IUGR at 21 weeks, similar experiences?

[1sttimeexpatpapa]

Hello,

Today my girlfriend is 21+4 weeks pregnant and we have recently learned that our baby has restricted growth. We are actually looking for stories from people who have experienced the same or similar and want to share their experience with us.

At 18 + 3 we had an early 20 week ultrasound (due to corona). All the bones and all organs were well and as it should be. The baby was very small, averaged P3.7. Especially the waist size was too small. The head and legs too, but not worryingly small (although below the P10).
At exactly 21 weeks, we therefore had another 20 weeks ultrasound to monitor the growth. This ultrasound was done by another person. Her reading came down to an average of P2.3. Waist circumference, head circumference and legs were now more equal to each other.
We were therefore referred to the hospital and had an Advanced Ultrasound Scan there. This again showed that our baby is too small for pregnancy. The organs and brains are otherwise completely good. We did not get the average percentile with this, but it will roughly come out the same as the previous measurements. Conclusion: early IUGR (Intrauterine Growth Restriction). The umbilical cord has been seen to be attached to the side of the placenta, in the membrane, so the baby is unlikely to get enough nutrients. Also, the blood supply to the placenta is not optimal.

In less than a week we will have to go back to the hospital for a new scan. Then we can look at the progress and growth of our baby. It has already been indicated that in this case it can go in all directions: if the child continues to grow like this, we will just have a very small child. But if the growth curve starts to decrease, the baby may die in the womb. There is also a greater risk of neurological consequences if the baby lives.

We can only find information online about growth restriction (IUGR) from around 24/25 weeks. Are there people who have experienced growth restriction that was noticed during the 20 week ultrasound?
We would like to hear how it went with you. I wonder if it is possible for growth to improve? I only hear of deviating growth curves.

Thanks

Hi - I replied on one of your other threads before your latest scan, wanted to reply to bump this up and hopefully someone who has been through this personally will be along to share as well.
Can I ask -when you say blood supply to the placenta is not optimal, is it the uterine artery doppler blood flow that is abnormal? Or in the umbilical cord? That makes a bit of a difference in terms of likely outcomes - hopefully the doctor talked that through with you.
Did they talk to you at all about possible causes of the growth restriction, extra tests etc? Did they do something called a customised growth chart for you? Won’t go into all that unless you’d like me to, hopefully already covered for you.
From what you’ve said so far I think it sounds like it will be a scary wait for The next few weeks, as only time will really tell what your baby decides to do! Best thing you can do is try to take care of yourself and your partner’s mental health, and try to take it one day at a time because the not-knowing is very hard. I hope you have lots of extra support around you.

Hi @TenThousandSpoons0, thank you for your message.

It's the Uterine artery doppler blood flow that is abnormal. The artery pressure is too high, plus the umbilical cord goes into the side, which means it's a velamentous cord.

We haven't had a customised growth chart, but we have our next scan/meeting next Wednesday, is it something we should bring up?

Customised chart isn’t used in all areas - but sometimes it can be helpful, as it will take into account your partner’s height, weight, any previous babies, and adjust the estimated weight graph. Now that I think about it properly the customised chart only starts after 24 weeks tho so will have to wait a bit longer for that anyway. Generally if your partner is particularly petite it can be helpful, otherwise not so much.

It’s good that the umbilical artery doppler is normal. That tells you about how baby is coping just now and it would be much more worrying if that was abnormal - that will be the main thing the doctors are watching on repeat scans for the next few weeks. The velamentous insertion is pretty common and may well be a side issue at the moment.

The uterine artery doppler tells you about placental function (abnormal uterine artery doppler usually means growth restriction but can also just signify a risk of growth restriction or pre eclampsia developing later on). It doesn’t really help predict the time frame in terms of how baby will do, whether the growth will reduce quickly or not. At this stage you might be looking at getting all the way through to 37-38 weeks without needing delivery; more likely it would be earlier than that but couldn’t tell whether that will be the next few weeks or well down the track.

I think it’s worth asking them to explain to you the possible causes of the growth restriction when they see you next. It’s helpful to have them talk through each one in turn and give you an idea of what the thinking is. It sounds most likely the commonest one, placental insufficiency, because of the high uterine artery measurement - but they should consider and talk you through the other causes as well. For example, sometimes infection can cause this -it’s unlikely because the scan is otherwise normal, but it’s easy to do a blood test for your partner to rule that out.

As I’ve said before it’s really just a waiting game. At 21+4, with normal scan otherwise, and normal umbilical artery doppler, as well as normal “interval growth” (ie staying on a similar centile over the last 2-3 weeks of scans) you should definitely feel very hopeful that baby will survive (I only mention this because I think you said before that you’d been told baby could pass away in the womb). What’s the estimated weight just now?

Sorry - another long message but I hope that’s helpful. All of this should be stuff the doctors will cover with you, and certainly please talk all the same things through with them! But I know how long the waiting feels until the next appointment, and I want to try to give you good information in the meantime as I know you’re probably going nuts on google!

@TenThousandSpoons0

Customised chart isn’t used in all areas - but sometimes it can be helpful, as it will take into account your partner’s height, weight, any previous babies, and adjust the estimated weight graph. Now that I think about it properly the customised chart only starts after 24 weeks tho so will have to wait a bit longer for that anyway. Generally if your partner is particularly petite it can be helpful, otherwise not so much.

It’s good that the umbilical artery doppler is normal. That tells you about how baby is coping just now and it would be much more worrying if that was abnormal - that will be the main thing the doctors are watching on repeat scans for the next few weeks. The velamentous insertion is pretty common and may well be a side issue at the moment.

The uterine artery doppler tells you about placental function (abnormal uterine artery doppler usually means growth restriction but can also just signify a risk of growth restriction or pre eclampsia developing later on). It doesn’t really help predict the time frame in terms of how baby will do, whether the growth will reduce quickly or not. At this stage you might be looking at getting all the way through to 37-38 weeks without needing delivery; more likely it would be earlier than that but couldn’t tell whether that will be the next few weeks or well down the track.

I think it’s worth asking them to explain to you the possible causes of the growth restriction when they see you next. It’s helpful to have them talk through each one in turn and give you an idea of what the thinking is. It sounds most likely the commonest one, placental insufficiency, because of the high uterine artery measurement - but they should consider and talk you through the other causes as well. For example, sometimes infection can cause this -it’s unlikely because the scan is otherwise normal, but it’s easy to do a blood test for your partner to rule that out.

As I’ve said before it’s really just a waiting game. At 21+4, with normal scan otherwise, and normal umbilical artery doppler, as well as normal “interval growth” (ie staying on a similar centile over the last 2-3 weeks of scans) you should definitely feel very hopeful that baby will survive (I only mention this because I think you said before that you’d been told baby could pass away in the womb). What’s the estimated weight just now?

Sorry - another long message but I hope that’s helpful. All of this should be stuff the doctors will cover with you, and certainly please talk all the same things through with them! But I know how long the waiting feels until the next appointment, and I want to try to give you good information in the meantime as I know you’re probably going nuts on google!

Hello TenThousandSpoons0,

I'm the partner/girlfriend. Just wanted to thank you for taking the time to write. Your message is really helpful and we'll discuss all points you mentioned with the doctors when we will see them next.
Last Monday our baby was estimated just over 300 grams at 21+3.

Thanks for taking the time to put this in writing for us. It's appreciated :)

I’m glad it’s been helpful - I know it’s a very stressful thing to go through! X

Our first DC was early IUGR, had a scan about 21 weeks and was measuring a couple of weeks behind. Significantly small the whole way through (for example, femur measurements were off the chart). We had an amniocentesis at 26 weeks to rule out any genetic causes, couldn’t find any.

Bub was born at 37 weeks by c section, weighing in at 2.1 kgs, stayed in SCU for a week and no long term issues that we can tell so far.

Oddly enough, growth has improved to around 30th percentile, which is unusual for IUGR.

I hope all works out for you.

@yesyesdear thank you for your positive message - this is really great to read.

@TenThousandSpoons0 - wow, thank you so much for the insightful message and pointers we should be looking at. Our scan is tomorrow and this will definitely be helpful!

@1sttimeexpatpapa I have been wondering how things are going for you?

@TenThousandSpoons0 pretty well actually - the baby was born on 26 August, 32+5, weighing 950g, we managed to get up this weight just with momma staying at home, on the sofa, all day every day, we left the city and went to the countryside for about 6 weeks, which seems to have worked well. We found ourselves a great Gynaecologist, who was also the head of the polyclinic and offered to 'take our case on' and be our specialist for 4-5 weeks to help get us over the line. We got the weight up from 500approx to 950 in those weeks and that made all, literally all, the difference..
His organs are all fine, he's now up to 1.4kg and is steadily growing, drinking himself, breathing himself, with, as far as we know, no long term issues so far..
We're very happy, and of course thanks to you for the advice when we had no where to turn to..
Still along way to go, but we've come a long way.. and hopefully it will be a happy ending!

That’s fabulous news, well done and congratulations!

Hi,

We are in a very similar situation, can I ask what sort of things you did to get the weight up?

@Beccaelizabeth

Hi,

We are in a very similar situation, can I ask what sort of things you did to get the weight up?

Hi @Beccaelizabeth sorry I only just saw this.. how are things now? To be honest, to get the weight up is really unscientific.. but we basically put the mother to bed rest, laying all day of the sofa on her left side. Relaxing and eating good nutritious food.

@TenThousandSpoons0

That’s fabulous news, well done and congratulations!

Just want to say thanks.. your words in a difficult dark time were super helpful. The baby is now 7 months and weighs 6kgs! And no long term issues

Congratulations on your baby boy. I'm glad all ended well, must have been a scary time.
@Beccaelizabeth hope all is well with you and your baby