Sunday, August 30, 2009

Anxiously awaiting our first US!

Tuesday, Sept 1st, is "the" day!! I am both more excited that I can ever imagine being AND equally just as scared to lay eyes on that ultrasound screen.

Let's not elaborate on that last part though. I mean, really. At this point that does no one a bit of good. I'm staying positive and focused on the fact that a Tweedle, or two, have by now camped out very nicely, deep inside my lining and are leasing my uterus for the next 8+ months. I'm also very excited that the official countdown to holding baby(ies) has already begun!!

What we might see!
On Tuesday, I will be 5 days and 4 weeks along. I believe Dr. Ahlering will be performing an internal ultrasound, so that he can see as many teenie tiny details as possible. Let's face it. At this point, teenie tiny is pretty much all that would even exist. I was amazed that the book my mom just gave me on pregnancy said the baby would be about the size of a the letter "o" in the book, or that of a mustard seed, currently.

I am fascinated about what we might expect to see at this point, so I did a little googling (surprise, surprise :P) and found a smattering of things. As states, "The gestational sac(s) is often the first thing that most transvaginal ultrasounds can detect at about 5 weeks. This is seen before a recognizable embryo can be seen. Within this week, at about week 5 ½ to the beginning of the 6th week, a yolk sac can be seen inside the gestational sac. The yolk sac will be the earliest source of nutrients for the developing fetus."

Details on each of these, and more, is outlined below - all taken from this site, which I found to be a wonderful resource! Usually I summarize my sources, but it was all so interesting! (to me anyway!)

Gestational Sac: The gestational sac is the earliest sonographic finding in pregnancy. The gestational sac appears as an echogenic (bright echoes) ring surrounding a sonolucent (clear) center. The gestational sac does not correspond to specific anatomic structures, but is an ultrasonic finding characteristic of early pregnancy. Ectopic pregnancies can also have a gestational sac identified with ultrasound, even though the pregnancy is not within the endometrial cavity. The gestational sac first appears at about 4 weeks gestational age, and grows at a rate of about 1 mm a day through the 9th week of pregnancy.

Twins?: Twins and other multiple gestations can usually be identified fairly early in pregnancy. They may be seen with two separate gestational sacs (diamniotic, dichorionic twins). They may be seen as two fetal poles occupying the same gestational sac (monochorionic twins). It is useful to identify twins early as the prognosis varies, depending on the chorionicity and amnionicity of the twins. A "vanishing twin" occurs in about 20% of twin pregnancies. In these cases, one of the twins fails to grow and thrive. Instead, its development arrests and it is reabsorbed, with no evidence at delivery of the twin pregnancy. It will prove useful to advise patients of this phenomenon who are found to have twins early in pregnancy.

Yolk Sac: As the pregnancy advances, the next structure to become visible to ultrasound is the yolk sac. This is a round, sonolucent structure with a bright rim. The yolk sac first appears during the fifth week of pregnancy and grows to be no larger than 6 mm. Yolk sacs larger than 6 mm are usually indicative of an abnormal pregnancy. Failure to identify (with transvaginal ultrasound) a yolk sac when the gestational sac has grown to 12 mm is also usually indicative of a failed pregnancy. Yolk sacs that are moving within the gestational sac ("floating"), contain echogenic material (rather than sonolucent), or are gross misshapen are ominous findings for the pregnancy.

Fetal Heart Beat: Using endovaginal scanning, fetal cardiac activity is often seen even before a fetal cell mass can be identified. The fetal cardiac muscle begins its' rhythmic contractions, and that rhythmic motion can be seen along the edge of the yolk sac. Initially, the fetal cardiac motion has a slower rate (60-90 BPM), but cardiac rate increases as the fetus develops further. Thus, for these early pregnancies, the actual cardiac rate is less important that its presence or absence. Sometimes, with normal pregnancies, the fetal heartbeat is not visible until a fetal pole of up to 4 mm in length is seen. Failure to identify fetal cardiac activity in a fetus whose overall length is greater than 4 mm is an ominous sign. It can sometimes be difficult identifying a fetal heartbeat from the background movement and maternal pulsations. You may find it useful in these cases to scan with one hand while taking the maternal pulse with the other. This makes it easier to identify sonographic movements that are dyssynchronous with the maternal pulse.

Fetal Pole: A mass of fetal cells, separate from the yolk sac, first becomes apparent on transvaginal ultrasound just after the 6th week of gestation. This mass of cells is known as the fetal pole. It is the fetus in its somite stage. Usually you can identify rhythmic fetal cardiac movement within the fetal pole, although it may need to grow several mm before this is apparent. The fetal pole grows at a rate of about 1 mm a day, starting at the 6th week of gestational age. Thus, a simple way to "date" an early pregnancy is to add the length of the fetus (in mm) to 6 weeks. Using this method, a fetal pole measuring 5 mm would have a gestational age of 6 weeks and 5 days.

Crown Rump Length: This term is borrowed from the early 20th century embryologists who found that preserved specimens of early miscarriages assumed a "sitting in the chair" posture in both formalin and alcohol. This posture made the measurement of head-to-toe length impossible. Instead, they subsituted the head-to-butt length (crown rump length) as a reproducible method of measuring the fetus. Early ultrasonographers used this term (CRL) because early fetuses also adopted the sitting in the chair posture in early pregnancy. Today, the crown rump length is a universally recognized term, very useful for measuring early pregnancies. The CRL is highly reproducible and is the single most accurate measure of gestational age. After 12 weeks, the accuracy of CRL in predicting gestational age diminishes and is replaced by measurement of the fetal biparietal diameter. In at least some respects, the term "crown rump length" is misleading, because during much of the first trimester, there is no fetal crown and no fetal rump to measure.

Symptoms few, but still present
I woke up Friday morning to a bit of spotting. This was the second occurrence of this, actually, but the first time it was so tiny it wasn't worth mentioning. This go-around, I wasn't super freaked out about it, but obviously a little concerned. It was just enough to tinge the Endometrin discharge that occurs, but nothing more, and it didn't continue throughout the day, nor did I experience any serious cramping. Although, I did wake up to some type of cramping in the middle of the night. It's not unusual for me to get up one to two times each night to pee (good thing I can easily fall back to sleep, right now anyway), but this night I woke up to a bit of either cramping or maybe what were slight uterine contractions. Either way, it was somewhat noticeable, but seemed to go away after I went the bathroom and lied back down. As for tonight, I have been having some mild pinching in my uterus again, which I'm taking as a way for the baby(ies) to let me know they're in there, growing away!

Looking forward to delivering some more good news soon! Please pray that our baby(ies) are cooking away and growing at a healthy rate for a very young 5 weeks, 4 days of age! Thanks again, everyone, for the many congrats and well wishes. We have loved each and every one of them and are still so very thankful for all of your kindness!

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sonja August 31, 2009 at 8:56 AM  

I can't wait to hear whether you have 1 or 2 tweedles! So exciting! Post as soon as you get a chance please! =)

By the way, my IVF cycle got moved up to September, so I start the drugs in a week! Definitely will be going back to your old posts to prepare myself for what to expect.

Good luck tomorrow!

Kate August 31, 2009 at 8:08 PM  

Good luck tomorrow!

Maureen September 1, 2009 at 9:49 AM  

Hi Cathy! I just wanted to wish you luck today at your ultrasound!! I'll be thinking about you and can't wait to find out how many you've got cooking in there :o)

Anonymous December 27, 2009 at 11:58 PM  

I recently came accross your blog and have been reading along. I thought I would leave my first comment. I dont know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.


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