What is Arthrogryposis?

We first learned that something was going on with Dylann during our 20 week ultrasound appointment on July 12th. Up to that point, things had been "normal" for my pregnancy other than some more intense sickness at the beginning that I didnt have with Micah. We decided to bring Micah to the appointment so that he could learn at the same time as we did, what the gender of his new sibling was going to be. He was bored with the whole thing so it was very distracting while we were there and we didnt spend much time looking at the ultrasound with the tech. Towards the end the tech got quiet and said that our baby had club feet. She also said that her right leg was tucked under her butt so she was not able to tell us the gender at that time. She then went to talk to our MD and told us we were going to meet with her after. I knew then that something else was going on that they werent telling us. We met with the MD a few minutes later and she didnt tell us much more other than that babies who have club feet oftentimes have other things going on so they wanted us to go have a level 2 ultrasound to see if that was the case. I left there feeling sick and confused but was happy when I found out they were able to get us in to have that second ultrasound that same day so we didnt have to wait the entire weekend to learn more. Jeremy and I went that afternoon to see a Maternal Fetal Medicine specialist for the ultrasound. When we arrived, we were told we are first going to meet with a genetic counselor. That counselor is the one who told us they had seen more then just the clubbed feet on the ultrasound. I felt frustrated that we had to hear this from someone we knew for like 3 minutes. She told us that in addition to the feet, the baby's arms werent moving as much as they would expect and that her leg looked fixed in the tucked position under her butt. At that point, we went through a genetic genogram to see what ran in our family but that was pretty much a blur. All we knew was that we were not aware of anything that ran in our family so this was pretty much a shock. After that meeting, we had our second ultrasound that showed the same things noted above but didnt show any issues with the baby's heart, brain, spine, or other structural concerns. The baby was also measuring exactly the right size for the gestational age. That had to be promising, right? They also told us that they were 90% certain it was a girl! After the ultrasound, we waited for what felt like hours in the room waiting for the MD to come back. When she did, she came back with the nurse and counselor so we knew things werent going to be good during that conversation. I know we talked for half an hour but all I remember was the MD saying they were very concerned for the baby's prognosis, that what they were seeing is a symptom and could be the result of over 150 different diagnoses (this "symptom" is called arthrogryposis, which means congenital joint contractures), and that many parents choose termination at this point. From there I stopped listening. Through my own research, I learned that the different causes of arthrogryposis include muscular issues, joint issues, chromosomal problems, genetic issues like muscular dystrophy, neuromuscular issues, or central nervous system function issues. From there it was a blur over the two weeks while we had an MRI and more ultrasounds with the hopes that the diagnoses that were more severe or fatal would be ruled out. Luckily the MRI showed no structural issues with her brain or central nervous system and the ultrasounds didnt show more regression in her limb movement. We were offered an amniocentesis to test for some chromosomal and genetic issues but there werent any ones in particular the MDs were thinking it might be so the procedure seemed more risky with the odds of miscarriage being higher than any of potential diagnoses they might have found. We decided against it. So, from there, we were to wait. It was a very long 4 months trying to work and take care of a 3 year old with this on your mind. We took comfort in a number of things that were seen in the biweekly ultrasounds.. she was growing right on schedule, her arm movements continued to improve through many of the appointments, she managed to turn head down which indicated some normal movements in her arms and torso, and they didnt find any other issues with other areas of her body. She also showed breathing motions early and maintained those. Since I had a C-section with Micah and due to the placement of her legs throughout the pregnancy, the right one stayed tucked and bent and her left one was stuck in a straight position, we had a planned C-section for 11/13. We had to deliver at Fairview Riverside since they wanted a level 4 NICU nearby since they didnt know what to expect. Our MD kept telling us, "everyone is just so confused on what is going on with your daughter." That is helpful to hear over and over again. Thankfully and with great relief, she was born and started crying immediately. There were 4 staff from the NICU at delivery and they decided she was doing fine and didnt need to go there! She was able to stay with us in the hospital and came home with us as soon as I was able to leave after 3 nights. Her arthrogryposis only affects her lower limbs. She does have the clubfeet and her knees are fixed in the positions we saw on ultrasound. She also has limited movement in her hips from side to side. At this point, they think it was caused by an amniotic band. There is a ring around her right calf that looks like a rubber band was wrapped around it. Our MD and the NICU MDs think that this band was keeping her right tucked in that position and subsequently kept the left leg straighted on top of it. So, the joints didnt get to move in uetero like they needed to and got fixed in those positions. Her calf muscles are also underdeveloped as a result. None the less, she has and already has had a long road ahead of her. I will talk about her treatments and tests so far in another post. She is perfect!!