The "Triary" - 23 Weeks 3 days
Neil, Emilie, & Amelia
November 8, 1999 
23rd Week (Late Second Trimester)
The Pregnancy: 23 Weeks 3 Days
The Mother:
Total weight gain 36#.
Blood Pressure 118/70.
Trace proteinurea (small amount of protein is spilling over into her urine--quite normal in this situation).
Negative glusosurea (no sugar spilling over).
Hct 31.4%, which indicates anemia. All clotting factors are normal. Her thyroid function blood work indicates that the thyroid is functioning at normal levels on the thyroid medication she's taking (called a "euthyroid" state).
Her contractions are still less than 4/hour, as determined by Matria--a tocometry (measurement of uterine activity) company. With the Matria equipment, she wears a belt around her abdomen for an hour, which records uterine activity data she can then modem to a central station. The nurses at the central station can then notify me of any worriesome patterns of contractions, helping to give me the earliest opportunity to address any preterm labor, which of course we're on a trigger edge for here. Mom has now reached "critical mass," making pre-term labor a particular concern--so far so good. Cervix is still undilated and unsuspicious. Besides all of the hormonal interplay leading to labor, there's also a size constraint, after which the uterus tends to want to empty--by expelling the intrauterine contents. Translated: The uterus thinks, size-wise, that there's a term single pregnancy, and contractions may become likely.
She has become very short of breath. The diaphragm, the main breathing muscle, lies under the chest and must move downward so that the negative pressure created in the chest will allow the lungs to draw air in. With the very big "load" in her abdomen, this limits the range of movement downward the diaphragm can experience, diminishing the volume of air breathed. As of now, she must sleep with the head of her bed elevated, because lying flat will cause the babies to "slide" upward even more, and breathing will be impossible. But as she continues to grow her babies, things will get worse. I have prescribed an oxygen concentrator so that she can sleep with little nasal prongs that can deliver oxygen to her during the night.
Her SalEst tests have remained unsuspicious. This is a test that measures salivary estriol to hopefully predict when premature labor may be imminent.