The "Triary" - 33 Weeks
Neil, Emilie, and Amelia
January 17, 2000
33rd Week (Third Trimester)
The Pregnancy: 33.3 Weeks
(33 Weeks, 3 days)
The Babies:
For the first time, there seems
to be some slight discordancy
among the triplets. The Neil (Baby A) is falling slightly behind
his two sisters, Emilie and Amelia. This finding is not particularly
disturbing for three reasons. First, there still is not that much
difference among the weights. Secondly, triplets have their own growth
curves, different from that of twins or
single babies. A weight less than that expected isn't necessarily
Intrauterine Growth Restriction (IUGR). Thirdly, look where we are!
We have triplets at 33-34 weeks. Even if delivered today, these babies
would do well. They would need some oxygen for sure, but the complication
rate at this point is low compared to just a month ago.
The Mother:
The cervix is still "long,
closed, and posterior." This essenctially means that it has not thinned
out, a necessary condition for and a result of dilation; that it is not,
in fact, dilated; and that it has not positioned itself in line with the
birth canal--the path of exit for the baby (-ies). In other words,
a posterior cervix is called just that because it points to the mother's
posterior. As thinning out (effacement) and dilation
proceed, it moves to "mid" position, then "anterior." These are all
of the things a doctor checks for when performing a vaginal exam near term.
Development of these characteristics has a direct bearing on how "inducable"
a delivery would be for an elective induction of a vaginal delivery.
Effacement, position, dilation all factor into something called a Bishop's
score, which is indicative of the ability of a cervix to undergo successful
induction.
This mother of triplets has
the cervix of steel!
There has been a big change
for the mother. Three babies have taken a toll from a surviving-daily-life
standpoint. The edema (swelling) is more pronounced. Movement is
getting very difficult, and even just the trip to my office is a big, exhaustive
exercise. I have a frank talk with her and her husband about perhaps
delivering her babies a week earlier, on January 25 instead of February
1. We agree to watch her closely and make a disposition on this possible
change next week, WEEK 34. All other parameters
are stable. It's just the mother-as-incubator and her stamina that
seem to be deteriorating.
Matria, the service that provides
the home monitoring for contractions, has
sent the data still indicating only sporadic, harmless contractions--still
never more than 4/hour. This patient has not once needed a single
drug to stop contractions--a rarity in multigestational obstetrics.
The SalEst test, a new test being evaluated
for predicting those at risk for preterm labor, has remained unsuspicious
as well. Because she is now at 33 weeks, it looks like she's escaped
steroids as well (to mature the babies' lungs), because it isn't recommended
once past 34 weeks.
I privately begin to doubt
we'll make it to February 1. In anticipation, I "double schedule"
her C-Section, holding out a spot on Janurary 25 and February 1.
I call Dr. Alma Levy, the neonatologist at St. Tammany Parish Hospital
to tell her we may be going a week ealier. I consult with Dr. Gabrielle
Pridjean, the perinatologist, and she indicates that on either day, she'd
like to participate with me on the surgery.
TO WEEK 34
