Midwife not referring me for growth scan

[Haggardly]

I requested a referral for a c section 3 weeks ago, and had my first appointment with the hospital last week. They sent me away 'to think about it' and booked to see me again at 36 weeks.

I'm currently 34 weeks. Had my 34 week appointment with midwife yesterday. Fundal height measurement is attached and as you can see is......pretty concerning. She didn't refer me for a growth scan, saying they'll 'likely' do one at 36 weeks.

Is this normal??

I don't know if I should complain or not.

TIA for any experiences/views.

Why do you want a growth scan? It's your right to request a section, what do you hope to gain from a weight estimate?
Fundal height is so innacurate anyway, many trusts don't even measure it anymore. Scans also very innacurate, particularly late gestation and terrible for falsely predicting big babies.

I know that must feel very scsry to you, but it’s really common for fundal measurements to shoot up, and yours has happened so late that it’s pretty expected. Mine did it from 22 weeks 😆

Itd be commonplace to get a growth scan around 36 weeks incase it affects any labour plans - such as baby being big enough that shoulder issues become possible - but fundal measurement is horrifically inaccurate and so you are not usually referred for it unless you’ve got other risk factors too. If you’ve already opted for a section, you won’t really need that scan either, as you’re not planning to try a vaginal labour and the babies size doesn’t matter for a section.

You could get a private scan, if you’re concerned?

It isn't such a concern for a growth scan and weight estimate if baby is measuring big, when you are opting for an elective c section. There are sometimes factors that make bump measure bigger like gestational diabetes, but if you've had a negative GTT or are low risk and with no glucose in urine it is highly unlikely this is a cause.

If you are worried about polyhydramnios (excess amniotic fluid) then you could ask the consultant at your appointment what they think regarding whether a growth scan is appropriate.

Sorry what I meant to say was even if your baby is genuinely big and predicted as such by the scan, the recommendation would be induction or section anyway. If you aleady plan a section then I don't see what difference a weight estimate is going to make.

At this stage it is most likely positional causing an inaccurate measurement, that's a completely ridiculous measurement so don't fret. But do ring your antenatal unit and tell them what you want. You are in charge of your medical care, you just have to be firm with them.

I don’t really understand what outcome you are want?
Fund measurements are so vague and not hugely representative of baby size in the first place, and even if baby has had a period of more intense growth … so what?
At 34 weeks it’s getting a but late to test and treat for gestational diabetes and you’ve requested a c section anyway so you aren’t worried about pushing out a too big baby so a slightly raised fundal measurement isn’t a big deal.

Totally normal not to have a mode of delivery appointment until 36 weeks.

As for fundal height measurement, I echo previous post, very unreliable. Plus even with a growth scan referral, there may be a wait that means you wouldn’t get a scan in your 34th week anyway.

Also for context, I had a fundal height measurement off the chart at 32 weeks, went for a scan, everything was absolutely fine and he was recalculated back onto his 90th centile line where he has remained (now 36 weeks)

if you're requesting a c section anyway, it doesn't matter? That's why she hasn't referred you. both fundal measurement and growth scans are notoriously inaccurate anyway. I'd only think you'd need a growth scan if you were planning a vaginal birth, and wanted to consider if that was still the best plan.

All urine tests have been normal throughout pregnancy - I assume they test for GD when they test urine?

Midwife examined bump and said baby feels long. Head is down in pelvis. She said they might give a scan at 36 weeks. I'm just asking, if they 'might' give a scan surely that's part of normal care? If you're all saying it isn't part of normal care that's fine, I'm just checking because my care hasn't been very good up to now.

I’m surprised at the replies you’ve had. With such a huge jump I’d want a scan to make sure everything is okay, you haven’t got excess fluid etc? Scans are so quick and harmless and in other countries like the US they do them frequently through pregnancy.

This is from the nice guidelines for antenatal care;

If there are concerns that the symphysis fundal height is large for gestational age, consider an ultrasound scan for fetal growth and wellbeing.

so yes I’d expect a growth scan, to check well-being and if nothing else put everyone’s mind at ease. Are the babies movements okay?

Many trusts don’t do a scan based on one measurement alone and wait until the next on to see if it was an error or a pattern:

@Haggardly if you have GD it can show up in your urine but I don't think it's guaranteed, I've been tested for it twice and I had to go in for a specific test (you go in and they take fasting bloods and then you drink a sugary drink and they take your bloods again after two hours).

Even if you did get a growth scan i'd take it with a pinch of salt - they were way off with my first born!

My cousin just had a 10lb baby predicted all the way through as bang on average! Born 2 days after due date, no issues.

They’re not harmless, but they are low risk.

Theres no way to tell if you’ve excess fluid on a scan, or get an accurate baby measurement at this gestation. That’s why it’s not being offered.

The US have a lot of scans because more scans = more insurance charges…

you need to go in for a special test usually over 2 hours for GD - ketones and/or glucose may show up in your urine but it's not a given. I have gestational diabetes and glucose has never once shown in my urines, and ketones only once which my midwife said could have many explanations.

I'm also surprised by all the responses minimising your concern. Fundal height measurements are not an exact science but this isn't a slight discrepancy - it's a big leap and your arc is climbing way off the chart. If you have undiagnosed gestational diabetes it can cause your baby issues after birth, eg a big drop in their blood sugar, so even if you're having a c section it is worth knowing about. Would also be concerned about polyhydramnios.

Please do seek a second opinion. I don't think 'you might get a growth scan at 36 weeks' is good enough really. It might just be that the baby is long as the midwife says, but at the moment you have no peace of mind and that does matter too. You could try:

• your hospital's antenatal clinic
• its maternity assessment unit
• call the community midwife team and speak to a different midwife from your usual one
• see if your GP could refer you where midwife will not
• if all else fails, book a private scan

I don't know which if any of those will make a difference but it is worth a shot given how atypical that chart looks. There's a strong chance that everything will be fine, and I don't think you need to panic, but that doesn't mean you do nothing. Good luck!

Thanks I think I'll give MAU a call, I've been in a couple of times over the past few weeks (once for reduced movement and again for a checkup before they re-prescribed painkillers).

Fundal measurement is very unreliable in indicating an issue. As its just one measurement that is out, and no other issues (have urine samples picked anything up?) I wouldn't expect an referral for a scan yet. My experience is unless there are other factors, you wont get a referral for a scan unless there are two measurements out of place. (three pregnancies experience).
I'd maybe question it just in case but not worry about it. You say nothing else has been picked in up urine test and you have been in for reduced movements and other appointments, so lots of scope for things to be picked up if an issue.

My fundal measurements always measured the top of of my curves....but my babies came out less than 15 centiles so it really is accurate in my opinion. Even the scans predicted large babies

Get a private 3D ultra-detailed scan, for peace of mind.

Erm no don't do that! Most of these private scans are intended as experiences for the parents to enjoy looking at their baby not medical at all. Also they don't have your history, notes ect.

Polyhydraminos (excess fluid) is literally diagnosed through ultrasound 🤔

If growth maintains that trajectory/above 95th centile at 36 weeks they will refer you for a scan. Referrals made prior to that point for ? big baby will be rejected unless polyhydramnios is strongly suspected on palpation. That’s the guideline that I know and using the same system that you’ve sent a photo of, so quite possibly talking about the same Trust

In fact - regardless you’ll have a scan requested at 36 weeks as if that growth trajectory drops it will trigger one too

I was going to say the same thing. Ours is two unusual readings that trigger a growth scan, not one.