35 week scan update

It was back to Oxford again this afternoon for another scan. The situation with Jessica’s heart looks pretty much the same as it has been at the last few scans – the foramen ovale still appears to be very small but there is blood flow through it and Jessica appears to be coping well. Her size wasn’t measured today but as far as we know she is still continuing to grow well. She is certainly still a little wrigglebottom and is moving around lots (particularly in the evenings) and getting hiccups at least a couple of times a day. Just the fact that she is active and as well as can be expected is a huge blessing.

We have one more scan appointment booked at Oxford for 38 weeks and that will be the last appointment there before the induction the following week. Hopefully Jessica will continue to grow well and hold off her arrival until September and we will keep praying for the best possible outcome for her.

Transfer of care to Southampton

We had an appointment in Southampton today to meet with the team there for another scan and to discuss the plan for birth. Whilst the team at Southampton have been kept informed about our scans in Oxford and have seen some of the pictures, this was the first time they had seen us and so carried out a detailed scan. Unsurprisingly, the situation with Jessica’s heart is much the same as it was on Monday. However, today’s scan looked more closely at Jessica’s umbilical cord than previous scans and shows that it only has two blood vessels (one artery and one vein) whereas normally it would have three (two arteries and one vein). The team are not too concerned about this – it is something which is more common in babies with congenital abnormalities anyway and although it sometimes indicates kidney problems, Jessica’s kidneys seem to be functioning normally. Just another piece of information though!

The team at Southampton have also helped further clarify the problem with Jessica’s heart. Initially, we thought that it was a variant of hypoplastic left heart (where the left side of the heart is very underdeveloped) but this is not quite the case. The left side of the heart is a reasonable size – the problem is the lack of functioning mitral valve (the valve between the two chambers on the left side of the heart) and the restrictive foramen ovale (the hole between the top two chambers which the Oxford team attempted to enlarge with surgery). The VSD (the hole between the two bottom chambers) allows blood to flow through the left ventricle (the bottom left chamber) and at present the foramen ovale allows blood flow into the left atrium (the top left chamber). This means that the aorta (the main artery providing blood flow to the body) appears to be a normal size (it tends to be smaller in cases of hypoplastic left heart). However because the foramen ovale is very small, this is restricting blood flow and causing back pressure into the blood vessels in the lungs which may be causing the pulmonary veins and vessels in the lungs to become thickened.


Although the methods of analysing the extent of the blood flow problem allow a reasonable assessment of the situation, they are to some extent indirect and it is not possible to be absolutely certain how bad the flow will be after birth once the lungs are in use and the post birth blood circulation is in operation.For ongoing care, Jessica will probably need another operation to open up the foramen ovale (probably by surgery rather than the balloon method used before) as this is the weakest link in the overall blood flow. If the flow is very poor, then she will get very sick quite quickly and in these circumstances she would not be well enough to undergo surgery and recover successfully and no more will be done. If however she appears reasonably well and ‘healthy’ such that she will recover from surgery, then they could attempt to open the hole and improve the situation. However, we don’t yet know how bad the damage to the blood vessels in the lungs will be as a result of the back pressure and won’t know for certain until they are in use after birth.

Clearly there are a range of scenarios from very poor to not too bad which we won’t know until after birth and this will determine what happens and how long this journey is likely to last.

Having been booked at Southampton today, we now have a total of 4 hospitals taking part in our care – we are thinking of starting a guide to fetal cardiac services of the south of England! We also now have a more definite plan for birth – assuming that Jessica doesn’t come early, Louise will be induced at 39 weeks. The induction has been booked so that the post birth resources of staff and facilities can be arranged ready for Jessica’s arrival and also because of the distance we need to travel to get to Southampton!

If Jessica decides to make an earlier appearance, then we will go down to Southampton still but if there isn’t time, then we will go to our local hospital in Wexham Park and Southampton will arrange to retrieve us after the birth for ongoing care.

After birth at Princess Anne Hospital in Southampton, if things look good, we will transfer over the road to the main Southampton General Hospital for care under the paediatric cardiology team whom we met today. They also arranged a tour around Ocean Ward which is the paediatric cardiac ward where Jessica will be cared for if she has surgery.

We were initially anxious about the change in care from John Radcliffe in Oxford, where we had come to know the team quite well and felt safe in their hands, to a new hospital in Southampton. However, having been there today, we felt very much at ease and some of the team looking after us Louise knows from her days as a student midwife so the familiar faces really help. We feel that Jessica is in the best possible hands.

Whilst we know that realistically the odds of surgery being a viable option are still very low, we will continue to pray that this will be an option available to us once Jessica is born.

We are due to have another scan at Oxford next week to keep monitoring the situation with Jessica’s heart and will update again after this.

34 week scan update

We have had another scan at Oxford this afternoon. Jessica is still growing well (latest weight estimate is 4lb 13oz) and is as active as ever. At our last scan, the hole that was enlarged through the surgery appeared to be fairly similar in size to how it was before the surgery and this is still the case. Since then, the team at Oxford have come to the conclusion that repeating the atrial septostomy and enlarging this hole with a balloon after birth is unlikely to be possible and any attempt to enlarge this hole would need a full-blown surgical procedure. The plan for birth has therefore changed and is as follows: if post-birth surgery remains an option, we will be going to Southampton for the birth. If the option of surgery is ruled out and we are back to the original plan of comfort care, we will go to Oxford.

At present, as far as we know, the Southampton team are still willing to consider attempting surgery after Jessica is born. We are due to have another scan later this week in Southampton and to meet the team there so that this option can be discussed further with them. We have been advised by Dr Manning (our cardiac consultant in Oxford) not to raise our hopes too high – the odds of Jessica being suitable for post-birth surgery are still fairly low due to the severity of her heart condition. At the moment, we are just thankful that it is still considered to be a possible option although as the due date gets nearer and nearer, we are feeling a little more anxious about where this journey will lead us.


On the plus side, Jessica still appears to be coping well with everything and we got to see her little face on scan today which was just amazing. We will update again after our appointment with the Southampton team.