32 weeks how do you know baby is fine without a scan?

[HelloOverHere]

Hi ladies,

So I'm 32 weeks today and my last scan was at 20 weeks. Midwife has taken measurements of bump every 3 weeks and bloods have come back normal.

I know I can pay for a private scan and have asked midwife if I need another scan - she said no and that I'm completely normal.

Without going for a private scan how do I know everything is fine with baby?

I think the theory is that if anything developmentally was wrong this would show at the 20 week scan and if you’re measuring fine then baby is growing fine and the midwife checks a normal heartbeat. The main way to tell baby is fine is their movements as a scan is only really a snapshot of them being fine at that moment whereas movements tell you on a continuous basis

31 weeks and I have the same question. I had a private scan at 28 weeks and I have an nhs one at 36, but I’m thinking about getting one at 32 weeks. It seems to long without checking on whats going on in there.

I’ve been wondering this too. I might pay for another scan at 28 or 30 weeks (my last one was at 19 weeks and I’m now 24). Not sure I have the spare funds at the moment though!

What would they need to check via ultrasound?

There are no developmental abnormalities that suddenly occur after 20 weeks. As long as the baby is growing (midwife measures regularly), has a healthy heartbeat (again midwife monitors) and active (you can feel it moving) then that's as good an indication as anything that everything is fine.

A third trimester scan has been shown to improve outcomes and is useful in detecting growth issues that would otherwise be missed (measuring isn’t completely accurate). Unfortunately the NHS decided that the benefit to those few babies it would make a difference to isn’t worth the substantial additional cost as the majority don’t need it.

I’ve paid for a scan between 32 and 36 weeks with each of my pregnancies for that reason.

3rd trimester measuring using ultrasound isn't hugely accurate either....

As someone else said, a scan is only a snapshot. With DD2, I had a growth scan at 28 weeks and 32 weeks as DD1 was born at 28 weeks. Both showed that the baby was growing well, however I went in to labour 5 days after the 32 week scan. There's no way that could have been anticipated - from a scan or anything else. A scan can show you that the baby is growing normally, but it can't tell you what may or may not happen to the pregnancy. All you can really do is monitor movements and react to any change or any new symptoms.

Standard NHS procedure is to only have 2 scans at 12 and 20 weeks unless clinically indicated. The idea is that you monitor movement and the heartbeat is checked at your routine appointments.

That said studies have shown that a Doppler scan between 32 and 36 weeks improves outcomes for babies. I have had BP issues in my pregnancies and so have had regular NHS scans. If I hadn't I would 100% have paid for a private scan between 32 and 36 weeks.

If you want a bit more information look into the work of Professor Nikolaides who is a foetal medicine specialist (he is behind the nuchal screening at 12 weeks).

Doesn't a scan look at how healthy the placenta is and measure blood flow, etc.? And, even if the measurements aren't totally accurate, it has to be more accurate than a tape measurer over your tummy done by different people each time. I feel it does give more information on the health of the baby than just listening to the hb every once in awhile or trying to track movements (esp. if you have anterior placenta and movements are hard to feel).

@Sunshinegirl82 that's really helpful info, exactly what I wanted to know. Thanks so much!

I had a scan at 28 weeks and have another 2 booked in at 34 and 37 weeks... I'm booked for a cesarean though so that might be why. I would def book a private one if my last one was at 20 weeks tho..

In lots of countries later scans are routine. If I had the money I’d have one.

Doesn't a scan look at how healthy the placenta is and measure blood flow, etc.?

Yes. And my 20 week scan with DS was perfect. At 31 weeks I developed HELLP syndrome and had an EMCS within hours of diagnosis. My placenta had stopped working properly weeks before and DS was no longer getting the nutrients he needed. He only weighed 2lb 6oz. I was extremely lucky to have the EMCS when I did as he wouldn't have survived much longer and neither would I have. A scan would have picked up on this earlier.

However, I also agree with what someone else said. A scan is only a snapshot. What if I'd had a scan at 28 weeks and everything was perfect? And my placenta stopped working the day after? It wouldn't have changed the outcome.

@f00k studies give shown that scans between 32 and 36 weeks DO improve outcomes. The key is that during the scan they need to examine how well blood is flowing through the cord to baby.

It won't catch every issue but it does make a difference. Kings hospital (where professor Nicolaides operated his NHS practice) introduced additional Doppler screening and an additional standard scan at 32 weeks following which the rate of stillbirth at the hospital fell significantly (it may have been as much as 50% but I would need to check that figure).

@Sunshinegirl82 absolutely, but I was referring to a scan not changing the outcome in my situation. As DS was born at 31 weeks so it would have been too late with a scan after 32 weeks. I don't know when things started to go wrong so I don't know at what point an extra scan after 20 weeks would have been helped me. I just meant that I could have had a scan that again showed everything was perfect like the 20 week scan, but then things obviously at some point stopped being so.

I had a scan every 4 from 28 weeks with DD, which was very reassuring after everything that happened with DS.

Do you ladies think every four weeks is enough? I had a scan at 28 weeks and I am thinking of having two more at 32 weeks and 36 weeks.

I had a previous loss too and I'm anxious, but midwife won't do any scans as I'm measuring fine.

@f00k did they not pick up your HELLP syndrome at the routine midwife appointments? By taking bp, testing for urine in protein, etc.? When they measured you weren't you measuring small if baby was only 2 lbs and placenta had stopped working weeks earlier? I'm terrified they would have missed that at all the antenatal appointments you must have had between 20 and 31 weeks...

I had regular growth scans due to my high BP and they were every 4 weeks so I would have thought 32 weeks and 36 weeks would be fine. I'm not a medical professional though so obviously if your dr or midwife advise something different I would follow their advice.

Perhaps discuss your plan with your midwife at the next appointment? I'd also suggest having the scans at an actual hospital rather than the baby bond type places. I had my extra scans (early ones as later ones were NHS) at the private clinic attached to our NHS hospital.

@sadtoday21 yep those signs were missed. At my 28 week MW appointment, I saw a different midwife than I usually had and she had a student with her. The student measured my bump and said I was measuring small. The MW did it and told the student she had measured wrong and it was fine. Also had a trace of protein in my urine but I was told it wasn't anything to worry about. That was almost 9yrs ago now and at the time I hadn't read anything about pre-eclampsia or HELLP syndrome so I didn't push for further investigation. I'm sure the chances of things being missed like that are small and I was just unlucky! Also a trace of protein isn't always something to worry about. With DD they said anything +1 they would investigate further and I had lots of extra scans and I was under consultant care, so I really felt looked after second time around. I'm 7 weeks pregnant with DC3 at the moment and fingers crossed, I'll have another healthy full term pregnancy. But at least I'm now armed with knowledge and I know what to look out for.

@Indella @Sunshinegirl82 Do you have any links or more details about the evidence that scans in the 3rd trimester improve outcomes?

I have been told I am measuring on the large side by my midwife, however they don't routinely do scans because of this and I have no other risks. I'm weighing up getting a private scan but also don't want to cause myself worry because of it, so it would be interesting to see the research on scans in 3rd trimester being a good thing. Thanks

Scans at 30 weeks plus are great for picking up blood flow or other structural abnormalities but not great at size estimation -

@Keha This study basically concludes that it’s not perfect but a third trimester scan is better than nothing. If you’re going to book one make sure you book it at a hospital where they are trained to interpret the results not one of the bonding places that simply look for a heartbeat and sex.

mercyperinatal.com/journal/screening-for-fetal-growth-restriction-with-universal-third-trimester-ultrasonography

@Keha This study specifically looks at Doppler assessment ( checking them blood flow through the placenta and cord )

obgyn.onlinelibrary.wiley.com/doi/full/10.1002/uog.15729

@Keha SANDS themselves found that third trimester scans improve the detection of growth restricted babies compared to just measuring. Didn’t find them all but found more, similar results to the first study. It’s all about money why they are not offered in the NHS.

www.sands.org.uk/our-work/research/studies-we-fund/pregnancy-outcome-prediction-pop-study

Can you request serial scans? I'm having scans every 4 weeks on the NHS because of my mental health and also because I have ulcerative colitis. But they said they can do it if the mother has anxiety? Might be worth speaking to someone or calling the labour ward instead of just your midwife?