The "Triary" - 33 Weeks
Neil, Emilie, and Amelia
January 17, 2000
33rd Week (Third Trimester)
The Pregnancy: 33.3 Weeks (33 Weeks, 3 days)
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 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.