Ultrasound: Fetal Growth Concerns

During an ultrasound at 30 weeks, my doctor took extra measurements of my baby's kidneys. She said the baby's abdomen measured small (27 weeks) and it could be due to lack of nutrients. My doctor avoided the question and just scheduled me for another ultrasound in a month. What should I do?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

I must admit to feeling at a loss and a bit perturbed that someone would provide you with so little information, worry you and then leave you to wait it out.

If your care providers were concerned that your uterine size was a bit small for your gestation, they would order an ultrasound. Ratios between the fetal head and fetal abdominal circumference and fetal femur and even fetal feet are all considered, to come up with an idea of fetal age. It is most helpful in detecting fetal growth restriction if the measurements can be done in series, comparing one to the other.

There are types of growth problems that the baby can demonstrate. One is asymmetric growth restriction when the baby's head size seems appropriate for dates but the abdominal circumference or femur length seems to indicate a smaller baby. This would be more related perhaps to a problem with nutrition of the mother in late pregnancy, or an infection in the second half of the pregnancy. Babies who are born a bit smaller than normal usually catch up after birth. It would be best if you could get a bit more rest, lying on your side for a few hours every day to improve uterine blood flow.

Make sure you are getting an excellent diet. If you smoke, drink alcoholic beverages, take recreational drugs or work in a high-tension, strenuous job, you should quit these activities. Improvements in work schedules, diet and rest can help the baby catch up while still in utero. If the deficiency is quite severe, sometimes these babies do better on the outside, and must be delivered early. Of course, rarely, growth problems can be caused by some fetal defect. A discrepancy of three weeks is significant but not alarming; although I would not wait four weeks for a reevaluation.

I would request that a level two ultrasound be done as soon as possible in a setting where there is a perinatolgist to interpret the findings. You could request that a non-stress test or a biophysical profile be done, which would give you more information on the baby's status. Amniotic fluid volume, fetal tone, fetal movements and heart rate are parameters which would be discovered with such testing.

I think you need a second opinion, and I would make some effort to secure this. I hope all goes well and this finding turns out to be of no significance.

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