IUGR

[hsmom]

Hi,
I dont know if any of you guys are or have been in a similar spot. I am 23+1 and at my 20 week scan was told baby was measuring 2 weeks too small. I have since been to fetal medicine locally who diagnosed Symetrical IUGR + low amniotic fluid and a reverse flow on ductus venous.
I am v anxious as I lost my last baby at 21 weeks due to congenital heart disease and cant shake this permonition that it is all happening again.
Any advice, thoughts? I have booked an appointment at FMC to see Prof Nicolaides and hope he can give me some answers. At my midwife appt on monday she found a heartbeat.
Thanks for any advice or similar situations,
hsmom x

Hi I'm sorry to gatecrash not been on here before. I am 22+ 5 and am in a similar situation, I was diagnosed with extreme early onset of IUGR at my 20 wk scan. My little girl was only measuring 17wks. My care has been transferred to Oxford where th consultant gave me little or no hope and told me my baby is unlikely to survive as she is too tiny ( 7oz) approx. I had an amniocentesis as he thought it was likely my baby had tripolodgy and I would therefore require a termination. Th results have come back negative. Th apt in Oxford was two weeks ago today and I am having to wait until nx mon for a repeat scan to see if she has grown. I have been torturing myself trailing th Internet when I came across your blob. I wanted to say u have given me great hope and I am
So happy that things have turned around for you it shows miracles do happen. I hope we can be as lucky as my consultant also told me it was likely I would loose her naturally after a couple of weeks however I still feel her moving every day and her heart beat is normal.
Sorry to go on and thanks for taking time to read this.

Dear GenTay,
I am sorry to hear you are going through the same turmoil. Hang in there - things do change.
Its great news that your amnio came up clear. Its not long before your next scan on Monday. They will look very closely at the performance of all the blood vessels in and out of the placenta I am sure, to see if its placental insufficiency.
They are still 'suspecting' that's what the cause is for me, and I am still grappling with having amnio or not.
I will PM you.

As for me, had the dopplers scan yesterday - all looking OK - fluid continues to be normal. Next growth scan will be next wednesday 9th.

Sparklies - how many weeks are you? We cant be so far apart, eh?

sh77 - not long now! Hope you are OK and taking it easy.
take care all
xxxx

Thank you for taking th time to reply to me and I just want to thank you for giving me some hope, and all th best for your next growth scan il be keeping everything crossed for you x

hsmom I'm glad to hear your scan went well. That is a fabulous weight!

GenTay I hope that things turn around for you.

Hope your scan goes well today, thinking of u all xxx

Oooh, good luck with the growth scan today!

Sorry I missed your last reply. I'm 31 weeks so not far off you. I can't remember if I said, but I was at high risk of IUGR due to really, really low PAPP-A at my 12 week bloodwork but ironically baby is measuring a few weeks ahead by ultrasound as of last week. You really can never tell with these things!

My amnio is on Monday if I decide to go ahead with it. I'll let you know what they say about the risks all the same :)

Hi Sparklies,
I have just come across the concept of low Papp-a. What constitutes a 'low' result? I have googled but dont seem to find any ranges. Mine was 1.060IU/l equv to 0.460MoM.

Good luck on monday - My US is at 4pm.....

GenTay - thanks for thinking of me. Have sent u a pm.... xxxxxxxxx

Thanks!! :) Hope it went well today! I hate late-in-the-day ultrasounds when they're likely to be stressful ones.

0.46MoM for PAPP-A is above the cut-off for "low".. which is 0.35-0.4 depending on the clinic really. So it's on the low end of normal rather than "worryingly low" if you see what I mean!

The MoM values (whether for bHCG or PAPP-A) are based upon your gestation, your weight, whether you smoke believe it or not, and several other factors, so the iu/i measurement on its own is not used. It's the MoM value that is fed into the formula to calculate risk. However, it does mean that if your gestational age is wrong, or you're weighed with a coat on, or other tiny things like that, the MoM can sometimes be a long way off what it should be.

Thanks Sparklies, I did ask the consultant about it and he confirmed that he didnt consider my result to be 'low'.
I am still grappling with amnio as I have a horrible premonition that something is seriously wrong. I know its natural to be anxious but its almost taking over.
Yesterday, at 30+2, my baby was around 1050grm (so about 2 lb 5oz) so she is growing but still way behind where she should be (about 1450grm). The femur length is the one thats still way way behind measuring at less than 27 weeks.
My screening was very low even taking into account my age (I am 41). my risk was 1:1453. There are no evident markers on the scans for any significant problems apart from the obvious small sizeI had TORCH screening too.
They still think the most likely reason for the IUGR is placental insufficiency - BUT I have NEVER had a single doppler scan where the uterine or umbilical arteries have been anything but 'normal'.
I guess the dilemma is whether to risk early labour. I know the risk is slight and they would give me thr steriods just in case. sorry for prattling on.......

Sparklies - why did you decide to wait until 32 weeks?

hs xxx

Very glad to hear your little one is still growing! :)

There's so many scary things about an amnio. Not just the risk of losing the baby, but the Wait For Results. And then what if the results are bad? Even if we could have testing without any risks, there would still be that fear and reluctance based on those results. Of course if all is fine we want to know NOW, but if it's not, would we rather carry on in limbo instead of knowing? It is hard to say.

I know just what you mean about the anxiety taking over. Even with the not-so-bad odds in my situation, it has taken over - it is hard for it not to. Pregnancy is a naturally anxious time anyway, but give a "face" to that fear with something actually being possibly wrong, and there's no stopping the worry.

One thing that brings me comfort is on another board I am on, a poster talked about how when she was waiting it out she would get "signs" - e.g. weird coincidences, bad dreams etc that her baby was "the one" (in X) and she was so sure it was going to happen. And then.. her baby was perfectly healthy. Plenty of other people chimed in with similar stories too. Goodness knows I have convinced myself on many occasions so the fact that others go through this and it is all okay is reassuring! Obviously some people do go on to get bad news after all this, but not everyone :)

From my own research, short femurs are not a great marker for Down syndrome at least. Yes, it's common for babies with Down syndrome to have femurs that measure behind but the reverse is not true at all - i.e. it's not true that babies with short femurs are likely to have Down syndrome. My first two both had short femurs (2 weeks or more behind) and are fine.

32 weeks is the date given by various organisations (including ARC and my own hospital) as a "safer" time to have an amnio. The risk of miscarriage becomes the risk for preterm labour basically. From what limited research I have been able to find - one study looked at around 1,000 third trimester amnios (done for lung maturity admittedly) and although there was a complication rate of 0.7%, none of the mothers or babies died. Most complications were pPROM or PTL as you might expect.

It's interesting that the dopplers are saying the placenta is just fine - I wish I knew more about that sort of thing but it's (so far!!) not something I've needed to research.

On the plus side your baby is past the "magic" 1kg weight limit - apparently this makes a big difference in survival rates.

Hang in there. When is your next scan - what's the next move?

Hi
So I'm now feeling very confused and not really sure what to think. At my consultant apt today he wanted to discuss whats going to happen after birth and th nicu stay! I was told on Monday I'm going to loose my little girl in a very short period of time and offered a termination. A few days later they are discussing giving me steroids in two weeks and the birth. I honestly dont know what to think. I'm 24+1 my little girl measures 18/19weeks and the outcome looks so poor so why are they getting my hopes up. Is it possible just a discussion they have to have incase a miracle happens?
From a very confused Gen xx

oh Gen - what a rollercoaster you are on.... That particular consultant may think there is a slim chance that things may turn around. I cant imagine they would do anything just to keep your hopes up. Thats better news but still a concern.
It is so difficult when the news seemingly conflicts and what seems to be a categorical fact for one medical expert is more of a judgement from another.
When is your next appt?
hsxxxx

My next consultant apt and growth scan is two weeks time however I'm going to fetal health twice a week for th midwives to check heart beat
Xx

Good luck with the next one. I was just reading some of this tread from a few weeks ago and its astounding just how far my baby has come. I am keeping positive for you - sometimes babies can defy all the odds.
Take care and let me know how the next appt goes - my next scan is this wednesday for dopplers. 31 weeks today.
hs xx

hi hsmom

sorry i haven't replied in ages. i understand the anxiety you are facing given there is nothing to suggest why baby is small. she is doing a really fab job of growing and it could turn out to be nothing hopefully. and you are right - let this threa be a reminder of that.

throughout my preg, i was looking for things that pointed to problems but my son arrived safely on wednesday and is fine. i feel real joy for his presence but the deep sadness at not being able to leave the hospital with my first baby won't go away.

i will be following your thread. please pm me if you need any advice.

Hi all - just dropping in to see how you are all getting on. If it is any comfort, DS1 was small throughout pg with short femurs, he was scanned throughout pg and continued to grow on and was born on 9th centile (6lbs femurs stayed looking short at all scans) and now is a very healthy, very normal, leggy 5yo.

DS2, as I have explained before, was also tiny throughout pg and was IUGR, born 4lbs but fine. His femurs were also short, even in comparison to all his other measurements. He is still tiny, but gorgeous and healthy - except today, with a horrid tummy bug - at 14m. All my dopplers were normal from about 28 weeks on. I think that the natural thing to happen with IUGR is for baby's growth to concentrate on the brain and head and then downwards through the body - in order of importance. That is why legs end up lagging behind!

HSmom as I said in my PM a few weeks back, I completely understand your worries about what could be causing the growth problems, but it really is most likely to be placental and I think that while most likely amnio will confirm what is not a problem, will it then stop you worrying about the hundreds of other possibilities that it would not pick up? It didn't for me. Also, before going for the amnio, how would you feel if nothing is wrong, it triggers prem labour? Is it worth the risk? I am pretty sure that the drs, especially prof Nicolaides, would have told you if they thought DS was a likely possibility..there are so many other markers that would have been picked up.

Have posted some pics of DC's on profile for you to see how normal the boys turned out, I am sure your DD will do the same, she has such a great chance at the weight and stage she has reached already, I think she is a fighter, just like ds2.

Gen - good luck, I really feel for you. Things may yet turn around though, it doesn't sound like you should give up hope yet. Keep us posted.

Sh - congratulations!You will be going home with your little bundle soon and the hospital will be a distant memory. Try and enjoy being looked after by others for a while, even if its not the same as being home. Where are you?

Apologies, sh, I now realise what you mean about leaving hospital with your first baby, I reiterate my congratulations on DC2 but am so sorry for your earlier loss.

Sh congratulations how wonderful and nice to hear some new news. I hope your both well and enjoying every minute. They grow up so fast so treasure these first few precious weeks.
Xx

what wonderful posts. Thank you sh77. I have been thinking of you and did think that your c section was last week but have shamefully been so selfishly caught up with stuff that I didnt pm you or post here. I am delighted for your new arrival - how did it all go? what was the weight of your DS? please share!
Sleepwhenidie - thanks also to you - you summed up my fears and concerns. I looked at your photohs! Thanks - what a lovely family you have. Am erring on the side of the amnio - I know it wont tell me everything but i feel i need some firm answers on some stuff.seeing fetal medicine again tomorrow and that will help me make my final decision. will let you know as I will prob have the steroids for lung development first so will likely have a few days before the proceedure.
Gen - great to see you on here. I am keeping you in my thoughts.
hs xx

Just to let you know poppy passed away today going back to the hospital soon to deliver. I have been prepared for this and I'm glad it was natures choice and I didn't have th termination they offered. Thank you all for being so kind and supportive, good luck with your beautiful babies keep me updated.
Love poppies mummy Genna xxxxx

So sorry Gen . will be thinking of you. xx

I am so sorry to hear your sad news Gen, I have been lurking and watching and hoping all would turn out well. Thinking of you at this sad time.

I have a growth scan coming up this Thurs at 26 + 3 as baby is measuring small. This thread has been a great source of support and help to me.

GenTay, I am so, so sorry :( :( Very much thinking of you.

Genna...... all my love to you.
So so sorry that Poppy had to leave you.
Am thinking of you. Please pm when you can.
Take care of yourself,
hs xx

GenTay, I am so very sorry that your little girl has died. I am thinking of you and Poppy.