20wks borderline small head and bilateral notches on doppler

[fairgame84]

Im trying not to panic. Everything else on the scan was normal but baby's head is bang on the line on the lowest centile. Not officially microcephaly yet but I'm worried. I work on nicu and worried that I've somehow contracted cmv or something else at some point and not realised. I had a nipt (iona) which came back low risk for trisomies and x linked abnormalities.

The doppler showed bilateral notches so they've started me on aspirin. I'm terrified now about iugr, placental failure, pre eclampsia etc.

The sonographer said I would be rescanned at 24 weeks but then consultant has said 28 wks instead. If the head drops below the centile at 28wks then I'll be referred to fetal medicine.
They plan to do twice weekly blood pressure monitoring from 32wks.

Im so upset. My last pregnancy was in 2004 and I had choleastasis so induced at 38wks. This is my 2nd and final pregnancy and it's been a nightmare from the start. We struggled to conceive then i had hyperemesis then a bad experience in antenatal clinic. I feel like it's all going wrong.

I don't know if I need reassurance or to be handed a grip because it could be worse. DH thinks I'm just panicking because of what I see at work. He's happy that the consultant isn't worried so we shouldn't be worried but that doesn't help.

Any advice would be appreciated.

I’m so sorry you’re going through this.

Obviously I can’t tell you everything will be ok but I can tell you my experience. At the 20 week scan and a subsequent follow up scan we were told that the baby seemed to have a serious brain abnormality. I was referred for an MRI which showed nothing of the sort, everything looked totally fine. However the MRI measurements were similar to yours and the baby seemed to have a very small head. Like you I was Googling frantically and wondering if I had picked up CMV.

Completely out of character for me but I really, really pushed to be seen by a fetal medicine consultant rather than wait for a review at 27/28 weeks which is what they wanted to do. She was great and explained it is so hard to get accurate measurements and a millimetre here or there can make a huge difference to the centile. She was also very honest about the fact that there is only so much they can tell from a scan and that errors can easily be made (which is how I ended up having an MRI in the first place). She also said a baby’s growth is not uniform and you might see the legs grow longer one day then the head get bigger the next or vice versa.

When I had a further scan the measurements were back in the middle range. And when DD was born her head circumference was actually larger than average.

I guess the main points I’m trying to make are:

a) make a nuisance of yourself. If the sonographer said you would get a further scan at 24 weeks, keep pushing to get one. As I said above this was so out of character for me but I just kept politely calling every day until someone agreed to see me.
b) scans are amazing things but they also cause all kinds of unnecessary worry.
c) like you, I had hyperemesis and a pregnancy full of worry due to these scans. But I honestly forgot it once DD born and as awful as it was, it was worth it.

Are you based near London? If so I can recommend a private fetal medicine clinic if that’s an option for you. I wouldn’t usually go for private healthcare but I wanted another scan for reassurance and I felt it was worth it.

There’s also a charity called ARC who I found were really good at providing advice on how the process works and who to speak to, although if you already work in a hospital you may know this.

Hope that helps a bit, there is every chance that it will all be fine but I know how worrying it is.

Thankyou so much for your message.

The clinic midwife said the reason for 28wks scan instead of 24 is because of accuracy and that growth isn't uniform like you say. The head was small on the 16wk nipt scan but not borderline like it is now. It has grown which is reassuring.
I will speak to my community midwife about moving it to 24wks because 8 weeks is a long time when you're worried. She's been amazing so far. It's down to her that I had the doppler yesterday because the dr I saw at my 12 scan said it was unnecessary and cancelled it but my midwife rebooked it.

Our nearest FMU is Leeds but there's also a private scan clinic there that does growth scans so i might just go private at 24 weeks.

I've just plotted my 16wk measurements on the chart and it doesn't seem as bad. She was only just above the lowest centile for her head then and she's dropped a bit on her abdomen as well so her growth is proportionate if you see what i mean.