From a High to a Low: Fetal growth restriction

My obstetric appointment didn’t go quite as exactly as hoped for.  The doctor measured the fundal height and asked me if I had an ultrasound yet, I said no.  So she said well you are going to have one today, you are measuring a small.  Since I entered the third trimester I have had comments about my small bump, but the doctors say that because I am tall and have a long torso Rocky has more room upwards which is why I don’t go outwards.  But then there is my weight issue, I have only put on 1lb in the past 8 weeks.

The doctor did a pelvic exam and Rocky’s head is very low down (yeh my poor bladder knows this well!), she had troubles getting to my cervix – ouchie that hurt a lot!  I am 1cm dilated (how much the cervix is open, from 0-10cm) and 50% effaced (how much the cervix is thinned and shortened that means the cervix can dilate more ready for labour, from 0-100%.).  Well that doesn’t mean much at 36 weeks and is perfectly fine.

I had more blood drawn and we headed in for our ultrasound.  Really at this point in the pregnancy it is very difficult to tell body part from body part.  These technicians are very skilled!  She pointed out a head of hair….really it looked like white mess and I couldn’t tell there was even a head!  As she measured Rocky’s tummy, the size was measuring 29 weeks and 30 weeks…she took the measurement several times, and everytime is showed between 29-30 weeks, way behind.  But when she measured her thigh bone it measured spot on 36 weeks.  Rocky’s head is way down in my pelvis so she had a hard time getting a measurement, but when she did it measured 36 weeks.  With all these measurements, this meant that Rocky is weighing in at 4lbs 10oz – just under the 5th percentile for 36 weeks. Anything less than the 10th percentile is considered as growth restricted.  Her tummy size is in the less than 1 percentile. That is scary.  The technician confirmed that yes she was weighing in small, so went to give the results to the doctor.

We were then sent to have non-stress test.  I had heard about these, where you wear two monitors, one that measures contraction strength, the other the baby’s heartbeat.  You sit in a chair, relax and press a buzzer every time you feel the baby move.  This monitoring goes on for at least 20 minutes depending on how active the baby is, assessing baby’s reactivity and changes in heartbeat.  Rocky performed well!

After the non-stress test the doctor came back and explained her thinking.  Rocky has asymmetrical intrauterine growth restriction (IUGR).  Asymmetrical means that her head and length is normal, but not the stomach.  In more than 70% of cases, this indicates a likely problem with the flow to and from the placenta and baby not getting enough oxygen or nutrients.  Rocky diverts the energy for growing the brain and bones, meaning that the liver and fat build up doesn’t happen, which is why her tummy is so skinny. This form of intrauterine growth restriction usually occurs in the third trimester. (The other form of growth restriction is symmetric where the baby is small all over).  There are other causes of this type of restriction, but most of those we can rule out.  So we need to rule out the placenta problem and I have to go to Maternal Fetal Medicine specialist to have a special ultrasound to look at the flow to and from the placenta using a doppler.  The catch is I have to wait for an appointment.  The doctor said that I will be induced in either week 38 or 39 because the baby will do better outside my body.  But if I have placenta problems she will want to induce me ASAP.

I am now on twice weekly appointments including a non stress test twice a week and an ultrasound to keep an eye on Rocky…particularly as the amniotic fluid might reduce over the coming weeks they want to monitor that and ensure that Rocky isn’t struggling getting the oxygen she needs.

I am also on ‘rest’ not bed rest exactly, but just resting and preserving all energy for Rocky.  So I would have been signed off work if I wasn’t on maternity leave already.

There is no medical intervention that will stop this from happening, all that can be done is that we are both monitored closely and assess the right time to deliver Rocky.

What does this all mean for my labour, delivery and Rocky’s health?  We don’t know.  We know that there is an increased risk of her having problems during labour, I am more likely to need a cesarean section, there is an increased risk of still birth and perinatal mortality, she is also likely to have a number of health problems after being born in both the short and long term, or she may just be perfectly fine…but life is like a box of chocolates and you don’t know what you are going to get.

I have to remember and keep telling myself that there is nothing I did to cause this and that Rocky needs us to be strong and positive to help her make it into this world safely.

Now I just wait for my appointment with the specialist.  Until we know the placenta issue, we are helpless and not knowing is quite frankly scary 😦

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