The Terrors of the 20-Week Scan

Yesterday was the scariest day of my pregnancy so far.

There was always a fair chance that would be the case, given that the 20-week anatomy scan was scheduled for that date.

The anatomy scan, in case you don’t have babies but are (for some reason) reading this anyway, is when the maternal-fetal medicine specialist and ultrasound tech measure just about everything that can be measured on a baby: how long the baby is, how wide around the trunk, the width of the head, the length of the thigh and shin bones, etc. They also examine the brain, heart, and kidneys and look for blood flow to major organs and through the umbilical cord.

I know several people who got seriously bad news during the 20-week scan, up to and including the worst possible news: that something was so wrong with the baby, it wouldn’t live outside the womb for more than a few days. So, while I was looking forward to seeing Beano’s little face and belly and hands and feet, I was also terrified, starting from the time we made the appointment. As the day crept closer on my Google calendar, I grew more and more panicky.

That was before I woke up the morning of the ultrasound to find a fresh batch of test results waiting for me in my LabCorp inbox. My endocrinologist ordered the tests, because hypothyroid moms have to stay on top of their thyroid levels to make sure the baby has enough hormones to develop properly. But he also ordered a complete metabolic panel and a CBC, because it had been a while since I had either.

My thyroid workup was fine. The metabolic panel is where things got hairy. A few values were outside the normal range, including carbon dioxide, protein, and albumin, which were all slightly low. More worrying: the ALT value was slightly high, which could indicate issues with my liver.

Now, there were a few things I was worried about, for myself, before getting pregnant. I was worried about dying in childbirth and about having my choices taken away by doctors or midwives who might decide that pain relief was unnecessary or breastfeeding mandatory. But most of all, I was afraid of developing complications, because of my age, weight, and medical history. In our house, you’re not allowed to say “preeclampsia” or “HELLP syndrome” without holding a lucky rabbit’s foot at the same time — especially since my rheumatologist warned me that I’d be at increased risk for HELLP syndrome, because I have Behcet’s disease.

The “HELLP” stands for Hemolysis (basically, exploding red blood cells), Elevated Liver enzymes, and Low Platelet count. So you can see why I was not thrilled to have an elevated liver value.

I’m a monster who reads her phone in bed upon waking up, which means that when Adam got out of the shower, he found he huddled under my fuzziest blanket, clutching my Snoogle to my chest, and weeping over my phone.

“You OK, sniffly?” he asked, before he saw my face.

“I HAVE ELEVATED LIVER ENZYMES,” I shoved my phone in his face. “Look!”

“OK, let me see,” he said in his calmest voice. (I think of this as his nurse voice, but I think it would also come in handy during a zombie apocalypse.)

I passed over my phone and hugged my belly with both hands. “It’s too soon for her to go.”

“She’s not going to go!” The nurse voice had temporarily disappeared. “Jesus, why would you say something like that?”

Now we were both wrapped up in blankets like disaster victims and freaking out.

After a moment of reviewing my tests, Adam’s calm reasserted itself. “OK, these aren’t that bad. Your ALT is very slightly elevated, but nearly normal, and your other liver value is fine. Your platelets are fine. I think you should just call the doctor and see what he says.”

So, I did. Our OB’s office, thank God, is very good about getting back to people, so we got a call from the doctor about an hour later. Adam had to read the labs to him, because I was curled up in the fetal position — or as close to it as I could get, with an actual fetus in the way.

The upshot was that he wasn’t overly concerned, but wanted to monitor my liver enzymes with more blood tests. It was too early for preeclampsia, according to the doc, but we should keep an eye on things. It might turn out to be a fluky lab, or the start of something we’d need to know about for later, or a ginormous gallstone hanging out in the wrong spot. We would find out. But in the meantime, I was able to unwind myself from my position on the floor and stop crying for a minute. Good thing, because I was getting dehydrated.

Two hours after that, we were in the other OB’s office, getting the anatomy scan. Which was terrifying right from the start, because one of the first things the doctor said to me was, “Did you decide to opt out of the AFP test? I couldn’t find anything in your chart.”

We had never heard of an AFP test, nor did we have any idea of what it was. It’s the alpha fetoprotein test, by the way, and it tests for spina bifida. Who knows how that one got lost in the shuffle, but we hadn’t had it. Also, if we wanted it, we had about 24 hours to squeeze it in, before the lab cut us off for being too late.

“I wasn’t worried before,” Adam told me later. “But as soon as he mentioned that one specific test, I was sure that something was wrong. Not even spina bifida, necessarily, but something. I thought, ‘He’s going to start this scan, and we’re going to see something really, really bad on this screen.’”

So it’s nice to know that I’m not the only one who gets nervous about these things.

Long story short, he did the scan and we saw nothing atypical at all. We did see:

  • The baby sucking her thumb and yawning.
  • Adam’s nose, clear as anything, on her tiny little face. (Slight variations accounted for by size, and the fact that the baby has never had her nose broken.)
  • A spine like a string of pearls.
  • The heart, beating away at 150 beats per minute.
  • Two kidneys, two halves of a brain in a giant Hubley/Luckwaldt head, two eyes and two hands and two cute little feet, kicking away at the probe.

We left the office and both fell apart like our strings had been cut. Then we went to the other OB’s office and got some bloodwork done, and went to a diner for an outrageously early dinner. It was barely 5 o’clock, but I felt like I’d been up for about 20 hours.

If you see either of us today, don’t take our vacant facial expressions personally. Yesterday was quite a day.

greg-rakozy-38802 (1)
Greg Rakozy/Unsplash
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