Placental insufficiency - possible early cesarean

[Saffi5]

Hi, I'm very worried so looking to see what others have experienced

I went for a consultant appointment re. my blood levels yesterday at 35wks 4 days. Reassuringly they had improved since my last check but the hospital also performed a growth scan.

This apparently showed "intermittent end diastolic flow" and that growth has slowed (AC down from 57th centile at 20wks to 19th centile now) AC is now 286. HC still looks normal. Weight is 2142g, when i had a private scan at 29+3 it was 1410g.

It seemed at first that they would keep me in and perform a cesarean within a day or two. But the baby's heart monitored very well in follow up tests at 3pm and 10pm - all perfect according to the midwives. Movement throughout the day was as normal as it's always been, regular and strong.

I'm going for another heart rate monitoring now, and then a scan with a senior consultant to check placental flow again. PI was 1.33 yesterday.

Has anyone else had this sort of thing and what outcomes did you have? I really don't want a c-section pre-term very scared...

Dont be scared! I cannot tell you about my outcome yet as I am in a similar boat, but from the stories I have heard in the past 6 weeks small babies born at 35+ weeks tend to be absolutely fine, unless another problem has been detected too.

I have been monitored from 28 weeks on when it was discovered the baby dropped from 35centile at 20 week scan to 5centile, otherwise looking healthy and wriggly. Since then, she has been growing steadily at about 1-8centile, so no growth spurt in the past 6 weeks, but apparently she seems to be following her own growth curve well and doing well enough to benefit more from being in the belly rather than an incubator. After the 28week scan I was told to be ready to give birth very early and by C- section, luckily we are past the very early birth now, although the consultant still thinks c-section may be safer in our case.

I know lot of people who were born really small near full term, completely off the charts, including me, and they are absolutely fine (all adults now).

C- section is not the worst thing ever, if it is needed to save the baby, I will gladly undergo it, doctors know what they are doing and why, please dont let it scare you.

Lots of strength and patience.

Thanks for the message Casiopeia. It sounds like a similar situation.

My follow-up scan today was better. It showed again that the placenta is not functioning perfectly (too much resistance), but the blood flow didn't show the problem of yesterday.

There will be another growth scan next Monday and they still think an early c-section, but this is a way better outcome than seemed the case yesterday afternoon. All of the heart traces taken (2 hours yesterday afternoon, 40 minutes 10pm last night and 40 minutes at 10am this morning) looked perfect apparently, and her movements are perfect.

I feel much better this evening that I can carry her closer to term (37 weeks next Friday), and hopefully for another week or two.

I agree with you about c-section, if it's necessary than I will happily undergo it. Just the thought of it being so early was even more scary, although I know that babies have a good outcome at 35 weeks generally.

Thanks again for your reply, really appreciate it. Good luck with your situation too!

I had this. Picked up at 30 weeks, ended up having c section at 35 weeks. DS was 5lb 9oz, didn't need special care and we came home day 3. Other than being quite sleepy for a few weeks he caught up quickly weight wise and has had no developmental issues. The section was awesome, very chilled and I recovered quickly.

Please don't focus unduly on getting much past 37 weeks. There really are circumstances where the baby is far better off out than in. A dodgy placenta is a tricky unpredictable thing that can go very badly wrong. 37 weeks is officially early term and if conditions in utero are less than optimum, then a timely c-section or induction is a wonderful option. My baby had growth issues detected at 36 weeks and I was induced at 37w0 days, he was born that afternoon. They had prepared me for possible risks of breathing difficulties or other challenges but thankfully he was absolutely healthy albeit small. The placenta was tiny, thin and the umbilical cord skinny with very little jelly. I truly was grateful for this intervention as the risk of placenta failing or a cord accident was very high.

Even if your delivery needs to be right now, your baby is very close to maturity and full term and may even not need any additional assistance. I know your instinct is to keep the baby cooking as long as possible but please don't be frightened at the various options; it is marvellous that you are being closely watched and I would listen very carefully if your medical team recommend imminent delivery. It is possible you may be offered induction as an alternative (but depending on your specific condition, that might not be recommended for you) so perhaps you should use this time to look into what that involves as well.

Another one coming on to say 37 weeks is term - anything between 37 and 42 weeks is classed as term. My eldest was born at exactly 37 weeks and the birthing centre we're happy to accept us - they wouldn't do that for a premature birth. I'm glad today was better.

Thanks for all your kind and helpful responses. I had my third growth scan on Monday, and she had put on another 4-5oz since wednesday, although the abdomen scan was difficult due to her limbs being in the way. The consultant measured her abdomen as back up to perfectly normal, but he suspects that was over-reading. There was no more sign of the intermittent flow, thankfully, but placental resistance still showing higher than normal.

I am being rescanned again tomorrow, and the consultant told me on Monday that he may recommend booking me for induction next week.

I will be 37 weeks on friday, so I'm feeling much better as if the baby is delivered at least the baby will be term (two weeks later than feared last week) and it seems I will have the option of induction rather than only a c-section option.

Thanks again for sharing your experiences and stories; I will update this thread further once I know more.

No experience with placenta insufficiently but I had an emergency section at 30 weeks with DD2. The section itself wasn't as bad as I expected I was up and about same day and discharged on day 3.

From my little neonatal experience at 35 week the worst realistically to expect is some jaundice.

Good luck