Umbilical pressure (PI)

[schafernaker]

So it’s been picked up that baby’s growth has started to tail off at 31 (after being scanned due to reduced movements). The PI pressure at this scan was on the 19th centile. Fast forward 6 days and i was readmitted due to reduced movements and another Doppler performed- now up to 72nd percentile.

There has been a lot of discussion and conflict from the consultants on ward rounds what best to do. One flat out said no steroids, no further scans until the 2 weeks is up and we are ready for another full growth scan. The next booked another Doppler for early next week (4 days since the last) and has decided steroids are needed.

Very conflicted and tempted to go with the safety of steroids and a further scan. Just wondering if anyone else has been/is in a similar situation and what you were advised?

Also is it fair to say it’s pretty likely we will be looking at a preterm delivery? The jump in PI centile is really quite concerning to me! Ctgs all seem to be ok, we’ve had a couple of wobbles with heart rate plummeting but it has quickly picked back up and has been explained as baby sitting on the cord

Hi. Always best to just talk these things through as much as possible with the doctors looking after you. I would ask them to please sit and explain to you what is happening, and when they think baby is likely to need delivery (bear in mind they won’t have an exact answer for that but they should give you an idea).

Couple of things though:

• steroids are usually reserved for situations where the obstetrician thinks the baby is highly likely to need delivery within 48 hours up to a maximum of seven days. In general, if you are 31 weeks and the umbilical artery PI is within normal range (which it is) and nothing else is going on, then you are unlikely to need delivery within 7 days. They lose their effect following that, and really the best benefit is with that initial dosing rather than repeating later on (it’s a bit more technical than that - but hopefully that makes sense).

• things that would make you more likely to need delivery are if you have blood pressure problems (you likely have around 50% chance of developing pre eclampsia because it often goes hand in hand with growth restriction); or if there are other things going on with your health or baby’s health. I’m not sure what to make of what you say about your CTG - if baby is having true and repeated drops in heart rate on the monitor (for longer than 15-30 secs) then that would be a cause for concern - I wonder whether that is why the newer doctor is more worried?

• decreased movements in the context of a baby who isn’t growing is concerning. In that situation I think it is appropriate to scan again earlier than 2 weeks to look at dopplers. If baby was moving normally then typically 2 weeks would be the norm. I wouldn’t decline the next scan.

In terms of the actual centiles it is normal that there is variation. Above 95th centile is abnormal and below it is normal. The next scan will tell your whether it is truly trending upward or actually just fluctuating.

In some ways I think it’s understandable that there is some disagreement between your doctors about the best course of action as I don’t think your situation is super clear cut.

Have they explained what the umbilical doppler PI is measuring? Happy to go through it if not.

As a guide, with growth restriction the usual target is to reach 37-38 weeks unless the dopplers become severely abnormal or something else develops (preeclampsia, abnormal CTG). The frequency and type of monitoring depends on your overall situation.

But - cannot stress enough - every situation is different and you need to be guided by the team looking after you.

Hope that helps and sorry to ramble!

@tenthousandspoons0 really interesting thank you for taking the time to reply!!

-DC1 was a 33 weeker due to IUGR, RFM and high Pi (probably should have said)

-I had slightly increased blood pressure on one occasion last week but since then it has been fine. I assume the one occasion was a little stress related.

-there were 3, maybe 4 15 second dips on each of 2 separate ctgs. However on one these were all at the start of a 60minute trace, which then appeared to normalise, the other seemed to be every 10mins and then settled for the last 20 mins.

-My very basic understanding of PI pressure is it is to do with how the placenta is functioning. Growth scan showed a big drop in AC measurement but femur and HC was still relatively ok, overall dropped from 50th to 20th centile in the space of 2 weeks

• I guess we will see what is said this morning, I think it’s just the conflicting views that are making an already stressful situation worse. I understand it’s a hope and see, so I probably just need to be more patient!

As I said thanks for your detailed response

Ah so you’ll be a little familiar with preterm babies having done this before! I hope all goes well and you get an extra few weeks though :)

Sorry to jump on post I had my scan last week and they said they were concerned about the doppler pi it is 1.63 I'm 28weeks pregnant is that high high or just a little high? Not had this befor so it's confused me 🙄