Resistance to cord & PI high??

[EmmyJ21]

Since around 30 weeks I have constantly been at the hospital whether that's triage or admission. I've been diagnosed with obstetric cholestasis which I had in my first pregnancy. I have had spotting, reduced movements & most recently a larger bleed.

I was admitted 3 nights ago due to a large(ish) bleed. During this time I was sent for a scan to see if anything was showing the reason for the bleed. There was no signs of any bleed but the doctor wants to book me in for another scan this week due to high resistance in the cord?
Has this happened to anyone else? I am currently 34+6 days. Baby is growing fine but resistance in the cord. Is this normal?

34+4 days scan results
Head circumference >95th%
Abdominal circumference 94th%
Femur Length 10%
Est Weight 62nd%

Doppler:
Umbilical Artery PI 1.48
Enddiastolic flow: positive

Are they offering a C-Section or Induction? In my case it was ignored and turned out to be IUGR caused by ‘invisible’ preclampsia (I was never given the official term for it) that really affected DS’ growth (he was projected to be much heavier than he turned out to be as he was a tall baby) .

If it hadn’t been for me pushing for daily scans and an induction at 40 weeks on the dot he might not have made it. So I would definitely be pushing for an early intervention in your position.

@Ozanj

Are they offering a C-Section or Induction? In my case it was ignored and turned out to be IUGR caused by ‘invisible’ preclampsia (I was never given the official term for it) that really affected DS’ growth (he was projected to be much heavier than he turned out to be as he was a tall baby) .

If it hadn’t been for me pushing for daily scans and an induction at 40 weeks on the dot he might not have made it. So I would definitely be pushing for an early intervention in your position.

I have to wait until I speak to my consultant at 36 weeks where he will be booking my csection at 39 weeks anyway due to previous sections.

Could it be IUGR even though she seems to be growing after each scan?

It won't let me upload any pictures but my 32+3 days scan measurements are as follows:

Head circumference: 56th%
Abdominal circumference 78th%
Femur Length 6th%
Est Fetal Weight 21st%

PI 1.12
Enddiastolic flow positive

Are you small? I would personally worry about that femur length. The weight measurement is a guess based on the other measurements. So I would ask the consultant whether they are happy that the femur meausrement is so low in relation to the others; or if they think there may have been issues in the measuring. Def push to see the consultant before 36 weeks and try and push for frequent scans.

@Ozanj

Are you small? I would personally worry about that femur length. The weight measurement is a guess based on the other measurements. So I would ask the consultant whether they are happy that the femur meausrement is so low in relation to the others; or if they think there may have been issues in the measuring. Def push to see the consultant before 36 weeks and try and push for frequent scans.

I'm 5ft 3" so fairly small myself. I have just received a text saying that I have a scan booked for Friday. I'm worrying because I keep bleeding and they can't find any reason as to why but this is showing possible placenta issues ? It's making me think that's related to the bleeds. The doctor's are saying it's unrelated though

I had high PI from 27 weeks - I had Doppler scans every 2 days and growth scans every 2 weeks. My baby was following the 5th% all the way through. I’m tiny myself so being small wasn’t a big concern, it was more the resistance that was causing concern - the plan was to induce at 37 weeks but by 34+5 the blood flow to babies brain was starting to be compromised and her growth dropped to the 3rd% so I had steroid injections and was induced at 35+5. Baby was born at 36 weeks weighing 3lb 9oz. It was diagnosed as IUGR as my placenta wasn’t working as it should be (probably due to my health problems).

It may or may not be related to the bleeding but push for regular Doppler scans to be safe. If babies growth starts to slow they’ll most likely induce you early!

I had issues with blood flow through the cord. I read up all about it at the time and kind of understood it but have forgotten it all 6 months later! From what I remember, the PI figure is a ratio of two other measurements. They start to worry when it goes below 1, which it did for me and combined with apparent slowed growth meant I was induced at 36+3.

I think they always look at these measurements in the context of the bigger picture, as they're not always accurate. I remember one doctor / sonographer explaining that high resistance could be associated with "head sparing" (i.e. blood being directed to the head over the rest of the body) so they would look for the head being disproportionately large compared to the abdomen / femur as another indicator of a possible compromised placenta. You're probably best asking a professional though - I called my community midwife who put me in touch with the lead sonographer, who answered all my questions and explained things really clearly.

I had this detected about 35 weeks and was given growth scans. Around 36+5 they were concerned that head circumference may have stalled so I was induced at 37+1. Baby was born healthy at 37+3 weighing over 6lb. I am also small so this was a fine weight.

Listen to your doctors, they'll advise you.

@Vicky1989x

I had high PI from 27 weeks - I had Doppler scans every 2 days and growth scans every 2 weeks. My baby was following the 5th% all the way through. I’m tiny myself so being small wasn’t a big concern, it was more the resistance that was causing concern - the plan was to induce at 37 weeks but by 34+5 the blood flow to babies brain was starting to be compromised and her growth dropped to the 3rd% so I had steroid injections and was induced at 35+5. Baby was born at 36 weeks weighing 3lb 9oz. It was diagnosed as IUGR as my placenta wasn’t working as it should be (probably due to my health problems).

It may or may not be related to the bleeding but push for regular Doppler scans to be safe. If babies growth starts to slow they’ll most likely induce you early!

Would Friday as planned be okay for the next scan? Or would this be too late? I'm starting to worry now as if baby isn't getting enough nutrients etc surely this could go downhill very quickly

@3ormorecharacters

I had issues with blood flow through the cord. I read up all about it at the time and kind of understood it but have forgotten it all 6 months later! From what I remember, the PI figure is a ratio of two other measurements. They start to worry when it goes below 1, which it did for me and combined with apparent slowed growth meant I was induced at 36+3.

I think they always look at these measurements in the context of the bigger picture, as they're not always accurate. I remember one doctor / sonographer explaining that high resistance could be associated with "head sparing" (i.e. blood being directed to the head over the rest of the body) so they would look for the head being disproportionately large compared to the abdomen / femur as another indicator of a possible compromised placenta. You're probably best asking a professional though - I called my community midwife who put me in touch with the lead sonographer, who answered all my questions and explained things really clearly.

Her head is measuring >95% whilst her legs at the 10th% so would that count as abnormally large? It seems as though within the 2 week space between scans her head and abdomen have shot up rapidly but femur is only slowly growing. But it is still growing. (Moved from 6th to 10th centile)

@EmmyJ21 your doctors would be best placed to advise. If they're not panicking then there's probably no need to panic. It might be worth chasing them tomorrow though and asking some questions. The squeaky wheel gets the grease etc. My baby was born absolutely fine - I wonder whether she actually needed to be induced early, especially given how inaccurate some of these measurements can be. Better safe than sorry though.

I had this with DS. Was in hospital 2 weeks from 28-30 weeks due to reduced movements. Finally had a growth scan at 30 weeks and there was poor brain activity due to cord flow, placenta insufficiency etc. He was officially diagnosed with IUGR once born at 30+4 weighing 2 pound 1 ounce. He's now a very small but active and smart 2 year old.

I was fobbed off quite repeatedly but once I was referred for extra scans and monitoring, the ball was rolling. They know what they're doing, they have yours and babies best interests at heart. If you're concerned, I'd tell them as such and push for extra monitoring etc if that's the case.

I had something similar. At my 34 week midwife appointment, my fundal height hadn’t changed since last time so she referred me for a growth scan. Baby’s growth was fine but I had a high Doppler reading too. I think the average high was 1.4. I then had to have twice weekly scans to monitor the flow and I was booked for growth scans. It was still high at first before it started to go down to a normal level. Subsequent growth scans were all normal. At my last one at 39 weeks the consultant recommended an induction on my due date as a precaution. I took this and she was born weighing a healthy 7lb9oz

What does high PI mean I had growth scan today and I have high pi is it something to worry about. Something about the blood flow from my placenta to umbilical cord is high

Mine was showing resistance, but they checked a blood vessel in babys brain which showed it was ok. At 37 weeks it was showing 96% resistance...baby was born at 39+1 (I was induced at 39 weeks, due to baby measuring small).

What does high PI mean? Is there anything I can do as it’s really worrying me

It measures how resistant the placenta is to blood flowing into it. High resistance = low blood perfusion (how much blood the placenta gets). It can be a cause for reduced growth, sometimes sure to preeclampsia or the placenta struggling for dinner reason. I hope this helps - I asked about my low pi yesterday and was told this information but in my case a low pi is less of a concern than a high pi.

Sorry about the typos!

Hi @Dipsydoodlenoodle
Can I ask was it a different type of scan to check the baby's brain vessels? Or is it the normal doppler scan?

I had high PI readings on week 28 scan and baby has dropped to 3rd centile now so super worried.

@Angeldelight21

Hi *@Dipsydoodlenoodle* Can I ask was it a different type of scan to check the baby's brain vessels? Or is it the normal doppler scan?

I had high PI readings on week 28 scan and baby has dropped to 3rd centile now so super worried.

Sorry for the delay on replying. It was just a normal dipper that they did at the growth scans.

My baby was born 6lb 7oz and I think she was around the 5th centile (based on my height and weight).