36 Weeks - ultrasound and OB appointment

Today was a day I was looking forward to...because I got to see Lily Pie one last time before she pops into the world. I only ever had the two ultrasounds with Byron (the last being at 18 weeks) so it has been exciting (not to mention very worthwhile) seeing this bub again a few extra times.

The main reason for the ultrasound though, was not a good one really...it was to check whether the renal dilatation had gotten worse. In my 30 week ultrasound it was considered Lily had mild renal dilatation. Unfortunately, today it was revealed that she has moderate dilation.

The report concluded: "Fetal anomaly identified – Bilateral hydroureter and hydronephrosis".

It was noted the renal pelvises are dilated and measure 1.6cm on the left and 1.5cms on the right. There was no evidence of a duplex collecting system. The renal cortex appeared normal in thickness. Both ureters are dilated, but no ureterocele (a congenital abnormality found in the urinary bladder) was detected. No other anomalies were detected and the bladder wasn’t distended. Also, it was noted the presence of a normal bladder and liquor is reassuring for overall renal function.

In laymen’s terms, I have discovered that Hydronephrosis is a "stretching" or dilation of the inside or collecting part of the kidney. It often results from either:
• a blockage in the ureter where it joins the kidney that prevents urine from draining into the bladder. Urine is trapped in the kidney and causes the kidney to stretch; or
• Vesicourteral reflux, which is the congenital condition (children are born with it) in which urine backs up from the bladder and into the ureter toward the kidney.

I was advised that Lily will require a paediatric review after birth and a neonatal renal scan around 5 days after she is born. It is likely that she will be treated with antibiotics with follow up ultrasounds to see how she is progressing.

The doctor did discuss these finding with me which was great. He also noted that she is perfectly happy in side and that if there was a problem they would deliver her now. They will know more once she has been examined after birth, but until then it is good to know that she is happy!

Moving on...my next cause for concern is her size. Her measurements were as follows:

• Head Circumference: 335.8mm (high end of the spectrum)
• Abdominal Circumference: 338.9mm (high end of the spectrum)
• Estimated Fetal Weight: 3181 grams (high end of the spectrum)
• Femur Length: 70.3mm (average)

Considering Byron had a head circumference of 34cms when born and only weighed 3.5kgs its a little scary thinking how big Lily might actually get; especially so when they do most of their ‘fat’ growing in the next 3 to 4 weeks.

Whilst they didn’t mention it in the report, I did see on the ultrasound screen (when they were taking the measurements) that her measurements were akin to a 38 weeker – I sure hope she considers herself at 38 weeks gestation with 2 weeks to go!!! The OB didn’t seem at all concerned with her size, saying that she is at the upper end of normal and that babies often get bigger second time around. That doesn’t really appease my concerns at the moment, which (leaving the kidney issues aside) are how big will she be (over 4kgs)?; will her ever expanding head fit? (I had stitches with Byron and his head was only 34cms); will she fit period? I guess I never envisaged having a large bub. I always just assumed, considering she was a girl, that she would be smaller or at least not bigger then Byron. Time will tell I guess.

Other things that were noted from the ultrasound were:

• Heart action was present
• Fetal presentation is cephalic (head down)
• Amniotic fluid volume was normal
• Placenta position was anterior, not low
• She is definitely a girl (I saw her bits!)

The sonographer printed me out a couple of photos but they weren’t the best. Little Lily’s face is all squished up ‘down there’ making it very difficult to get a decent shot...not to mention her advanced gestation; not to worry - I will be meeting her shortly. I think it prudent to insert a Byronism right here:

I asked him if he wanted to look at the photos of Lily. His response at first was 'no' following which point I acted a little upset (well I was a little upset LOL). His reaction was to then come over and look at the photos to which he commented that he couldn’t see anything because "it was too dark in there". I guess he has a point - the photos are black and admittedly it is hard to see what you are supposed to be looking at. Silly of me to think he could actually see anything.

Following the ultrasound I had an appointment with an OB at the hospital. One and half hours later (yep that’s how late they were running) I got into see the OB. To my dismay, also in attendance at the appointment was the infamous midwife from my earlier appointment with the wonderful ‘bedside manner’!

I discussed my issues with the OB, including my symphysis pubis pain (see earlier entry) as well as the issues raised from the ultrasound. He was very rushed during the appointment which made me think he had other places he would rather be – not with me. Given I had the ultrasound the only monitoring of me was my blood pressure which was fine at 134/64. He noted that he wanted me back next week for a follow up appointment with an OB (probably a different one again no doubt) and that it wasn’t necessary for me to see my GP (but I will see her anyway).

I came away from the hospital feeling a little despondent. I can’t quite put a finger on what it was, but I guess the main feeling was that I don’t really have anyone in my corner backing me, so to speak. I have my GP but she really has no clout when it comes to the hospital (and inductions etc), which when you think about it is obviously so, considering she is not an OB. I can’t help thinking that if I had the one OB (someone that knew me and my issues) then the journey might be a little easier; that my concerns might be given some weight as opposed to being shrugged off as immaterial and of no consequence.