Triscuspid Regurgitation, and what it means for our baby

So this is a diagram of a heart that the doctor drew for us. (If you click on it, you'll be able to see it larger.) He is a pediatric cardiologist who also specializes in prenatal heart development.

What this shows is a view of the heart, as if you are facing the baby, so the right side of the heart is actually shown on the left. The arrows show blood flow. He also wrote out a bunch of info for us, which is rather helpful as it helps us to remember what was said. So, here are his notes.

Tricuspid Regurgitation (TR)
- leakiness of the main valve on the right side of the heart
- Your baby's TR has gotten worse over time. It appears that one leaflet does not move normally, causing the leaflets to not close normally --> this leads to valve leakiness.
- The TR is causing the right side of the heart to stretch out. This has become significant enough that the heart is competing with the developing lungs for space in the chest.
- For now, the blood flow patterns in the various arteries and veins in the body appear normal. This might change if the TR gets worse. We know that changes in the blood flow patterns can herald fetal distress and may be an indication to deliver the child early.
- Any decision to deliver the infant needs to be thought through carefully. Delivering an infant prematurely has the main downside of having immature lungs- this is complicated by the fact that the lungs appear to be squeezed by the dilated heart. We will be able to do things for the child, however, that we would not be able to otherwise.
- Risks of keeping the baby in mom longer include: (1) worsening of the TR to the point that the pulmonary valve fails to open (the right ventricle can't guarantee enough pressure to open the valve). This could cause the infant to be critically ill at birth. (2) congestive heart failure- the blood "backs up" in the right side to the point that it interferes with normal circulation, resulting in fluid accumulating and the potentially damaging side-effects (this is called "hydrops"). (3) if the heart continues to dilate, it will continue to compress the lungs, interfering with normal development.

I have arranged for you to meet with several other doctors to take a team approach to this problem. We will keep in close contact and monitor the baby carefully.

Another thing to note, is that in fetal development, the right side of the heart does about 2/3 of the work, while after delivery it does 1/2 the work. However, due to the various issues, the right side is currently doing more than 2/3 the work.

The other appointments he mentions haven't been set up yet (we were there at the end of the day) but it looks like I'll be going in twice a week for various tests- once a week with him, and other visits with other people. Also, I was planning to deliver at a different hospital, but this one has a better NICU, so I will be transferring my care to a doctor at this hospital.

And as to when we'll be meeting Baby Bredford? Well, in a perfect world, the heart problems don't worsen, the lungs develop enough, and I go to 37 weeks. But of course we don't live in a perfect world. So Baby will be here at some point in the next 6 weeks. By going in twice a week they'll be able to keep a close eye on things and determine if Baby will be better cooking longer or coming out, knowing that he/she isn't fully developed.

30 Weeks

Your baby rivals a good-size cabbage in weight, tipping the scales this week at 3 pounds. (Length: about 15 3/4 inches, head to heel.)

30 Weeks- Development

Your Baby This Coming Week

Your baby now weighs about 3.5 lbs (1600g) and measures about 18 inches (40cm) in total and about 11.2 inches (28cm) from crown to rump.

Your baby's increasing size means that she has less room to move around in your uterus.

Your baby could already be moving into the head-down position.

Your baby's lungs are maturing and their lining, which prevents air sacs from collapsing, is growing. This lung development means that your baby would have a much greater chance of survival if he were born prematurely.

About 16 fluid ounces of blood are flowing through the wall of your uterus to the site of the placenta, though your blood never mixes with your baby's blood. It is separated by the placental barrier which is a very thin wall. Water, nutrients and waste are exchanged across this barrier at a rate of 0.3 fluid ounces per second.

Your baby swallows amniotic fluid and urinates.

Your baby's ears are sufficiently developed to hear and recognize your voice, the voices of other family members as well as familiar musical tunes.

Your Body This Coming Week

Most women have gained about 19 pounds by this point in pregnancy. The weight gain is made up of the baby, the placenta and the amniotic fluid as well as enlarged breasts, an increase in blood volume, water storage, fat and protein.

You feel your baby moving about regularly and this may cause you to feel bonded with him. You don't need to worry though if you do not already feel bonded with your baby. For some women, the baby still seems abstract when it is inside. You may bond rapidly or gradually after the birth.

Fatigue will probably continue and you may feel breathless after physical activity.

Colostrum may be leaking from your breasts. However, this does not occur for all women and in no way indicates that there will be a problem breastfeeding if colostrum is not present before birth.

You may have trouble sleeping for various reasons: it may be difficult to find a comfortable position, you may have to urinate frequently during the night, baby's activity can prevent you from sleeping and you may be feeling anxious.

Your back probably aches since the muscles and ligaments that support it have begun to relax and loosen in preparation for labor.

You may have also developed some varicose veins.

30 Week Journal

How far along? 30 weeks
Total weight gain/loss: Up another 2 pounds. At this rate I believe I will be above the "recommended" weight gain for my starting weight and height, but I'm not overly concerned.
Stretch Marks: Nothing new. I really can't complain.
Sleep: Most nights I find myself waking up to pee. And it seems I tend to wake up consistently between 5 and 5:30. I usually fall back to sleep pretty quickly and I'm very glad there's a bathroom attached to our bedroom. When house hunting last year, there was one we looked at that only had a bathroom on the lower level. Chris didn't think it would be a big deal. I knew otherwise. I'm glad we decided not to buy that house. :)
Best moment this week: Got a wonderful car load of hand-me downs from my friend Mel. Still need to find the time to sort through them and figure out what's what. For now, they're pretty much all in the living room.
Worst moment this week: Afternoon sleepiness.
Movement: Oh my! Baby has been moving up a storm this week. Not so much with the kicks that I've been feeling in the past, but with lots of pressure up against my belly. Which prompted these texts last week.

Me: Please tell your child to stop abusing me.
Him: Katrina Anne/ Bennett Henry Bredford stop abusing your mother!
Me: Thanks. I like you you used the full name.
Me: Baby didn't listen.

Belly Button in or out? Barely still in. I feel like a broken record saying that every week.
Wedding rings on or off? On.
What I'm going to miss/What I can't wait for: Can't wait for Baby to get here. Wish I didn't have to wait another 2+ months.
Milestones/Fun Moments: The nursery got painted this week. Our friend Kristin will be coming in late September/ early October to paint some murals for us as well. But for now, the main wall color is up and the ceiling and trim has been painted. Much brighter now! I also finished knitting the pair of socks I was working on and started on a soaker (used as a cover with cloth diapers).
What we need to do: Need to finish getting the room ready and get a car seat, but pretty much feeling like things are under control.

29 Weeks

Your baby is as big as a butternut squash, weightwise -- about 2 1/2 pounds. (Length: a tad over 15 inches, head to heel.)

29 Weeks- Development

Your Baby This Coming Week

Your baby now weighs about 3 lbs (1400g), measures about 10.8 (27cm) inches from crown to rump and measures about 17 inches (38cm) from head to toe.

Your baby is probably aware of your Braxton Hicks contractions, which you experience regularly, even when you do not notice them.

By this time, your baby is very active and you feel its movements frequently.

Your baby is still practicing breathing movements which have now become rhythmic.

Sometimes your baby gets the hiccups when she accidentally swallows amniotic fluid the wrong way.

She is getting fatter and plumper. On an ultrasound, you can see your baby's activities quite easily.

Your baby has periods of rest and periods of activity now. Your baby is probably most active when you are trying to rest.

Your Body This Coming Week

Your uterus has now risen to about 4 inches above your bellybutton. Backache probably continues and you are probably feeling increasingly fatigued. This may be exacerbated since you may also have trouble sleeping. Whenever possible, try to put your feet up. Extra pillows will probably help you to find a comfortable sleeping position.

You may be constipated; your nose may be stuffed; and you may have the occasional nosebleed. You may also have trouble breathing as your enlarged uterus crowds your lungs. You may at times feel faint and dizzy. You probably feel huge, but you'll get bigger still!

Some women take great pleasure in their changing form while others feel it is a nuisance. If you are among the latter, you can take comfort in knowing that it is temporary, that your partner and others probably find you especially beautiful, that you are as close as you can be to your baby and that your body is providing him with all he needs.

29 Week Journal

How far along? 29 weeks
Total weight gain/loss: Woo hoo- no change. Actually, to be technical, down 2 tenths of a pound.
Stretch Marks: Nothing new.
Sleep: Decent, but waking up with some hip pain. Mostly just sore from lying on my side.
Best moment this week: I think one of the best moments was last night. I finished the quilt!!!!
Worst moment this week: Stabbing myself with numerous pins while sewing. :)
Movement: Yup. Baby was especially active on my way to work this morning.
Belly Button in or out? Almost an outie. It's actually very weird looking.
Wedding rings on or off? Still on. My watch has been coming off frequently though.
What I'm going to miss/What I can't wait for: Want to hurry up and get the nursery painted so that I can get it all arranged properly.
Weekly Wisdom: Don't overdo it. 2 hours on Sunday weeding crabgrass from flower beds took its toll on me!
Milestones/Fun Moments: Nice to know the bedding is complete. Maybe I can reclaim my dining room table?
What we need to do: Finish up the nursery. But for the most part I feel like things are under control.