigen, but sorry you're having to go through the headache of figuring out how to get a thimerosal-free version of Rhogam.

    I'm always amazed at how much you've researched and know! I didn't even know that Rhogam used to have thimerosal. I am Rh negative, and our very first clinic (we only did IUIs there, not IVF) never bothered to give me a Rhogam injection when I started bleeding during my first pregnancy/miscarriage, even though they knew both my and R's blood types. (He's Rh positive.) It wasn't until we moved on to another clinic to do IVF that they told me (2 days before Christmas) that I should have had the injection and that if I did have the antibodies, they would recommend a gestational surrogate instead. It was really tough to enjoy the holiday that year wondering if the loss we had experienced would be the only pregnancy I'd ever get to experience. (Ha - little did I know!)

    About the head circumference - Miss A's head lagged the rest of her measurements pretty significantly, too. I worried about it, although the ultrasound tech and the peri kept saying they weren't concerned. She came out fine. Her head might have seemed a little small when she was first born, but it has grown, and it doesn't look too small for her body in any way. One thing to be aware of for later on - once the Kiddo is born, head circumference is a very unreliable measurement if it's done manually, which is the only way I've seen it done. Some MAs leave a lot of slack in the tape measure, others pull the tape measure totally tight. During one of Miss A's well exams, her head was measuring smaller than the previous exam a couple months prior! The doctor had never seen a baby's head shrink before, so he had the MA re-measure, and the second time around, she measured it a half-inch larger. I don't get worked up about it anymore...

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  7. Hello from ICWL week! The funny thing about this process is that the stress and curve balls never end. I really enjoy how much information you describe - you posts are very informative.

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  8. Yeah for 25 weeks! From one worrier to another, worrying is never stupid! It doesn't change anything either, of course...sending good thoughts!

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  9. I'm A neg Rh neg and didn't get the Rhogam shot at 28 weeks with my 2nd pregnancy. I had it immediately postpartum with #1, and I had no risk symptoms for any fetal/maternal blood mixing this time (no spotting, no uterine trauma, and a negative antibody screen post delivery #1) so we skipped it. If I had any sort of uterine trauma during the remainder of the pregnancy, there was a 72 hour window in which you can get the shot to still have it effectively block the antibodies from being formed, and I was plenty comfortable with that. We also did an antibody screen around 36 weeks just to double check that I was still negative. I get that with a surrogate you don't want to risk her not getting into the doc soon enough after a fall or something, but I just thought I'd share my experience for those who are reading this post!

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  10. Arohanui @MyCheapViolinFebruary 3, 2014 at 10:08 AM

    Hi Jay! I've been keeping up with your blog but have difficulty commenting now that my on-line life has reduced. I'm also rhesus negative (1 in 7 Europeans are estimated to be so not too rare in NZ), and I'm exactly 4 weeks behind your surrogate in my pregnancy (Yes, I'm pregnant!! It's a boy!). We don't routinely give a 28/40 anti-D in NZ (only if pv bleeding, trauma, amnio etc) and only give it after confirmation of a positive baby's blood group from cord blood postnatally. I'm so glad all is going well with the pregnancy, don't lose too much sleep over the inability to breast feed, big hugs from me xx

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    1. OMG it is so absolutely amazing to here this!!! So excited for you! Will you resurrect your blog? Where have you settled down? Wish you were still on FB!

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