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

Hello everyone.
I just wanted to post a little update on my IUGR journey so far.
Now 32 weeks and I had my growth scan on monday.
The growth is now slowing - baby estimated at 2lb 11oz, which is 6oz in 2 weeks thus not as much as needed to keep her on the 'appropriate growth' curve (that would have needed to be about 3lb).
Consultant now saying that 34 week scan will be critical to decide delivery or not.

I also had a different doctor doing the scan than I have been used to. Not a good bedside manner (virtually silent!) and he scanned FOR AGES. In doing so he had a good look at the heart and has now found a small VSD (hole)! I now have to see a fetal cardiologist in 2 weeks - I know its good that they are finding these things but I just wish I could be in blissful ignorance for a bit (well, maybe not!).

My consultant said its not a very big hole and these things often close themselves. It wasn't visible (or wasnt there) at 20 weeks when I had the last cardiac scan (lost my last baby to congenital heart disease so they always planned a cardiac scan anyway).

Other stuff - I had the steroids last Friday and Saturday, and had the amnio at 32 weeks on Monday also. I got the preliminary results yesterday evening and there is no evidence of the 3 trisotomies - Downs, Edwards and Pataus. They have also confirmed its a girl and that there are no anomalies on the sex chromosomes (so no Turners). I am obviously very reassured by that but still worried that the IUGR combined with VSD may be caused by some underlying problem. Dont think that fear will go away!

Anyway - thats all for now for me.

Also wanted to send my love to Gen. Thinking of you at this very tough time.

hs xxxx

Good and bad news then! Great news that there is no sign of the main trisomies - especially with the tiny VSD that might have been a concern. Hopefully the VSD will close over - your consultant is right - from what I've heard from others they often do.

Sorry to hear about the growth slowing and possible early delivery :(

Hang in there - obviously the full karotype will give a better picture and I hope that comes through soon and brings you further relief!

Hello ladies - I could use some of your fabulous mumsnet insight again following todays scan.

No measurements today - just dopplers and fluid. 33 weeks + 0 (cant beleive I have actually got this far!).
Dopplers 'normal' and deepest pool of amniotic fluid was 4.5 com which he said was sufficient.

BUT, he also said there is an elevated V max in the Middle cerebral artery in baby's brain (measuring 69.7 cm/s vs 56.5 last time this was measured). He couldnt really say (or I couldnt ask the right sort of questions) to establish what this means or could mean.
Any thoughts?
He has also refered me for another scan at local hospital on Friday as he didn't want me to go a full 9 days to next scan (ny next appt at fetal med is wednesday 6th). Waiting for them to call with that.

Hope all is well with you ladies
hs xx

Hello hsmom- I haven't any advice on your recent scan I'm afraid, just wanted to check in and say hello, and it is so great you have got to 33 weeks. I hope all is well on Friday, it all sounds a little vague but it must be good that you are being so closely monitored. All the best.

Hi. I wanted to post an update on here for anyone who might have been/be in the same position.
I had my 34 week growth scan yesterday (at 34+2).
All dopplers fine and baby put on what feels like LOADS of weight to me- over 1lb in 2 weeks! Its still less gain than average babies at this stage but now she is measuring 3lb 12oz... they were talking about short times in transitional care.... days or weeks, not months in NICU. Its such a releif.
I also got final karyotype results from the amnio. All apparenmtly normal.
At last I feel I can imagine having a baby.

Next scan is cardiac scan on tuesday (for small VSD discovered at 32 weeks), then 36 wk growth on 20th April.

Thanks and best wishes to all of you who have been following my journey over the last 3 months or more - Having your moral support and advice has been invaluable.
I will continue to post mini updates on this thread, and hope that the last few weeks are boring!

Was thinking of you yesterday. You truly have a miracle baby. Each post has brought good news. Can't believe you are 34 weeks already! Just think about getting to 37 weeks - not long!

Thanks sh77!
How are you doing and how's your fab DS?
Is your section scar on the mend?
I have been told I will have a C section, but its almost 8 years since the last one - any advice or tips? I read somewhere about taking arnica but wasnt sure and havent got around to asking the mw's.

He is doing great and feeds like a hungry monster all the time.
My c-sec was a fab experience. I had practically no pain, did not need painkillers when i came home, and scar has healed beautifully - almost non-visible. The main thing i liked about the cs was hat it was very controlled and a neonatologist was on hand straight after. ds had cord wrapped around his neck 3 times - quite scary to think what could have happened with a natural delivery.

ok tips for c-sec:
get big knickers - i got 5 for 2.50 from primark. mw might put mesh knickers on you when she put the pad on. i made mistake of not putting more supportive knickers on at this point and bled everywhere when i walked.
arnica - from boots - dose 30c. i took these with my painkillers in hospital. had no bruising or tenderness.
tea tree oil - wipe scar to prevent infection once dressing comes off.
don't be surprised if you see huge clots in pad - likely to be because you haven't moved around much so blood has pooled.
also, don't be surprised how quickly catheter bag fills up - check regularly and get mw to empty.
canula in hand might be in for around 24 hours and when you have done 2 big wees.
i was walking within 4 hours - mw encouraged movement. it made me vomit though.
if i can think of anything else, will let you know.

Oh wow, what great news!! :) :) So glad to hear all is looking well and the amnio came back great!

sh77 has some great tips for c-section. Must get myself some arnica in fact before I forget! Who knows if it works or not, but no harm in trying!

So true about the catheter bag. After my TAC operation (getting my stitch fitted - similar to a c-section) my catheter was full during the night and I was in complete agony and thought something was horrendously wrong. It took them a while to spot it was just my bag..

Good afternoon. Just back from an antenatal at the local general hospital.
The staff are marvellous and lovely :-)
My local consult now thinks I might even go past 38!!!
frequency of seeing them seems to be ramping up a bit. Cardiac scan on Tues, then a dopplers next Fri. Growth on wed 20th, at 36+2, and then a dopplers and antenatal at 37+1 to book a CS. With all the bank holidays, I am just so pleased they are fitting me in so much...
Also had FAB mw saying they would rather give me 20 checks if I am worried about movement or anything at all, than have me silently fretting at home.

Sh77 - thanks for fab advice. I am off to Boots shortly to get the arnica and a new bottle of tea tree oil. I assume you didn't take any before the operation.
You mention 'supportive' big pants.... The cheap ones I already bought are not really supportive at all. Did you get special 'tummy control' type ones?

Sparklies - how are you doing yourself? >35 now..... what have they said to you about delivery?

Hi hsmom, just wanted to say thank you for sharing your experience. It has given me a lot of hope! I'm currently 28+4 & after my growth scan on Wednesday it looks like growth is slowing down (due my my high bp issues I think). My Consultant is "going to try and get me to 34 weeks", so worried about baby not growing & having the baby early - I'm guessing they will opt for c-section?

I also have another growth scan on the 20th April (when I will be 30+2) as well as a scan to check the blood flow. Please can someone enlighten me what the latter involves? I should have asked me Consultant on Wednesday but it was all a bit much to take in. :( Just feeling a bit like I'm somehow to blame.

Hi WiiUnfit, I have been having weekly growth scans and blood flow dopplers since 24 weeks for growth problems with my babe and am currently 29 + 6 + counting!

The blood flow dopplers are very much like a scan, they use ultrasound to check the flow to and from the placenta, in my case this usually involves the ultrasound being pushed in to the sides of my tummy, but this is probably more down to the position of the babe and placenta. Basically it just feels like having a normal scan.

My problems seem to be down to placental insufficiency rather than BP, but I guess the procedure will be the same.

Really hope it all goes well for you, we are going from week to week hoping things stay the same with the placenta, we had steroid injections at 27 weeks - it really is a rollercoaster. Happy to be of any help answering any questions I can, lots of others on this and other threads though who are probably more knowledgeable and further down the line than me.

p.s hsmom, sounds like things are going in the right direction for you, which is fab news. We are 30 weeks tomorrow and it feels like a major milestone we never thought we'd reach.

Thank you Milly, my placenta is anterior so it'll probably be in the side for me too I'm guessing then.

If you don't mind me asking, why did you have steroids at 27wks? I'm guessing this is something they're going to want to do with me at some point to help baby mature but I thought they administered them before delivery? I'm going to have to start writing all of my questions down, usually when I get to see my Consultant he says "do you have any questions?" and I sort of go "ermmm... nope" because I can't remember what I wanted to ask!

Congratulations on you & hsmom getting to 30 weeks, great milestone to hit! :) Everyday I'm sat here like "okay, 28+4 today, half way to 29 weeks... 28+5 today, nearly 29 weeks..." just counting every day as a major milestone, as my Consultant said "the best incubator in the world is your womb!"

hsmom - Doing great, thanks! I had a lot of contractions around 33-34 weeks, but they've since disappeared. I have a feeling I may even hit my ELCS date of 38+2 but we shall see! I'm 35+4 today - I had DC2 at 35+5 and she had apgars of 10/10 and came home with me with no SCBU time so I'm feeling very happy :)

They're really looking after you well. That's amazing they're suggesting 38 weeks after all you have been through - so glad things are looking so positive.

Hi WiiUnfit, I think steroids are given if they think delivery is fairly imminent, the consultant said the benefits to the baby last 6 - 8 weeks though, and are principally in maturing the lungs. From my googling it seems that prem babies who have been given steroids are also less at risk of other associated complications, and generally have a better chance.

The injections themselves were given 24 hours apart (I believe they can be given 12 hours apart if delivery is super imminent) and were fine, a little like a bee sting after the needle came out and my boobs got huge a few days after which may or may not have been related (they have since deflated!).

I agree that it feels so strange to be ticking off the days and weeks, I keep doing silly things like buying pregnacy vitamins and thinking ooh if I reach the end of the pack I'll make 32 weeks and that will be amazing! We're currently holding out for Easter as the next major milestone. Have been feeling the baby move loads in the last few days and understand (and hope) that to be a good sign, but we'll have to wait and see at the next scan on Tuesday. I'll be thinking of you on 20th April when hopefully things will all be going in the right direction.

Ah right thanks, I'd heard of the using them for helping to mature the lungs. I'm afraid to google if I'm honest. :( However, having said that I'm sat here watching last Monday's One Born - scaring myself senseless...

I keep forgetting to take my pregnancy vitamins!

29 weeks tomorrow! Baby is still moving lots over here too, feeling loads of kicks, punchs and movements even with my anterior placenta!

Hoping your scan on Tuesday goes well, please let us know & thank you, hopefully they will!

hello ladies!
WiiUnfit - sorry I have been MIA- we are moving house on wednesday (utter madness in terms of timing but couldn't really afford to turn the offer down!) and I have been either packing or cleaning all weekend and today. shattered now.
Milly was spot on with the blood flow scans or 'dopplers'. They tend to check for a number of things - the uterine artery and umbilical arteries (which are the ones to and from the placenta to you and to baby). in my case they also checked the ductus venosus (sp! a small vessel between baby's liver and baby's heart that closes soon after birth), and also the blood flows in baby's brain (MCA - mid cerebellum artery, i think). The scanner has a different setting that shows the blood flows as red and blue colours and amplifies the sounds. They then kind of 'freeze frame' them and do some measurements. They also tend to measure fluid on these scans either at 4 points around the baby to create an index, or at the 'deepest pool'.

As for the steroids - I had them too for lung development - but I waited until 31+4-5. I am not naturally at risk of prem labour, but I had them because i had amnio at 32. Obviously that has a slight risk which at 32 is prem labour, as opposed to miscarriage. A bee sting is a perfect description! After about 30 mins it was ok. For the timing of when to have it, I asked my consultant and did some research - I also asked some people (on here!) whose experience pointed to the steroids being most effective if they were within a week or so of delivery so I didn't want to have them for no reason/risk as apparently you can only have them once. My consultant was fine with my suggestion. Hope that helps a bit and good luck for making it to 29 today :-) Yayyyyy! Thats so reassuring for viability!!!!

Sparklies - what great news on your timing. I am 35 weeks today so you are 6 days ahead! They haven't booked my ELCS date yet but I anticipate that at 38+1 which will be the day after May BH (not sure I will make it that far but it seems somehow within reach now)

As for me, i have the cardiac scan and dopplers tomorrow morning, then another dopplers on Friday.

Take care all, hs xxxx

Hi hsmom, congratulations on the move! :) It doesn't rain but it pours & all that...

Thank you for the info! Keeping all my fingers & toes crossed for good news. At my last growth scan they said the fluid level was over to 50th percentile so that's good! 29+1 today & still hanging on! My blood pressure is still flying from low to high & vice versa, not fun. :(

I don't know why I thought you were 30 weeks I think I misunderstood Milly's comment - "we are 30 weeks tomorrow" [pgbrainemoticon]

How did your cardiac scan & dopplers go? Hoping you meet your target of May BH!

Hi all, I was wondering if you could give me some advice. I'm 24+3 and my 20 week scan was fine apart from v short femur measurement (outside th normal range). My Down's risk is 1:2100. I read that short femurs can be an early indication of poor growth so I've booked a private scan for next week when I'll be nearly 26 weeks. Is there anything in particular I should ask them to look at during the scan? I'm v anxious about this pregnancy because it's taken me a long time to get pregnant, I had a mmc last year and a horrible first trimester with bleeding on and off and lots of trips to the EPU.

hi hs - wow a lot on your plate! make sure you are getting lots of rest. re arnica - took it 2nd day with painkilers. some mothers start on the day bfeore c-sec.

re big pants - i mean the massive granny pants that cover your tummy. no need for anything more supportive.

reallygrumpy - sorry you are facing this anxiety. poor growth would normally show in small tummy measurements and larger head measurements as the nutrition goes to the brain to protect it. i don't think short femur is a sign if iugr. my baby had tiny head measurements and all else was normal. i was really worried but he is a very alert and normal 5 week old.

Hi reallygrumpy. I dont know too much about femurs being short in isolation - my baby was small all over and recently the head and abdominal circ have been a little ahead, but in my last scan the femurs appeared to be catching up a bit (either that or she was laying in a position that allowed a really good measurement).
I know that sleepwhenidie posted on this thread above (on 14 march) about her DS having small femurs and all her pgs being the same but now all are healthy happy DC's! Take a look - hope it reassures a little.

AFM - not the best news yesterday. Dopplers fine as always, but the cardioligist found not only one 'medium to large VSD' but also a few more smaller ones which he described as 'like a tea bag'. More worrying however was a narrowing of the aorta which means I will have to deliver at BWH so its close to the childrens hospital in case surgery is required. I am a bit knocked for six. I really thought we were over the worst. feel like crawling in a hole and not coming out until its all over. Not coping too well today! Hey ho. Got shed-loads of unpacking etc so will go and get on.
Cherrio for now, hs xx

ooh and sh77 - thanks for advice re-pants, and arnica! Will defo get stocked up. Need some new nighties too for hosp, so will prob go at the weekend.

reallygrumpy - short femurs don't usually tend to mean a whole lot. All three of mine have had them. My first two were born at 95th percentile for size (no idea about this one yet!) They're not even really considered as a soft marker for Down Syndrome as it's so common to have them.

hsmom - Oh no, I am so sorry to hear about the VSDs :( Last thing you needed on top of everything else, what a stress. Bugger!

Hi reallygrumpy, another one with short femurs here - in fact I raised this with my consultant yesterday - we've had CVS, (I think they can be a soft marker for downs) and he said in our case these are most likely to be because of the IUGR. I am trying not to worry about this on top of everything else.

Hsmom, sorry to hear about your new worry, will be thinking of you.

We had ascan yesterday an dopplers etc all the same as last week, although growth still minimal and baby very small, they are now talking in terms of a 33 week delivery which is great (currently at 30 + 4), well I guess great in the context of us thinking 28 weeks was a milestone!

Also going to go arnica shopping, does anyone have any idea about strength tablets?