Fundal height: three weeks small for dates at 17 weeks, please, please advise

[Upwind]

I had an appointment with my midwife today. She basically said three weeks out for the fundal measurement was the limit of what they could allow for. But you only normally see such a big discrepancy at a later stage of pregnancy. My fundal height was measured at barely 14cm.

I had a scan at thirteen weeks which showed an active healthy baby. My midwife spent ages looking for a heartbeat today and eventually found one. In my area you only get one scan, which I have had, and anyway she was adamant that a scan would not help me. I tried to argue that it might either provide reassurance or confirmation of bad news but that was brushed aside. I was feeling so shocked and distressed that I did not argue much.

Instead, I have to go back next week so the fundal height can be measured again. And I was told to call the triage number if/when I experience pains like period pains or bleeding.

I have been frantically searching the internet for information about measuring so small at such an early stage, and have not found any. I was ttcing for a long time and am absolutely certain of my dates, which tie in perfectly with the scan.

Just to add - while I was there the midwife tried to call the hospital triage for advise, but could not get through.

I really, really think the fundal height measurement thing with a tapemeasure is an absolute crock of shit.

Really.

My DD was measuring small all hte way through my pg and she was 8lb 4, so hardly small!

Apparenlty I'm measuring 5 weeks too big this time but I'm takign no notice - they said it may be a growth spurt but if it coninues to be big, they'll scan me. Surprised yours won't scan again?

Could you ring you rMW and tell her how anxious you are? maybe enquire about cost of a private scan?

totally agree with mamaG. DS was measuring small for dates and they "predicted" he would be 4lbs at birth. he weighed in at 7lbs 6ozs. also the heartbeat can be difficult to find if your placenta is anterior (ie at the front of your womb)and the baby is behind it.

re the tape measure thing, the junior m/w at the health centre swears by its accuracy but the senior one who has looked after me through both pregnancies doesnt measure your bump and says that every baby is different and as long as you are getting movements (not sure you will be at 18wks) no bleeding, swelling or pain, baby is OK.

where abouts are you where you only get the dating scan? i'm in scotland and you only get one scan here but you can call the maternity day assessment units for advice and they will arrange a scan that day for you.

Thank you MamaG, I know it is not accurate - but my measurements are so far off. I know it is simply not a good sign

I wouldn't be so upset if it was measuring too big! How far off were your measurements first time around?

It was 9 years ago, I really can't remember sorry.

Do enquire about a private scan, I think some places only charge £40 which could really put your mind at rest

Fundal height measurements should only be used as a guide as they are so inaccurate.

My mw doesn't use a tape measure she just checks that at each appointment the fundas is where she would roughly expect it to be, ie at 20 weeks it should be around the height of your belly button etc etc

I think your MW handled the situation really badly tbh and has probably worried you for no reason.

fledtoScotland - I am in Edinburgh, will call the hospital now.

Thank you all for the reassurance! I am hoping there is nothing to worry about.

upwind - the maternity day assessment unit is only open til 4.30pm here in east kilbride (dont know about edinburgh) but the triage at wishaw is 24hrs and they will arrange a scan for the morning. i had to go in when i had a bleed at 24wks and was scanned the next day.

am sure you will be ok though - keep us posted.

Honestly, in my area they don't even start doing them until 24 weeks. Some areas don't do them at all. Baby is far too mobile and small for it to be accurate.

I was induced because fundal height was behind and scan showed baby

I just called the hospital who said I could come in this evening to be seen if I like but they could not offer a scan. I will do that, at least a second opinion from someone else would be reassuring.

go and get reassured.

Yes, do go, it will put yopur mind at rest

(fwiw they didnt measure me until 24 weeks either)

my (very experienced) MW has never taken a tape to my belly. she said she knows where the top of the uterus is meant to be in relation to everything else and that a tape is just a guide really. I would've thought that 17 weeks is too early to gauge as well.

I hope you can get some reassurance from the hopital tonight

Completely agree with 17 weeks being too early to measure properly. Round my way they don't measure fundal height until 26 weeks. Hope all goes well for you.

I really wouldn't worry. At 40 weeks, they measured me and said that I was >90th percentile and put "big baby!" on risk factors on my notes. 6 days later my baby was born at 7lb 13oz

Update: I went to the hospital yesterday evening, and had a long wait as they were very busy. I saw a midwife and registrar there, who both confirmed that the fundus is smaller than usual but probably nothing to worry about . They were able to discuss reasons for this besides the grim ones - my small frame, first baby etc and were generally reassuring. My own midwife had not even hinted that these things could cause a smaller fundal measurement. If it is still a few cm less than usual in a few weeks' time, I will be referred for a growth scan.

So, the panic is over, and I am grateful to Mumsnet and the hospital. But I never want to see my assigned midwife again. I think she was scaremongering in the most pointless way - there is nothing I can do about this, and she was refusing to consider a scan. I don't respect her judgement now, to my mind, such measurements should only be taken if an unusual result will be acted on in some practical way. Going back a week later so she could repeatedly prod me again would only reveal either little change or some small growth. It would have added to my distress and anxiety over this - hardly a good thing in pregnancy!

In case anyone in a similar situation finds this thread in the future - there is a summary of possible implications available here:

...It's also common for pregnant women to have a fundal height that is a few centimeters smaller than expected. This could be due to:

A very slim frame or well-conditioned abdominal muscles
Tall stature with a straight back, so the uterus doesn't protrude forward as much as in average-height women
A smaller, but perfectly healthy baby
Similarly, if you were measuring much smaller than expected for the number of weeks you've been pregnant, or if the measurement continues to increase at a slower rate than expected, your doctor may suspect:

There is too little amniotic fluid surrounding your baby (oligohydramnios), which may indicate a problem with the baby or the pregnancy.
Your baby is growing at a slower rate than expected, a condition called intrauterine growth restriction.
An ultrasound is often used to help your doctor determine the cause.

Upwind I'm glad you updated us, thank you - so pleased that you are reassured. Agree your MW sounds shite! My small-measuring DD (mentioned yesterday) was my first baby and I'm only 5' 3 - as I said she was 8lb 4 when born

upwind - glad all is ok. do you live near to the maternity day assessment unit? you can request that they take over your care so that a senior m/w takes over your care for the rest of the pregnancy.

Upwind I am glad that all is ok. But, honestly, it would be a gross overreaction to try and transfer your midwife care because your current midwife told you that you were measuring below the level she would expect, and that you were to come back the following week for a repeat measure.

Your midwife was being diligent and careful in monitoring your pregnancy, and it was your reaction to this which concerned you, not the facts she gave you. She was simply telling you that your fundal height was low, and she wanted to monitor you again next week. In addition, she gave you the information you needed on what to do in the event of any symptoms of miscarriage.

I would rate that as a midwife who cared enough to cover all her bases. If she hadn't, and you did have bleeding/pain, we would all be berating her for not giving you adequate support.

Please take a moment to step back and try to look at this from a different angle, and realise that although you were understandably anxious, your baby's health is paramount, and your midwife was simply trying to safeguard this.

Thanks again MamaG fledtoScotland, googling reveals no information about this maternity day assessment centre? If it was possible, I'd gladly switch

Lou - she never gave me any information on miscarriage symptoms at my booking in appointment. At this stage you would expect the risks to be reduced, and she gave me the information in the context of the fundal height issue, clearly suggesting that it put me at greater risk. Realistically, it probably does. But being given that news and no benign reasons for a low measurement, anybody would be distressed. Also, my midwife did not otherwise discuss the implications of the low fundal height or what it might mean. Simply making it clear that it was a major cause for concern and worth calling the triage number there and then for advice. When she could not get through she was adamant that anyway, "a scan would not help me".

That is plainly untrue, if nothing else, a scan would allow a more accurate estimation of the baby's growth and whether the low fundal size was due to a lack of amniotic fluid. It could provide reassurance or confirmation of a problem - though I was happy in the hospital to be told that a scan was not justified at this stage but would be in a few weeks if the measurement was still so much lower than expected. They did not try to fob me off, and they did explain why it might not be a problem. I left the midwife, persuaded that my baby was not growing. I left the hospital knowing that it is some cause for concern but hopefully does not mean anything. Had I not gone to the hospital I would have been left extremely anxious and upset. I don't see how that could have good for my baby's health.

which hospital are you going to? here in east kilbride there is the day assessment unit at hairmyres but also at larkhall health centre and wishaw general.

Well, upwind, only you can judge whether the midwife seemed to have your best interests at heart. I personally feel that it is a little unfair for you to accept willingly the hospital's decision that a scan was not warranted, but be upset that the midwife was telling you that a scan at this stage was not indicated.

I will leave this thread now, because frankly I haven't got the energy to argue the toss, and the main thing is that you got the reassurance you needed, and that your baby is ok. I wish you well in the rest of your pregnancy, and hope that you have a great birth.