We cannot do NSTs every day due to limited resources. Only myself or other visiting US attendants know how to do BPPs and our growth ultrasounds remain very inconsistent in accurancy. In fact, it is difficult to even get a correct AFI!
But what we lack in precision and accuracy, we attempt to overcome with perserverance!
Betsy came to us with a BOH or bad obstetrical history. She had had five prior pregnancies - all lost at approximately 26-28 weeks gestational age. This was her first time coming to Tenwek - she was actually travelling for four hours - from a large teaching hospital to see us! The history was murky and there were no records. She said that she had no previous medical problems - no high blood pressure, no illnesses and the babies were all stillbirths.
At the time she presented, she was ~ 24 weeks. An ultrasound showed adequate fluid but there was a severe discrepancy between the head and abdominal circumference. The placenta looked to be grade II by my ultrasound. Her blood pressure was normal, but her HIV test was positive. She was counseled and started on anti-retroviral medications. I decided to keep her on bedrest until another ultrasound could be done in 2 weeks.
Over the next two weeks, Betsy began complaining of .... well everything! Body weakness, pain, fatigue, postprandial vomitting, nausea, dysuria....etc... She seemed to keep a constant urinary tract infection and at times she would have an occasionally elevated blood pressure.
I began to get a little frustrated. It was difficult to tell if her symptoms were real, rooted in fear, the result of her new ARV medications....but after two weeks, a repeat ultrasound suggested that there was still a component of disconcordant growth, so I continued her hospitalization and tried to give her reassurance.
At 28 weeks, the baby appeared to be growing though still was not a normal size for the dates. Again there was discordance between the head and abdominal size and now, her blood pressures were consistenly elevated. A diagnosis of preeclampsia was made and some medicines for blood pressure control was added to her long med list.
At 30 weeks, Betsy began asking me to deliver her. She had never made it that far in any previous pregnancy and she was scared to continue the pregnancy. At 30 weeks and 2 days, a routine lab check showed decreasing platelets and elevated liver enzymes, so we opted to deliver by emergent C section.
The baby, a girl, weighed only 1417 gms and was quite vigorous! She squirmed and tried to cry as I held her tiny body in one hand.
Betsy was overjoyed to see her baby. And of course, I was satisfied because I had managed the case as best I could. But as obstetricians, sometimes we forget that our part of the story is truly only the beginning....
Baby Chebet is now ~ one month old. She is gaining weight but recently was diagnosed with pneumonia. Please pray for this tiny girl and her mom! Betsy continues to perservere in supporting her daughter and says that she thanks God for every moment that they have together.....
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| Betsy and baby Chebet |
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| Baby Chebet |
Will pray!
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