AIBU to be annoyed about Growth scan?

[noisytheo]

Sorry in advance for long ranty post...

My ds (dear son) was born at 30 Weeks by emcs due to IUGR and reduced movement, the only reason that I am classed as high risk in this pregnancy. I have been having growth scans by my consultant every 2 weeks since 24 weeks and although baby is smallish (just over 10th centile), she is following her own curve which the consultant was happy with.
The other day I had my 35 week (34+6) growth scan but my consultant was on holiday and so i had a sonographer and a student. The student took the measurement for femur length and head and then as baby was in a difficult position, the sonographer took over for abdomen. When my consultant does the scan, he is very consistent and it takes him a matter of seconds to get all the measurements but this scan felt fumbled and difficult and the student was asking lots of questions as she took the measurements which although understandable, did not fill me with confidence.
Sonographer brings my notes to me after scan and says that it looks like baby's growth has slowed down a bit, shes now measuring between 5th and 10th centile. Which obviously based on my history with DS (dear son) was quite alarming. However, I didnt feel happy that this was an accurate reflection of her growth due to how difficult it was to get the measurements and the fact that it was a different person entirely taking them to the last 5 scans, also the fact that the sonographer did not check the student's measurements or redo them.
It is not until I got home later that I realised the only measurement that was below average and therefore bringing down EFW as a whole was the femur length...even more frustrating was that according to yesterday's scan, baby's femur has actually shrunk since the last scan!? How is that even possible?
I don't want to sound like a cow but I am so annoyed that considering how important these scans are considering my history with DS (dear son) that more care was not taken, the sonographer didn't check the students work AND didn't review the previous scan and think it unusual that her femur has apparently shrunk! Now I've got this big marker on the growth scan that suggests baby's growth has slowed when I am sure isn't true. This could have massive implications on when they bring baby out. I'm just really disappointed, especially as you build your hopes up for each scan, I've waited 2 weeks and feel like ive got a bogus result and that it was a big waste of time! :(
I feel like i cant complain or demand a rescan because I don't want to be THAT person. Do I wait til my consultant is back and try and see him? Or do I just wait the next 2 weeks worrying?... Grrr frustrated

You won't be that person, if they're saying the femur has shrink, it suggests the measurements are likely incorrect. I wouldn't sit around worrying for the next fortnight, I'd give them a call.

No-one is going to be upset about you pointing out that the femur can’t have shrunk.

U/s measurements are not perfect, they have quite a large margin of error. I would contact your midwife who I expect will reassure you. To give you an idea of how widely inaccurate I was told all was well and measuring just shy of 8lbs approx (reduced movements at 39 weeks) 4 days later she was born at 6lbs. They then looked at the scan and said they didn't understand why she was so small (second dd also small, I cook small babies!)

Thanks guys, I think I'll phone them today. So annoyed at myself for not noticing while I was there..but then the sonographer didn't notice either!
They're not keen on me being induced due to previous early section and so i either go naturally or have to have another csec and i REALLY want a VBAC so it's so important that nothing 'jeopardises' that if it's not accurate IYSWIM. Now I've got this big scary 'shes not growing blob' on her lovely growth chart.. And it's bringing back horrid flashbacks on my DS's chart that was static after two scans.

Ring them up.

One of my twins had iugr too and I also had fortnightly scans. The fetal maternal med consultant told me very drily that she was "taking some of the earlier scans with a pinch of salt" and that different practitioners have different rates of accuracy.

I would not seek an earlier scan but would flag your concerns by phone in advance and personally, I don't let students near me for antenatal or birth stuff. Due to stretched resources, they are often left unsupervised to perform tasks they shouldn't be performing and once they have made a mistake, it is too late.

My partners face when they introduced the student, his eyeballs rolled so far back into his head! she literally went 'femur length is from there to there right?', took the measurement once and that was that. I just think that considering how growth is so important in our case and how close to the end we are, the sonographer should have at least checked it. I know I'm going over and over it but I'm just a bit fuming because I'll be paranoid about movement for the next 2 weeks. I dont think i want a rescan (partly because I'm utterly sick of going to the hospital and this is my last week in work too), but yeah i do think I want to make it known that it's bllcks...!

My partners face when they introduced the student, his eyeballs rolled so far back into his head!

He sounds delightful.

Well he wasn't wrong was he!?

The best guide for how someone will treat you, is how they treat other people.

Have they changed anything based on this scan? Or is the plan still the same until next scan? If the same then it probably won't make much difference especially if your consultant compares measurements. As others have said the accuracy of measurements isn't great and a small difference can change EFW. A change from 10th centile to between 5-10th also isn't big but seems more at this end of the scale. I actually wouldn't have been concerned by the student checking where the measurement went from and to and if sonographer was happy with where the student had chosen then there is no need for the sonographer to repeat it. It is understandably a worrying time for you and I hope your next scan goes well.

I would definitely bring it up. I wasn't even told my repeat anomaly scan was done by a student I asked my midwife later who confirmed that it was. I had 0 images of babies heart and she wasn't able to get any, she seemed a little out of her depth kept asking for reassurance at every turn, and freaked out and went completely silent when I became upset (not at her at the fact that we still didn't know if he was ok and they weren't going to try again). Just shrunk back against the wall.

Growth scans are not that accurate, any measurement should be taken with a pinch of salt- especially later in the pregnancy as baby gets harder to see/measure. It could be the baby's position meant the measurement was different, or even the equipment being used was different to your last scan. Definitely raise your concerns so that it can be checked next time by your consultant though.

Re the student, all of the medical professionals caring for you were students once, and if everyone was as rude and demeaning as your dh was (and a lot of posters seem to be) there wouldn't be many competent people in those roles.

No Nothings changed actually, they will rescan in 2 weeks as per, I think it's more for my own reassurance and that this meant she's dropped under that bottom thick line! I was upset at the fact that it could have had implications on the birth plan, although I think it's probably easily explained by the in accuracy of measurements.
She was also quite jokey/flippant and needed quite a lot of reassurance (not to mention leaving halfway through because one of her student friends popped her head round the door - much to the annoyance of the sonographer). I get that they have to learn, absolutely I do, but i think maybe not for high risk patients specifically with historical growth concerns..or Maybe it would've been appropriate for the sonographer to just to check her work?
Sorry, I should add.. My partner's eye roll was very much secretly and for my eyes only, she didn't see. We've been together for 16 years and so im obviously happy with 'the way he treats me' :)

@noisytheo obviously nowhere near as distressing as your situation, but I had the same sort of situation with a student midwife - she performed my 25 week growth check and Doppler like she was handling a hot potato! Literally swiped my belly weakly with the Doppler, found a faint hb and said "think that's ok?" like a question for the attending midwife. Was awful. Worried constantly til my 28 week appointment. Thankfully I haven't had to see a student since but I certainly won't be letting one near me again. If I was you I would ring and request another appointment sooner, can't hurt to ask! Also for what it's worth I think my husband would be livid as well

Youre being ridiculous! The sonographer will have watched what the student was doing, unless she left the room! And as a student, they need to spend time with all types of pregnancies. If they only worked with perfect text book pregnancies how would they know what to do with anomalies? As others have said, growth scans are not 100% accurate which accounts for the reduction in femur length. Despite what you think, the sonographer will have taken note of this. And of course the student will have asked lots of questions, she's learning!
I could understand your concerns if as a result of the scan you were being rushed in for early delivery, but you're not. You go back in 2 weeks, and will be 3 weeks off your due date which is within the acceptable limits for normal delivery. You're clearly high risk due to your previous pregnancy. So don't be surprised if this baby slows down growth wise.

Hmm it doesn’t sound to me like the sonographer was fully paying attention, to be honest, if I was in their role and someone seemed unsure I would be watching like a hawk and making sure it was all done correctly, all patients do deserve a high standard of care and the students do learn by “doing” but also learn from supervision and reassurance if it’s needed that they are doing it correctly. I often have students in my appointments and have had good experiences , the appointment is slower due to them being asked questions to make them think such as and what are we looking out for here ect. But at least I walk out knowing my examinations were done correctly. I know it can’t be that interactive for every visit and a point comes when they need to spread their wings and fly solo(but still be supervised) but the student in this case seems like a lost soul and it does sound like the job was done wrong if the measurements were very out! I wouldn’t sit worrying I would ring and ask, you are not being unreasonable and if you are concerned it might have an impact on future decisions you will be up the wall for two weeks! I would love to hear what your next scan shows though I imagine the femur will have a miraculous growth spurt ha ha.

From my experience sonographers (whether they are with students or not) are usually more accurate than consultants when it comes to scans, especially if said consultant was just taking ‘seconds’ to take the measurements. I would be questioning the previous measurements and returning to the consultant to ensure their measurements were accurate.

From my experience sonographers (whether they are with students or not) are usually more accurate than consultants when it comes to scans, especially if said consultant was just taking ‘seconds’ to take the measurements. I would be questioning the previous measurements and returning to the consultant to ensure their measurements were accurate.

This.... consultants dont spend all day everyday doing ultrasounds. Sonogrophers do. Much in the same way I tell patients who insist the doctor takes bloods instead of the phlebotomist, just because they're a doctor doesn't make them better.

However ring your midwife for reassurance. It cant hurt.

Came on to say exactly the same. When I had consultant or a doctor scan me they always said they’re not as good as sonographers. I have not known that many growth scans to be accurate amongst family and friends. Babies who were supposed to be big were small and vice versa - including two babies who were induced early because they were apparently so big - one was 6lb something in the end!

I was about to say the same as the last few posters, sonographers have always proved themselves to be far more accurate than consultants for me. They do it day in, day out.

You've got another scan in no time, see what happens there. I can appreciate that you don't want her to be under the line, but you need accurate charts, or at least as accurate as possible.

Have you ever thought the student didnt appear confident and jokey because she was nervous? I think you guys would make me nervous as a student..

Sorry what's iugr?

Dont be so ridiculous. The student is there to learn, thats why they're on a placement. To learn.

I had some sympathy reading your story, but your updates have made you sound awful.

They will not induce you based on this one scan - they may consider it if the (potential) issue persists at the next scan.

One of my twins had IUGR which went undetected. The only sign was his femur length which dropped to below 5th centile at 28w and 32w. If I hadn’t gone in at 35+1 feeling unwell he wouldn’t be here as he had stopped moving and I had no idea.

Will your next scan be with the consultant? If so you have nothing to worry about in terms of inaccurate measurements - either he’ll see that the last scan was wrong or there’ll be ongoing signs of reduced growth and they’ll have to act.