The Triary: 13 Weeks
The unretouched
photo shows three sacs and three fetuses, at about 13
weeks gestation. The color enhanced photo merely demarcates the
three with colors. Without realtime, live imaging, it's hard to make
sense out of these photos (see schematic). As the pregnancy progresses,
larger, more readily-identifiable images will be available.
Week 13 (September 1, 1999)
Mother presented to my practice as turned over to me by her infertility
doctor. Usually infertility subspecialists will keep the newly pregnant
patients until the end of the first trimester.
Above is one of the ultrasound pictures. This served as her initial
visit to me, at which time I gave her a general overview of what special
problems triplets would pose for her.
Because there is just so much
more pregnancy happening to her, she's at greater risk for pregnancy-induced
hypertension, gestational diabetes, premature
labor, placental abruption,
and the need for bedrest--if not hospitilization--from about 24 weeks gestation
onward (the third trimester).
I explained to her that measuring a fundal height each visit would be
meaningless and trying to listen to and separate all three fetal heartbeats
would be equally unmeaningful when we have ultrasound available.
My plan is the following:
1)Consultation with a perinatologist
2)Close observation of the fetuses
every two weeks for now and weekly during the second
trimester--all with ultrasound to document appropriate growth, absence
of discordancy, absence of placental
problems, and measurements of amniotic fluid.
3)Close observation of the mother
every two weeks for now and weekly during the second
trimester--checking weight gain, fluid retention, blood pressure, checks
of the urine for spillage of sugar and protein (a sign of pregnancy-induced
hypertension, formerly "toxemia"), and second trimester screens for pre-term
labor, gestational diabetes, and group
B beta-strep.
WEEK 15
To be continued...
