Asymmetric IUGR?

I am currently 28w 2d and just learned that our LO has asymmetric IUGR. Her head, limbs and weight are measuring on time, but her abdomen was a measuring at 26 weeks. She is 2lbs 3oz. Peri thinks I'll make it to 36 weeks but not certain and I'm being watched very closely. I'm so worried about the implications of this diagnosis. Anyone been in the same situation? Will she continue to gain weight? What is the prognosis if I had to deliver now or soon? Any advice is really appreciated.

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Hi there, IUGR is a tricky thing. In general, if you are going to be near a level III NICU then 28 weeks is probably the borderline for reasonable survival rates. (Although there are some parents on here with babies born before 28 weeks.) As long as her head is measuring on time that is probably pretty good.

However, there are some IUGR treatments that have been tried for mothers here: both viagra and oxygen for the mother. If you search "IUGR viagra" in the search box you may find what people have said about it.

Having lived with extreme IUGR, I would press the doctor for more information on treatments before delivery.

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Unfortunately, IUGR has too many variables for anyone be able to answer your questions with any certainty. As long as your daughter's head stays appropriate size for her gestation, chances are good that she'll not have long term impacts from the IUGR. In some cases, growth does slow, and nutrients to even the brain get decreased. That ups the chances of long term problems.

Your daughter may continue to grow at the same rate, she may increase the rate, or she may slow it. Again, there is no way to predict with any degree of certainty.

If you had to deliver now, or soon, chances are that your daughter would do well in the NICU. IUGR babies tend to act their gestation, not their size. For a 28-29 weeker, you'd probably be looking at 2-3 months in the NICU. Prospects for the long term would be good at this gestation.

Like Florinsmom said, there are things to try that help some women. Drink lots of water and eat lots of protein. Rest on your left side. Some people say bedrest does not work, but my own DD gained slightly more during the 2 weeks I was on bedrest than she did the 2 weeks prior to bedrest. Some people will also say that ultrasound weights can be off, but in our case they were spot on. If the measurement we took the morning DD was born was correct, then why would the earlier ones (of which there were many) not have been correct as well? That is why I feel as though the bedrest helped (albeit only slightly). I knew the weight at ~25 weeks, I knew the amount she gained at ~27 weeks and I knew what she gained another 2 weeks after that. I don't want to give the wrong impression - the gain was only a couple of ounces, but with IUGR, you celebrate every ounce. Even if the doctors don't put you on bedrest, rest when you can.

My daughter also had IUGR. She was born at 29 .5 weeks, and weighed 1 lb 14 oz. She spent 65 days in the NICU. She was very slow to gain weight until she was 4, when she finally caught up with other kids her age. She is 10 now, and in 4th grade. She did not escape unscathed, but she is doing well. She makes fine grades in school and already knows of our expectation that she'll go to college.

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Sorry that you're having to go through this. You are really not alone on this site, though. There are lots of well informed and supportive IUGR moms here who have been through what you're going through. You'll find a range of stories from very tiny and early IUGR babies to relatively late IUGR preemies. Please ask any questions you have.

My LO was suspected IUGR at 16 weeks, confirmed at 18 weeks. The IUGR was due to an insufficient placenta. We made it to 36 weeks. My son wasn't in distress before the decision to deliver was taken; I was also fine. Delivery at 36 weeks was precautionary (because the risk of stillbirth increases after 36 weeks and the odds are much better outside than in the womb), plus he had moreorless stopped growing by then. My son was 4lb, which I now know is quite big for an IUGR baby, but obviously still very small relative to a normal sized newborn. He spent time in the Special Care Unit, not the NICU. He had no issues with breathing. He had difficulty establishing feeding, but I don't think that this was related to the IUGR. He's a lovely, lively, happy almost 2 year old now.

What should happen in terms of your care is that your doctor should arrange for you to be monitored regularly. Obviously, my issues were discovered very early on, so I was monitored every couple of weeks from 16 weeks to 28 weeks. This involved having ultrasound scans to check on the baby's growth. From 28 weeks, the doctor stepped up the monitoring. I had to go for twice weekly checks. On one occasion in the week I would see the doctor. She would do a growth scan, doppler study (monitoring the blood flow to the baby) and measure the amniotic fluid (IUGR pregnancies tend towards low levels of amniotic fluid - called oligohydramnios - so she was checking for this). On the other occasion, I would see a sonographer who would do another doppler study and fluid measurement (they said they don't measure growth more often than once a week because there is too much room for error). On both occasions, I would also sit hooked up to a baby heart monitor so that they could check on my son's heart rate.

At 30 weeks, the doctor arranged for me to have steroid shots, the purpose of which is to boost the baby's lungs if they have to be born earlier than 34 weeks (when the lungs are supposed to be mature enough to do OK outside the womb). The following week, I was having my sonographer check-up when she noticed that the amniotic fluid was much lower than before - it had dropped by half in just a few days. I saw the doctor a couple of days later, and she immediately admitted me to hospital as she feared this may be a sign that the placenta was starting to fail. I spent just over a week in hospital where I was hooked up to the heart monitor twice daily and had ultrasounds twice a week. During that week of doing nothing, the fluid level increased again. On that basis and the fact that everything else was fine, I was allowed home, but from then on, I had to go to the hospital every day to have the heart monitoring carried out, and they continued to scan me twice a week as before. I was also told to have complete rest.

At 35 weeks, the doctor admitted me to hospital again. This time not because anything was wrong, but because it's standard practice to deliver IUGR babies at around 36 weeks, if there are no earlier indications, due to the risks of stillbirth in late pregnancy when the failing placenta might no longer service the baby's need to grow and lay down fat.

IUGR tends to present as you have described at the stage of pregnancy you are at - the head and limbs are OK, and the abdomen measures small first. Eventually, as the pregnancy goes on, the thigh bone can also start to measure small - this is what happened with my son.

The doctors consider lots of factors before deciding to deliver. The big decider is the blood flow to the baby. As long as this is still positive, the baby can get nutrients and continue to grow albeit more slowly than usual. If it becomes absent or reverses, this is an indicator that the baby needs to be delivered very soon. This is the reason that I had twice weekly checks on the flow so that any changes would be picked up quickly and action taken. They also consider factors such as gestational age/size and what this means for dealing well with being outside the womb, whether the baby's heart trace indicates that s/he is in any kind of distress, growth and amniotic fluid level (although this is only an indicator of possible issues - not a reason to deliver on its own).

There is not a lot that you can do to increase the baby's growth. However, there are some steps you can take to help the situation. Resting seems to be the most important thing - and doing so on your left side - which is supposed to increase blood flow to the baby. Drinking plenty of water is thought to help with amniotic fluid level (and if it doesn't, it won't do any harm to try it). Some people have been told to eat lots of protein to give the baby as much help as possible to grow (again, I don't know if it works, but it's worth a try). Others have mentioned medications which thin the blood - I guess this then makes it easier for it to cross from the placenta to the baby - this wasn't recommended to me, but would be worth asking about.

There are lots of stories on this site with positive outcomes at the gestation and size your LO is at. I'm sure people will answer your post and tell you about theirs.

Take care of yourself.

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Oh, in that great long post, I forgot to say:

There is a Yahoo! support group for IUGR. The ladies on that group are also very helpful.

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I am so sorry you have to deal with this!
I am 32 wks today, with our first child, and have been dealing with IUGR & bloodflow issues from 23 weeks. Our little girl was measuring behind (head 19th%, belly 8th%) at 23 weeks and we also had absent-ended diastolic flow, meaning the blood flow between her heart & the placenta was beginning to lag, if it progressed it would actually reverse back into her heart. I asked my peri if there was anything I could do to help her, and he said nothing is proven but I was put on complete home bedrest and told to take in as many calories/fluids as possible (calories for growth, so that even if she was only getting say 80% of the blood she should, it would at least be high calorie blood, and fluids because maintaining adequate amniotic fluid levels is crucial for her growth), and told to come back at 27 weeks because at that point they'd consider her viable and we could discuss delivering her if necessary.
It was a horrible time waiting & not knowing how she was doing, but at 27 weeks she had shown good interval growth, caught up to the 24th% (head, and 11th% belly), and her blood flow was no longer an issue! I am a firm believer in bedrest (dr said the goal is to keep the blood pooled in the uterus so reclining with feet up was actually better than lying down, since sitting forces the blood to where she needs it) and eating/drinking as MUCH as you can. I also had regular scans to check size, dopplers to check bloodflow, and biophysicals to check her status. She is doing SO much better than we could ever have imagined from our 23 wk appt!
Right now I am scheduled for a c-section at 33wk5days, due to my vasa previa (blood vessels covering the cervix, most likely related to her bloodflow problems), and the peri says that if she maintains her percentile (which she has been doing, give or take 2%) she will be over 4 lbs!! That is a miracle, since when we first discovered the problem she weighed only 445 grams. So be encouraged and do all that you can to help-- even if it doesn't make a BIG difference, it won't hurt and it will make you feel confident that you've done everything you possibly could to help your LO grow!
Take heart, because of where you are already, your LO has great chances of survival and great long term health even if you needed to deliver asap. Every day helps at this point, so celebrate that! I wrote on our bathroom mirror what day & week we were, and each morning adding one more day to the checklist felt so good! I would also ask to meet with a neonatalogist to ask what you can expect if your LO is born at different GAs. That really helped me, and for us passing 28 weeks was huge! It's at that point that the long term health rates really go up (at our Level III NICU).
Hang in there, and keep us posted! Feel free to message me if you'd like. Only 2 more weeks and we get to meet our tiny little miracle girl!

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Thanks so much to everyone for your good information, advice and kind words. Your personal experience gives me hope that this does not have to be such a dire situation. So far, I know my amniotic fluid and flows are ok. My Perinatologist said the blood flow to the placenta was "acceptable" which was not the word I was hoping for, but all other tests were fine. He did not give me percentages, and I did not think to ask since I didn't know anything about IUGR, but I now know what to ask at my next appt. My Peri also said he didn't want to put me on bed rest at this point, but I work from home so I have imposed my own bed rest schedule. I've also upped my protein, calories, and water intake significantly. Based on your stories, I know this can't hurt and will possible help. @Juliabrianne, your story is the first I've heard about things improving versus staying the same or getting worse. So good to hear this is possible.

For those of you who saw shortening of the limbs, did the limbs catch up (after delivery) or does your LO still have shorter limbs or asymmetrical limbs? I believe one my LO's limbs was borderline small. Also, how do they measure absent ended diastolic flow? My Peri showed me one test on the sono, which he said was somewhat like a blood pressure for the baby (or maybe umbilical cord), and it was fine. He told me once this dropped below a certain line, they would start to worry more. I'm wondering if that was it.

Again, thanks so much for your stories and support. I'm so glad to hear most of your LO's are doing so well. I needed that hope!

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re limb size - unfortunately I can not remember whether DD's limbs were considered to be shortened by the IUGR or not. I do know that, at 10, she has long legs and arms now. I buy her size 12 pants, and that is for the length, not the waist. In some of the pants, she still needs a "slim", depending on the manufacturer. DD was considered by some doctors in the NICU to be asymmetric IUGR, but considered symmetric by others. So she was somewhere in between. Now, she is as tall as most of her classmates, and taller than some. She has a slender build, but only looks skinny next to the chubby kids (of which there are a bunch).

It has been a long time, so I don't remember all the tests, but it looks to me as if your peri checked the umbilical flow. That is the test that shows what we were all referring to, which in our own case showed absent end diastolic flow for several weeks, until reverse flow occurred at 29.5 weeks. Often you can continue the pregnancy with absent end diastolic flow. WIth reverse diastolic flow, that is not the case. Take it easy and remember that, if the worst case scenario happens and you have to deliver soon, your daughter is far enough along that she should be OK. Good luck and keep us posted!

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