"Failing growth" / FGR / IUGR at 36 weeks - what care is reasonable to expect?

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Lib3rtine · 18/12/2020 14:34

Hi,
I'm 35+2 and been having weekly scans since 28 weeks when the midwife measured my bump small. They have been alternating each week and doing growth scan and cord PI and RI one week and just PI and RI the other. Babies growth has now increased up to 75th percentile but on Tuesday there was slight pressure in the blood flow going through the cord so they've got me back on Monday to check again even though baby had grown loads in two weeks, and then back on the 30th for a full growth scan. It doesn't seem like you've had the same level of caution and care that I've had and I've had none of your risk factors. If I were you I would be pushing to be seen in a week just for your own peace of mind. My hospital have not cancelled anything due to Covid and I think I've been given a really high level of care and they've been super cautious. Could you ring triage if you're not getting anywhere with the consultant?

Original poster

WoolyMammoth55 · 18/12/2020 15:19

Thanks @Lib3rtine for your reply. I'm so glad you've had good care! Thanks for replying because it's helping me to feel that I can be more forceful in what I'm asking for.

I will try triage now and see if I can get anyone to calm me down/book me a scan sooner. Really grateful for your advice

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Lib3rtine · 18/12/2020 15:24

@WoolyMammoth55 No problem at all, I hope you get a scan next week as I know how worrying it can all be. Have your movements all been normal? One thing they've drilled into me is that I have to have a low threshold for what I consider normal movement and if I'm in any doubt, to ring triage straight away.

MJBmummy · 18/12/2020 15:34

Different situation for me but I was under consultant care and had extra scans and midwife appointments from week 28 as I have a history of stillbirth and miscarriage. My boy is 11 weeks old now so this was during covid. My partner was also allowed to all appointments. I think if there is any reason to be concerned about your baby then you should expect additional care. Babies are far too precious to have a 'wait and see' sort of attitude. Be very clear with them about what it is doing to your mental wellbeing xx

Indecisivelurcher · 18/12/2020 15:44

Make sure you go straight in if you're concerned about movement at all. Don't be afraid to set up camp in triage.

physicskate · 18/12/2020 15:48

Honestly. That sounds fine to rescan in two weeks. The 50th centile to 28th seems well within the margin of error for a single scan. Remember scans are as much art as science. My daughter started on 90th centile at 25 weeks based on bump. Started having growth scans when she dropped below 50th by about 32 weeks. She was born on 12th centile at 40+5. I had nothing more than 2 or 3 growth scans and her growth showed she was continually slowing at each measurement. Slowing, but not stopping... I think they get more worried about stopping.

physicskate · 18/12/2020 15:49

Agree with @Indecisivelurcher about movements though!!!

Bolshybun · 18/12/2020 15:51

I would definitely push for the earlier scan like you have. My issues with intermittent high blood pressure started at 30 weeks. As they were concerned about me I went for twice weekly monitoring (baby monitored, urine test and bp monitoring) and weekly scans checking the placenta blood flow. Growth was checked fortnightly as our NHS trust said growth can be more clearly monitored at this frequency. I was induced as soon as they saw reduced flow and my daughters growth halted by 37 weeks. I was induced and had an emergency section as she didn’t cope with the contractions and I hyper stimulated with too many 🙈 All was well (she was 4lb 10) and she’s an active 7 year old now.

GrumpyHoonMain · 18/12/2020 15:54

@WoolyMammoth55

Hi all,

I'm 36 +2, a much-wanted 2nd pregnancy. I'm moderate risk due to age (40), high BMI, and thyroid issues. That aside it's been straight forward so far - mostly MW led care with 2 extra growth scans due to BMI.

Had my 2nd growth scan at 35 +6 and bub had dropped from 50th %ile to 28th. Cord PI and RI measurements were at the VERY lowest end of the healthy scale. There was no one available to discuss my results so they sent me home promising to call - and today I've been told I'll get a call on Monday to discuss and another scan in 2 weeks, at 37 +5.

I queried this and asked for a call today and a scan next week, 7 days after the first one, and was told (via consultant's secretary) that 'there was no clinical need to rescan so soon' and not to worry.

My BP has been mostly good but I've had 2 high readings recently, both by my community MW.

I'm basically worried about this pregnancy going off the rails at this late stage - that I'm being dismissed and that risk factors like the high BP readings aren't being taken into account by the consultants. I would feel much more comfortable with weekly scans going forward (obvs would be a maximum of 3 before DD so doesn't feel like I'd single-handedly bankrupt the NHS!)

Has anyone had this and managed to successfully argue for extra care? I know it's partly Covid-related that they are minimising contact - they've explicitly said that my additional monitoring would have been 4 growth scans in normal times but they're doing 2 instead due to Covid.

If I just shut up and wait to 37 +5 for this extra scan and (god forbid) something had gone wrong in the meantime, I'd never get over it :(

TIA for any thoughts or insights X

IUGR is a risk factor with high bmi and thyroid disease. I suggest you pretend you can’t feel the baby kick to get yourself face time with a consultant at the labour ward. They will scan, refer you for emergency ultrasounds and may induce if needed. Look after yourself and the baby

ivfbeenbusy · 18/12/2020 19:26

I get regular growth scans as one of my twins is measuring very small - less than the 2.5 percentile. I was told they don't really do anything less than fortnightly scans as it's not as accurate - due to the small margins they work to and with different people doing the scans each time

ivfbeenbusy · 18/12/2020 19:29

I suggest you pretend you can’t feel the baby kick to get yourself face time with a consultant at the labour ward

I don't think lying about something like this is morally or ethically right. She would be taking up resources that could potentially take away from someone who does genuinely need it.
The experts have said she doesn't need weekly scans - who are we to say she does??

Original poster

WoolyMammoth55 · 18/12/2020 21:37

Hi all, thanks very much for the advice. I did try triage but they referred me back to the consultant - given that we're talking on Monday there wasn't much they could do to expedite...

To be clear, the scan that I want to push for next week isn't the full growth scan but just the RI and PI check, to be on the safe side. Unless the consultant can really reassure me that those crazy low numbers are ok then I will push hard for that and emphasise that the uncertainty is causing me a lot of stress, which likely isn't helping the spiking high BP results.

At the moment movements are ok and I'm not inclined at this stage to lie about that. But I think the staffing levels here aren't good, hence why it's going to take 6 days from my scan to even discuss the results with someone - not ideal given how quickly things can go downhill.

Incidentally I also had an incident with my midwife early on where I wasn't told to take aspirin - then they realised at 30 weeks I should have been on it and told me to start taking it. It's one of the medications which is meant to help lower the risk of IUGR in cases like mine with risk factors - but the literature is clear that it only works if treatment starts before 16 weeks. So I'm aware that this could all maybe have been avoided if I'd had the right advice at the right time :( which is another thing that makes me feel like I can't just passively assume they're doing the best things for me and my baby - there's already an example of the service being overstretched and a chance to support us being missed.

Anyway, thanks again all for the help and advice - much appreciated! X

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Ragdoll1 · 18/12/2020 22:00

Hi Op.
This sounds similar to my story.
I had my girl 10 days ago at 36+3 as I had tailing growth, cord problems, and reduced movements.
I was having growth scans anyway as had similar with my son, but not this bad.
I had a scan at 35+2 and was induced at 36 weeks.
It's terrible noone was around to discuss your results.
Are you consultant led?
I'd be pushing for a scan sooner!

Original poster

WoolyMammoth55 · 18/12/2020 22:49

Hi @Ragdoll1, thanks a lot for your message. Hope you and bub are doing ok now at 10 days?

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Ragdoll1 · 18/12/2020 22:59

We're doing OK thank you, only a day and a bit in nicu, but she did need help initially.
She was 5lb 5oz, so tiny, it scares me but we were home in 3 days .
Keep an eye on those movements and if any doubt get to triage.
Hope u can get a follow up scan soon. X

GrumpyHoonMain · 19/12/2020 01:38

@Ragdoll1

Hi Op. This sounds similar to my story. I had my girl 10 days ago at 36+3 as I had tailing growth, cord problems, and reduced movements. I was having growth scans anyway as had similar with my son, but not this bad. I had a scan at 35+2 and was induced at 36 weeks. It's terrible noone was around to discuss your results. Are you consultant led? I'd be pushing for a scan sooner!

I had a similar issue. Only I was taking aspirin, taking blood thinners, was having weekly growth scans from 32 weeks and baby was only a little smaller. Something didn’t feel right so I lied and got myself in front of a consultant at 36 weeks in the labour ward and they spotted the movement issues. I then had daily monitoring and had a planned induction bang on due date which is when baby’s heart went wonky. He was born at 7 pounds but the IUGR wasn’t discovered until after my placenta had been examined - apparently I had a number of minor clots throughout it in what they thought was preclampsia.

So yes def push for scans or even monitoring.

TenThousandSpoons0 · 19/12/2020 02:36

Sorry you’re going through this stress OP.
Just thought maybe I could add a couple of things for you which may help.
The growth drop from 50th to 28th could easily just be normal variation- it doesn’t actually quite meet criteria to diagnose growth restriction at that, and would usually just be a reason to look again 2-3 weeks later. It also depends which of the measures have actually dropped - if the abdo measurement has dropped a lot then that might be more concerning, if it’s stable then that is reassuring, for example.
The doppler measures are very normal - umbilical artery PI that is at the low end of normal is even better. If it’s at the upper end that’s where you would maybe worry more, due to increased resistance inthe placenta - that would be a PI near or over 95th centile. Yours is the opposite - super reassuring. The more interesting doppler would actually be MCA and probably even more informative is the CPR which is a ratio of the two.
I agree that you have a few risk factors and watching growth plus your BP/symptoms is definitely a good idea. However more scans isn’t always a good idea and may lead to intervention earlier than required. It’s always a tricky balance.
I think you should go prepared for a good discussion with the consultant on Monday - and hopefully they can go through your growth charts with you. I’m not sure if you have a delivery plan in mind already but they may suggest aiming for 39-40 weeks or so with your background. I would say it’s reasonable to scan again at a 2 week interval - 37+6 - and Have the option of bringing delivery forward If any concerns. Weekly scan would definitely not be strictly indicated on the info that you’ve given, and I’d say most doctors/midwives would be totally comfortable that your baby is doing fine.
Of course you need to also be comfortable - so if after discussion with them you’re still feeling you want a scan then do ask for one, and good luck!
If you want to ask about any of the other measures on the scan report I might be able to help more.
As others have said, have a low threshold for getting things checked if you have any concerns about movements or other worries.
Also re BP - if you’re worried, you could look at upping those checks to twice a week - I believe some pharmacies will do BP checks but I could be wrong.
Best of luck with the final few weeks of pregnancy anyway, it’s such a hard time to get through in a lot of ways!

MJBmummy · 19/12/2020 08:31

@WoolyMammoth55 which hospital are you under, out of interest? Because I live in Somerset too and was under Yeovil who were fantastic throughout my pregnancy

Original poster

WoolyMammoth55 · 19/12/2020 15:23

Thanks all for the input - @MJBmummy I'm under Musgrove Park, we're actually equidistant between there and Yeovil but I just asked my only local mum friend for her advice and picked pretty much at random... Hey ho! Really glad you got good care at Yeovil.

@TenThousandSpoons0 thanks so much for your expert thoughts, it's great to hear that the low PI/RI results aren't worrying and about the AC measurement - that one is the most stable, HC and FL were a bit down. I think as much as anything it's been the wait to get any feedback on the report that's not good - the scan was on Tuesday and I'm having to wait until Monday to go through the results and the plan. I think that's a crappy amount of time to make a moderate-risk mum sit staring at a report stamped "tailing growth" without explaining any of it :(

I'm actually monitoring my BP at home most days so pretty confident that it's spiking up but not staying there full time. Anyway, here's hoping for a calmer time over the last few weeks!

Thanks again everyone X

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Original poster

WoolyMammoth55 · 29/12/2020 21:01

@TenThousandSpoons0 Sorry to bug you Spoons! I had the follow up scan today and the abdo measurement hadn't gone up at all (or by I think 2mm in 2 weeks). Some progress elsewhere but not AC, and I remembered you saying that could be a concern.

I've got a chat with the consultant tomorrow and will be 38 weeks then. Any advice? Cord measurements were still good (low end of scale) and they hooked me up to the monitors for 20 minutes and were very happy with his wriggling and HRV.

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TenThousandSpoons0 · 30/12/2020 19:05

Hi @WoolyMammoth55 I guess you’ve probably seen the consultant by now, sorry didn’t get this straight away. so hopefully you have a plan?

TenThousandSpoons0 · 30/12/2020 19:08

Oh - should probably amend to say plan induction or CS - not sure what your plan would be but the scan doesn’t mean you have to have either/or.

Original poster

WoolyMammoth55 · 30/12/2020 21:36

Thanks for the reply @TenThousandSpoons0, much appreciated :)

Had a chat with the consultant today - because bub looked good on the monitor, my BP is good and cord flow is good, and also because the sonographer noted "view restricted by fetal position" (which I hadn't noticed) he's booked me in for a CS at 39weeks, in 7 days time.

He said with margins of error for the restricted view and given other measurements were showing decent growth, he thinks advantages of waiting to 39 wks on lung development etc outweigh the risks for now.

He did emphasise to keep alert about movements and to try to rest whenever needed for the next week - easier said than done with a cooped-up 3 year old! But on the whole I feel comfortable with that plan.

Many thanks again for your advice, super kind of you

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TenThousandSpoons0 · 31/12/2020 17:25

That’s great, sounds like you’re getting good care and taking the whole picture into account - hopefully you’re able to enjoy your last stretch of one-on-one time with the toddler (ha!).