Follow-up Ultrasound

For those of you who read my previous post about my first ultrasound, here's a follow-up to satisfy your curiosity. I managed to keep calm until the night before my follow-up ultrasound. I admit that I had moments when I thought things like, "If this baby dies, I wonder if we'd bury him at the cemetery at the end of our road or at the cemetery where Grace is buried." But I wasn't consumed with the worry, and I wasn't continually suffering from physical symptoms of anxiety, like I was that first day.

However, being the realist I am, and following my usual proclivity to be prepared, I remembered what I had previously read about the link between choroid plexus cysts and trisomy 18 (Edward's Disease) the night before the follow-up ultrasound. Again I was shaken. The thought of delivering another child that would probably not survive birth, and if he did, probably not survive the first year, seized my heart. Reading statements in medical studies like, "It is strongly advised that genetic counselling be undertaken and amniocentesis be considered when choroid plexus cysts are identified in the fetus," were of course no comfort. 

But other information that I gleaned, while sobering, gave me hope that my fears would be relieved after this ultrasound. For example, I read: "Babies with trisomy 18 have an extra copy of chromosome 18... They have severe mental retardation and a variety of other problems including abnormalities of almost any organ system such as the heart, brain and kidneys. They have choroid plexus cysts about a third of the time.... many of the abnormalities associated with trisomy 18 can be detected by a careful ultrasound. In fact, fetuses with trisomy 18 almost always demonstrate abnormalities on ultrasound in addition to choroid plexus cysts, although some of these abnormalities can be quite subtle. If no additional abnormalities are detected by a thorough ultrasound, the likelihood the fetus has trisomy 18 is very low." 

I read that a thickened nuchal chord, club feet, curled wrists and clenched fists, cleft palates, abnormal amounts of amniotic fluid, and a slew of other things indicated trisomy 18. So I went to bed thinking that I would know something after the ultrasound, and that knowledge at this point would probably be better than the insecurity that the first scan had caused. That was not to be, however. 

I was called in for my follow-up ultrasound a few minutes early. When walking to the exam room, the technician asked, "So we're just checking the brain and placenta today, right?" 

Quickly I tried to gather my courage and wits and responded, "Actually, I was hoping that we could image some things that weren't in the first exam as well, since a lot of that time was spent visualizing the maternal lakes and the cyst." 

That, apparently, was the wrong thing to say. I think she actually stopped mid-step. "Like what things?" she enquired. I listed off blood flow through the heart and umbilical chord, the kidneys, fingers and toes, a facial shot, the spine, an amniotic fluid index. I trailed off. 

"We never scan those things." she replied, curtly. This woman had been the ultrasound tech for my last 3 pregnancies, and I had watched her scan all of those things previously for each of those children! I didn't know what to do with that statement. Perhaps she felt like I had accused her of not doing her job properly, but that certainly wasn't my intent. I climbed up onto the exam table. She pulled out the shelf for my legs and readied me for the transducer. Then she paused for a moment, as if in thought.

"Let me just double check your chart before we begin," she said, and exited the room for a few seconds. So there I lay, the door wide open, my burgeoning belly exposed, the protective paper over my lap. 

"Well, we saw everything we need to see, and it all looked good." she stated as she strode into the room and dimmed the lights. In my mind I completed her declaration by finishing, "Except for that cyst on his brain and the pools of blood in your placenta... and all the items that we didn't image at all." 

Right off she looked at the brain and said that she didn't see the cyst anymore. Then she looked at one of the maternal lakes and said, "These aren't big enough to worry about.... Did I tell you the gender? It's still a boy," using one of the calipers to point out the male genitalia. I did NOT know how to respond. 

That was going to be it. My mind scrambled for how to prolong this scan. "I'm sorry to be uptight," I apologized. "You see, I've had a daughter with anencephaly, so these scans make me anxious." She made some polite conversation and asked how I had found out and when, etc. I answered her nosey questions as best as I could, given my nerves and the memories that they conjured up. Then she told me that anencephaly was obvious on a scan. I tried not to sigh and plunged on. "I know that." I answered. "But I also know that I'm at increased risk for chromosomal disorders due to my age, that I have a history of birth defect and miscarriage, and that choroid plexus cysts are linked to trisomy 18. Something like trisomy 18 is what I'm worried about."    

"You can clean yourself up now." she said frowning, as she swabbed the transducer and wiped down the machine's handles. I used the protective paper she had tucked into the waistband of my pants and tried with only partial success to wipe off the copious amount of goopy ultrasound gel from my swollen abdomen. My nervous chatter continued. I told her that I had actually worked briefly for Acuson in the past, and we chit chatted about ultrasound companies and technologies. 

As I stuffed the giant wad of sticky paper into the medical waste bin she postulated, "In all my many years of performing ultrasounds, I've never seen a choroid plexus cyst that didn't resolve. I think that it's more the case that fetuses with trisomy 18 have a greater chance of having cysts than choroid plexus cysts indicate trisomy 18." I guess she was trying to comfort me. But only seeing the things that I had mentioned would comfort me. How could I trust her off-handed treatment of my very real concerns? How could I trust a woman who had misspelled my last name on the patient information screen, had my birthday off by 3 days (both digits), who asked my due date both times (even after having just checked my chart, and who showed me my son's "boy parts" again instead of letting me count his fingers?

I thanked her and numbly found my way out of the office as she called back the next patient. My mind whirled. I switched on my phone to call my husband, who had taken an hour off work to watch the kids during my exam to let him know I was through. The time on my clock was 1:05. My appt. was for 1:00. I sighed and dialed and told him that it was good news... I guess. 

All I know for sure is that the cyst is gone. I'll trust Providence to take care of the rest.  I'm not supposed to know more, I guess. Besides, there are ALWAYS unknowns and fears to face in any pregnancy. Seeing things on my son's scan would have been comforting, but still would not have guaranteed his health, a safe birth, etc. Time will tell in about 4 months anyway. So I'm trying not to be disappointed, but to be happy that it seems that the cyst on my son's brain is gone.