Update on Baby Measuring Small

darkpixie08

Hello all, I just did a whole bunch of research on babies that are SGA or small for gestational age, in case anyone else runs into this problem.  

Basically OBs worry that if a baby is measuring SGA, that there may be a breakdown in the placenta, and thus baby is not getting the proper amount of nutrients/oxygen called IUGR, or intra-uterine growth restriction.   

After talking to multiple OBs, it seems that one ultrasound is very rarely enough to really determine if a baby is SGA, or if there is IUGR.  Basically they measure the top of the baby's head to help determine size, depending on the angle of the baby, this can actually appear smaller (think of looking straight down at a plate, if it's tilted you are going to have the impression that it is smaller).  

 Thus is you have an ultrasound, and baby is measuring SGA, it is definitely a good idea to have a follow-up ultrasound done.  This will give you a clearer picture.  It is unlikely that baby will be a in a bad position twice in a row (unless you have an inept ultrasound technician).  If after a couple days, baby has not gained any weight, they will then shift to a lower percentile, and you will know there is a real possible problem.  Other things to look for are increases in fundal height, and the cord doppler ratio.  During the ultrasound the technician can measure the bloodflow of the umbilical cord, almost like a blood pressure reading.   If the fundal height is increasing, the cord doppler ratio is within normal range, and baby seems to have gained some weight, it is more likely that they are just small, but perfectly healthy.  Obviously fetal heart rate is also important.

One should definitely keep in mind that if baby is not doing as well, that they will not tolerate contractions very well.  It may (depending on the situation) be better to get induced with pit or breaking your water, before baby has a chance to become weaker.  If baby is on the weaker side, then they won't tolerate the contractions very well, you'll have decels for fetal heart-rate and are more likely to end up with a c-section.  

 This was an area that I had absolutely no information on, and wasn't really prepared for, so hopefully this info will help other women make informed decisions should they ever come across this problem.  I'm going to go back for a follow-up ultrasound on Monday, and we'll make the call based on all the above factors.

On a sidenote, I also learned that if meconium is present in the sac of waters, it will actually break down, and cause a women to dilate faster.  Basically if baby is distress, your body has a natural way to speed up labor (though obviously there are medicines that are a little bit more effective/quicker should it be necessary).  I am always in awe of just how perfectly the human body is designed, that it protects baby in such a balanced way. 

triumphantreturnofplanningbug

I love that you're sharing what you've learned.

Having a single umbilical artery, we had to learn about IUGR quickly. Our MFM specialist also emphasized that multiple ultrasounds are necessary to determine whether you're actually dealing with IUGR, and said that one of the major things they look at is growth in proportion to past size. So if your first u/s measures slightly low, your second measures slightly high, and your third measures average, they're unlikely to suspect IUGR. If the first measures around the 60th percentile, the second in the low 50s, and the third in the mid-40s, however, there's probably something going on that they'll want to really closely watch and possibly induce to avoid further problems.

If you still want more info, you might look into the different types of IUGR--some sorts mark compensatory growth restriction, while others mark overall distress, and that's a big factor for my midwives group in determining whether to induce and how soon.

I'll keep my fingers crossed for good news and good health at your Monday appointment!

kathleen02

My friend had this happen to her. She was having a "normal" pregnancy until about 30 weeks or so...this was a couple years ago so some of the details are spotty. But she was monitored quite often at that point like you said, via u/s. Anyway she began having contractions at 35-36 weeks and the baby was not tolerating them well at all. She was in the hospital off an on for a week and finally they gave her a c-section because again, the baby's heart-rate dropped dangerously low during some contractions. He was in the nicu for a few days...maybe it was close to a week but they both were sent home shortly after that and he's doing fine. Her son is on the small side still, but both his parents are small in stature so that part may be heredity.

SherryBaby77

Great info. Thanks! Good luck to you.