Growth scan/raised PI

[xcmx]

Hi all,

I’m new to mumsnet but am looking for those who may have experienced similar.

I am currently 33 weeks pregnant and have been having growth scans now for a few weeks, initially due to a small fundal measurement.

The first couple of scans were all fine regarding growth (24th and 30th percentile) but at the second scan it was picked up that the PI level (blood flow from placenta to baby) was high. This resulted in a visit to triage for monitoring.
Since then I had another scan during which the PI level was fine. However, yesterday I had another scan and not only was the PI level high again but the baby’s growth has slowed and is now at the 12th percentile (estimated to be weighing 4 pounds).

At the minute they just want to do extra monitoring in the form of more weekly scans, alternating between looking at PI and fluid levels and measuring growth. They have also said to be extra vigilant around movement.

I know these things can be inaccurate but just wondered if anybody had a similar experience? If so, I’d be really keen to hear from you. My first baby was 7 pounds 12, born 5 days overdue so this is a very new experience for me!

[Chasingbaby2]

I'm at 38 weeks, similar story. At 31, growth fine but PI high. 34 weeks growth and PI fine. Latest at 37 showed growth slower at around 10 th centile but PI still fine. Estimate 6lb so not that small really. Not exactly the same as you but I do understand your concerns. Having done my own research, with the cord pressure the real concern is if blood flow starts to become intermittent or reverse, and with growth things are a bit grey with scan estimates anyway so it's a wait and see situation there but 4lb at 33 weeks doesn't sound too bad.
With growth they will flag if you get below 10% but static will be more concerning than slowed if that makes sense.
Personally I'm not too worried about the centiles as the data will be inflated based on your previous bigger baby (mine was same as yours!)

[xcmx]

@Chasingbaby2

I'm at 38 weeks, similar story. At 31, growth fine but PI high. 34 weeks growth and PI fine. Latest at 37 showed growth slower at around 10 th centile but PI still fine. Estimate 6lb so not that small really. Not exactly the same as you but I do understand your concerns. Having done my own research, with the cord pressure the real concern is if blood flow starts to become intermittent or reverse, and with growth things are a bit grey with scan estimates anyway so it's a wait and see situation there but 4lb at 33 weeks doesn't sound too bad.
With growth they will flag if you get below 10% but static will be more concerning than slowed if that makes sense.
Personally I'm not too worried about the centiles as the data will be inflated based on your previous bigger baby (mine was same as yours!)

Thank you so much for your response @Chasingbaby2 and the information, that’s really helpful. The doctor did mention that if it goes below 10th and especially if it goes below 5th - he said at the minute it seems to be 10th-12th but we were initially told 12th.

Since posting this, I had a call from the doctor at the hospital and at my scan this week they are also going to measure blood flow to the brain, which a consultant will do. So, it’s good that they are monitoring and hopefully this can give us some reassurance.

Have they mentioned anything to you about early induction? It’s not something that has been mentioned to me but I managed to find a couple of older threads on here where that seemed to be the case.

[Chasingbaby2]

Yeah I've had the induction talk, but when I pressed for why it was only really due to smaller babies might not cope so well during labour. I've declined because I don't see how induction makes any sense as that process is more stressful for both of us than the natural homebirth I have planned. So I'm hoping to go naturally in the next couple of weeks and avoid the overdue conversation but let's see.
Yes blood flow to brain is good to check, they've done that at my scan too.
I've read all the studies that back up the induce early recommendations and it seems like below 3rd centile is more risky, or declining growth plus other concerns like low fluid and things like that.
Most trusts are very quick to induce for any old reason so im remaining sceptical and asking allot of questions at this stage.

[xcmx]

@Chasingbaby2

Yeah I've had the induction talk, but when I pressed for why it was only really due to smaller babies might not cope so well during labour. I've declined because I don't see how induction makes any sense as that process is more stressful for both of us than the natural homebirth I have planned. So I'm hoping to go naturally in the next couple of weeks and avoid the overdue conversation but let's see.
Yes blood flow to brain is good to check, they've done that at my scan too.
I've read all the studies that back up the induce early recommendations and it seems like below 3rd centile is more risky, or declining growth plus other concerns like low fluid and things like that.
Most trusts are very quick to induce for any old reason so im remaining sceptical and asking allot of questions at this stage.

I completely understand how you feel. I’d actually planned a home birth with my first but unfortunately had meconium in my waters. I’d also like to avoid an induction if possible but will have to see how the next few weeks go I guess as if things don’t improve I’m guessing I’ll be classed as higher risk.

Good luck with everything - I hope you get your home birth!

[CrispAppleStrudels]

I had this in my first pregnancy and also in my current pregnancy (35w). First pregnancy also had the induction talk as DD dropped below 10th centile (9th). Induction was planned for 39w but i actually went into spontaneous labour (with sudden and very high BP for me) at 38w. Her heartrate started to dip during labour even though she wasn't below 5th centile, so ended up getting her out in a hurry, but i was glad when she arrived earthside. She was 2.6kg (5lbs 12oz) when she was born so she was quite little.

This pregnancy, growth was holding steady at around 50th centile at my 28w scan although PI is still high, but we will see what happens at the 36w scan. I'd like to avoid induction if things are not already looking favourable so ive also discussed an elective section with the consultant. But going to wait and see what the growth scan is looking like before deciding.

[NewbiePL]

Good luck for the additional scans and monitoring. We’ve had a similar experience with high PI and baby’s growth slowing for the second time and not staying on the trajectory they were on. The second scan showed normal levels of PI in the cord but weren’t able to check growth as the original growth scan was only three days ago. They’ve recommended induction as they said the placenta shrinks towards the end of pregnancy and this can make things harder when baby is already on the smaller side.
Hope all goes ok with whatever happens next

[Chasingbaby2]

How many weeks are you @NewbiePL ?@NewbiePL ? I've never heard that the placenta shrinks

[NewbiePL]

I’ll be 37+2 when I’ve got my planned induction. I hadn’t heard about placenta shrinking either but doctor explained this can add to distress especially with baby being a bit smaller. I’ve got an appointment with a consultant the day before the planned induction so not sure if they’ll decide on anything different but I’ve almost mentally prepared myself for the induction now

[Chasingbaby2]

Thanks I will ask about the placenta. It sounds like you have a good consultant, mine have been terrible! So I am questioning everything and just lost fair tbh... Best of luck with everything wishing you and your little one well

[NewbiePL]

Thank you @Chasingbaby2 wishing you and your little one the best too.

[NewbiePL]

• it wouldn’t let me edit my last post but the placenta shrinking could be just my case to explain baby’s weight not going up the trajectory it was on but definitely work asking at your next appointment if that could be a reason for your baby being on the smaller side. Hope you’re able to get the birth you want and your views are listened to and respected

[Chasingbaby2]

Thankyou! I know they have checked PI and blood flow to the brain as a means of checking placenta function but no one had mentioned size, it's definitely going to be something I ask about

[xcmx]

Hi all,
Thank you all for the lovely comments on this thread. I thought I’d check in to see how you are all getting on?
I had my scan with the consultant today. Blood flow to the brain was good. PI level was also good, she took a few readings and the highest was 94th percentile. She thinks it may just be a small baby. She has booked me in again for Monday to check the dopplers/blood flow again and to have a look at the growth (as she didn’t do this today due to it being done last week).
Hope you’re all getting on ok.

[Chasingbaby2]

Great news! Hope the pi will continue to settle and you can rest easy for a while.
We had a cord pressure check today too with a great sonographer. PI is upper end of normal and flow to brain good too. We weren't scheduled for growth check today but he did check it off the record and we are tracking well at 6lb 4oz (at 38+2)
I've had a good long chat with my midwife and she's really not concerned about centiles. As long as growth is still upward as opposed to static, combined with dopplers and movement being good, she's happy :)
Sonographer was pretty dismissive about these growth charts too. It's just one piece of the puzzle and a pretty inaccurate one at that. The more opinions I get on the charts the less bothered I am about it.

[NewbiePL]

Hi all,
Glad things have been ok with your recent Doppler scans.
We had our second one that showed the flow and pressure was all normal but they were still cornered about baby’s growth as it was going down from the trajectory it was on.
We were booked in for a planned induction on the Weds and had our baby on the Friday. Baby is a little small but thankfully weight isn’t too low to be classed as low weight. I’m grateful we went for the induction because I don’t think baby would have continued gaining weight. There was only 6oz difference from the growth scan to when they were born. Thankfully the induction wasn’t too stressful for baby as my whole labour was less than 90mins!
Wishing you all a happy and healthy last few weeks of pregnancy and wishing you a safe delivery of your little ones xx

[xcmx]

Congratulations @NewbiePL - that’s wonderful news. I’m so glad that baby arrived safely and in 90 minutes, wow! Thank you for sharing, it’s lovely to hear.

I’m glad to hear everything is ok your end @Chasingbaby2 - not long to go for you now! We are in a similar position. We had a growth scan on Monday - blood flow all ok and baby is growing and now on the 19th centile. I’m 35 weeks and baby is estimated to be 4 pounds 15 so I really don’t think that’s a concern at all - I could still be on track for a 7-8 pound baby really! Have they given you the go ahead for a home birth? x

[Chasingbaby2]

Sorry @xcmx i forgot to update. Sounds like things are going well for you, it's anxious isn't it but you are basically at 5lb which sounds great! We have continued along the 8th centile and we're estimated at 6lb 6oz at 38 weeks so I'm pretty ok with that trajectory. Homebirth midwives arent bothered about the centile as long as we don't have anything else come up and movements are good ect :) I continue to decline induction weekly and have accepted that this will always be the consultant view. I keep agreeing to check again in a week it's working well so far to buy more time.