IUGR

I need more info about small for gestational size babies or IUGR. I have a doula client 36 w 4 day who measured 35 weeks the past two visits, in the same week. Her physician wants to do an ultrasound to determine baby's size and if it is growing properly. My gut tells me that this is a set up and the beginnings of the slippery slope to induction. I've seen many studies on macrosomia but what about suspected IUGR? What studies can she look at to know if there is true need to be concerned?

Thanks!

Sara

This isn't an issue that I have researched, so I don't have any studies to recommend. For an overview, though, here is a link to the National Library of Medicine's consumer information material on IUGR, which might be useful, and here is a link to informed decision making on Childbirth Connection's website, which can help your client in making decisions about her care.

-- Henci

hello!

from my birth expirience, it really matters who the doctor is and what goes on in the room,in terms of  general panic. my pregnancies have been IUGR, and each with a different doctor and approach.

my first, also ,discovered at week 35,on a standard checkup (1500 gr.)- which lead to general panic , and a c-section that day.needless to discribe the shock and the 3 weeks of preemee incubators etc.

this pregnancy, I have been checkuped alot- and my new doctor is all  for letting the baby grow as much as possible, as long as we see growth. even though I've been called to the delivery room a few times- she sent me home  inorder to give the baby more growth space.

Really, we can never know what would have been if I would have waited with the first,but I am sure that it also has to do with the doctors involved.

good luck!

Thank you for this input from the trenches. The problem with conventional obstetric management is that it only considers the benefits of intervening, rarely the harms. If there are no apparent medical complications in you or your baby or signs the baby isn't doing well (other than being small), which, after all, is the better option: delivering a premature undersized baby or a mature one? I think this ob is taking a much more rational approach.

I hope this ob is also open to vaginal birth after cesarean (VBAC), which will spare you, this baby, and any future babies the potential harms of accumulating cesarean surgeries. Write back if you are wanting more information on planning a VBAC.

Please let us know how everything goes this time and how big this baby is when it is born.

-- Henci

This is an old thread I realize, but I just wanted to add that measuring 35 weeks at 36 is not an indication for IUGR at all. Being 1-3 cm off is usually no reason for concern when there are no other worrying signs. Set up indeed. Just wow.

Thanks for the input. I do want to be careful, though, to distinguish between information and opinion on this Forum. Do you have a source for this?

-- Henci 

Here is a link to a study that shows how hard it it the find the exact same measurement even by the same practitioner

http://www.pubmedcentral.nih.gov/pa...ageindex=2

Normal variation of fundal height

http://www.mayoclinic.com/health/fundal-height/AN01628

Also interesting:

http://www.journals.elsevierhealth....7/abstract

Fundal height not always compatible with dates

http://parenting.ivillage.com/pregn...qg,00.html

http://www.fetal.com/IUGR/diagnosed.html

Personally, I would not even worry with a 3 cm difference at any given point in the pregnancy, unless the weight gain and growth remain low in consecutive visits.

http://emedicine.medscape.com/article/261226-overview

Screening for IUGR in the general population relies on symphysis–fundal height measurements. This is a routine portion of prenatal care from 20 weeks' until term. Although recent studies have questioned the accuracy of fundal height measurements, particularly in obese patients, a discrepancy of greater than 3 cm between observed and expected measurements may prompt a growth evaluation using ultrasound (Jelks et al).^{[script removed]9} The clinician should be aware that the sensitivity of fundal height measurement is limited, and he or she should maintain a heightened awareness for potential growth-restricted fetuses. In an unselected hospital population, only 26% of fetuses that were SGA were suggested to be SGA based on clinical examination findings.

One study using fundal height curves that customized for maternal weight, height, and ethnicity was able to increase the detection rate from 29.2% in the control group to 47.9% in the study population. As Yoshida et al indicated, these inaccuracies occur (1) because of the limited accuracy of predicting birth weight within 10% using ultrasonography in the third trimester, (2) because not all fetuses that are SGA have IUGR, (3) because individual and unpredictable changes in growth potential occur, and (4) because growth distribution is a continuum.^{[script removed]10}

To follow up on that, if a scan is performed with a 2 cm discrepancy in fundal height:

http://www.aims.org.uk/Journal/Vol10No3/resaut98.htm#2

So then, if IUGR is expected with a 1cm discrepancy, and a scan is performed and a management protocol is based on consecutive US, it seems to me that the possibility of this setting a woman up for a c-section early in pregnancy ishigh.

Just some information I gathered. I haven't needed to substantiate this in a long time as it seems to be a commonly accepted pratice to not worry about a 2-3 cm difference between gestational age and pubi-fundus measurement. 3 cm is really not that much and can be influenced by a lot of variables.

That said, I was always totally spot on. With all 4 babies!!! However, I know many women who have never been consistent. but seriously, 1cm difference? That reaks of over management.

[script removed]