On Monday I had my first MCA scan at 14 weeks and 1 day. We started MCA scans at 14 weeks with Callum as well and with Nora we had the first MCA scan at 15 weeks. I was very nervous leading up to the scan and expected there to be no heartbeat. I kept imagining how I would tell the siblings that their baby had died and wouldn’t be coming home. Thankfully we saw a good, strong heartbeat right away. The ultrasound tech measured baby and of course (s)he was measuring about a week or two ahead. Baby was super active and there was no extra fluid collecting around organs (ascites) so that was encouraging. The PSV numbers ranged from 20-22. According to this calculator, that would put the MoMs between 1.04- 1.14 which is in the normal range and does not indicate any fetal anemia. Dr. Moise reminded me that even severely anemic babies at this early gestation don’t show signs of hydrops or ascites so the lack of fluid build up doesn’t necessarily mean baby isn’t anemic. He also reminded me that there are technically no accurate PSV values below 18 weeks gestation that have been researched so he doesn’t know how accurate the calculator is before 18 weeks. There was one study done in Thailand in 2007 where they gathered data to showed normal PSV values for babies as early as 11 weeks gestation. But their MCA/PSV values differ from the values that we use now at and after 18 weeks, so I don’t know how confident I feel trusting these values either. Here is the chart of PSV values from the Thailand study done in 2007:
The values are quite different from the ones shown on both of these commonly used PSV calculators:
For instance, these are the PSV values that come to a 1.5 MoM at 18 weeks according to each calculator:
Thailand study: 1.5 MoM at 18 weeks = 30.9 PSV
https://medicinafetalbarcelona.org/calc/: 1.5 MoM at 18 weeks = 34.5 PSV
http://perinatology.com/calculators/MCA.htm: 1.5 MoM at 18 weeks = 34.9 PSV
According to the Thai study, my baby’s MoM at this last scan was just under the 1.5 cutoff. According to the Fetal Barcelona calculator, my baby’s MoM was 1.14 at the highest. I think Dr. Moise prefers the Thai study since it has data backing the numbers, but he goes with the perinatology calculator at 18 weeks and up (which is different from the Thai study numbers.) This has made me very uneasy since we basically don’t know if the baby is anemic or not. One thing I do know though, is that Callum’s PSV numbers were slightly lower than this baby’s at 14 weeks. His numbers ranged from 15-20, so that makes me worried that this baby is indeed Kell positive.
One good bit of news is that my titer is still much lower than it was before my treatments started. At the beginning of the pregnancy my Kell titer was 2,048 and after my 3 rounds of plasmapheresis it was down to 128 (several weeks ago.) They just tested my titer again on Monday to see how high it is now and it was 256. That is much better than 2,048. It’s still a very high Kell titer, but I feel encouraged that it hasn’t bounced back up into the thousands. That has given me a small bit of hope this week. Here is a picture of our beautiful baby at 14 weeks:
Please keep praying for us and for our baby and the medical staff treating us. They are going through a lot of extra stress as they try to meet the needs of their patients while dealing with the COVID-19 pandemic. They also have families of their own who they want to keep safe. It’s a hard time for everyone, especially those who are responsible for women and babies already in the middle of high risk pregnancies. I appreciate them so much. My next MCA scan is on Monday in Atlanta and we are still waiting to hear the results from the baby’s antigen test. We will update everyone as soon as we know!