iugr at 23 wks

I am 23+ wks and have been told my baby is 3 wks behind on dates, is very small and there is somethign wrong with the placenta. I've had all the chromosone tests, amnio and blood tests which were all clear. Docs dont know what is wrong with the placenta but baby is not growing. Baby is still kicking regularly though. Does anyone know if there is anything i can do to help my baby grow? i read something called submersion therapy on here, what is that? Thanks for your help.

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My DD was IUGR. It was first noticed at ~ 25 weeks. We did the same tests you did, and just like in your case, we had no definitive answers. All along, until DD was delivered at 29 1/2 weeks (weighing 1 lb 14 oz), she was active. I ended up on bedrest, with orders to drink lots of water and consume lots of protein. I took baby aspirin as well, but you should ask your dr about that before doing it. Good luck!

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I should have said that DD was diagnosed at ~25 weeks. I think the IUGR started before that. At the ~20 week ultrasound, I was told that, while still w/i normal parameters, DD's measurements were not what they should have been. The head sparing had probably already started by then.

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My dd's twin had severe early iugr - measured 3 weeks behind at 18 weeks. I read online about lying on your left side and increasing protein. I tried that for 3 weeks, but then the baby died - passed away at 21 weeks never growing past the size of a 15 week old fetus. I know it helps many people though and you are a lot closer to viability then I was.

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My last two kids were IUGR... both about 5wks behind. My DS was a 31wker, weighing 1lb, 10oz. We found out he was IUGR at 30wks. He had some GI and growth problems and also got pneumonia while in the nicu. He came home after 3mo. He's 2 1/2yrs old now and is doing well. He has a cows milk allergy which he will likely grow out of, reflux, and tubes in his ears due to repeated infections. He has also received all the typical therapies... PT, OT, feeding and developmental. He will likely age out of the program at 3yrs and I don't expect that he will qualify for any therapies after that pt. Although he is fine now, he has not had an easy 2 1/2yrs.

My DD was a 35wker, weighing 2lb, 10oz. She was followed closely from the very beginning. I went on bedrest at 28wks, took baby aspirin, ate lots of protein, took calcium and vit D, stayed on my left side... all the things mentioned in the previous posts. She spent 3wks in the nicu and has been home a week! She is doing great!

Do you know what the problem is with the placenta? Both my preemies had a single umbilical artery (the umbilical cord should have 2 arteries and one vein - my kids only had one artery). It is suspected that their placentas had to work harder as a result, and DD's placenta was considered large. DS's placenta abrupted during his delivery. I also had an amnio w/ DS and all the testing was fine. They felt no need to do amnio w/ DD since she looked fine on all the ultrasounds and also given DS's history of no abnormalities. BTW - if you are interested in learning more about both my preemies you can visit my blog: www.patnaud.blogspot.com.

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I don't know of the treatment that you mention. I was in a similar situation and was prescribed bedrest on my left side, from weeks 22-26.

Additionally, as we got to week 25, the doctors started doing umbilical dopplar ultrasounds to observe the flow in the cord. However, you must know that the conditions of this flow can be intermitant or change quickly and that those changes can result "reverse flow" and the baby dying.

In our case, we saw intermitant reversed flow at week 26 and the doctors said if we wanted her to have chance on the outside that we should deliver. My husband felt most strongly she should have that chance and we went ahead with it.

However, the ultrasound sizes may be off by about 10%. In our case, it was off by 25% in that she was 25% smaller than the ultrasound indicated. I am just mentioning this because technically your child could be 25% larger than they think. I certainly wish that is is so!

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This was Thurstons exact diagnosis. As a matter of fact, it was at 23 weeks that we were told something was wrong, and that my amniotic fluid was extremely low and that he was iugr. Well at 24 weeks they did an nst test and he was deceling and they told us it was only a matter of a week maybe that he was going to die inutero. Well he hung on, my placenta kicked back in and he made it to 27 weeks at 1 pound 4 ounces. During that 4 week period I was on strict bed rest, aspiring therapy and taking lovenox shots once a day. Not sure if that helped at all or not but hey, we squeezed four more weeks in. Thurston is still in the NICU after 7 very long and scary months, and his one main issue is his lungs. He was diagnosed with chronic lung disease. We are not sure what we are going to do yet but the doctors are trying different things right now and he may eventually need a tracheostomy. Anyway, if you want to read my blog, it is
Thurstonmossholder@blogspot.com
and you can start in February to see how my pregnancy progressed. Good luck to you it has been a very hard road, but I feel very lucky to have my son here with us now. He truly is a miracle!!!!!

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Thank you all for sharing. I am 33 weeks preggo with boy twins. At the 32 week sono - A is 4 lbs 6 oz and Baby B is 3 lbs. B is now diagnosed with IUGR. I didn't think that it would matter which side I slept on since babies are on both sides of my body!...And it hurts to lay on my left. (my hands go horribly numb as it is!! So I will up my rotein and drink more water (is that even possible? Hahaha).

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Just wanted to add another story - nothing that hasn't already been said really - but maybe it helps to hear another story and know how common IUGR is.

The PAPP-A blood test, which I opted to take at around 16 weeks, showed very low levels of PAPP-A (pregnancy-associated plasma protein A) in my blood, which would either have indicated an abnormality in the baby and/or that there was something wrong with the placenta. US scans did not indicate any abnormality (I opted not to do the amnio), but the placenta looked large and partially 'jelly-like'.

I was given US scans every couple of weeks from then on. The baby was always moving fine and everything looked OK, but he was small for dates.

Doppler scans were also performed. These measure the flow between the baby and the placenta via the cord - the higher the resistance in the cord, the harder it is for blood to get from the placenta to the baby and the fewer nutrients and oxygen the baby receives. As long as flow is still positive - in other words the baby is still getting nutrients - things are OK.

Around 29 weeks, I started to be monitored more frequently with twice weekly scans - always the Doppler study and once a week growth measurements.

At 30 weeks, I was given steroid shots in case the baby had to be born before 34 weeks. These help to boost the baby's lungs so that they have a better chance of breathing independently after birth.

Shortly after that at one of the routine monitoring visits, they found that the amniotic fluid had dropped dramatically. This is an indication that the placenta is more obviously starting not to service the baby's needs.

I was taken into hospital for over a week - the fluid level increased and I was allowed home again, but told not to do anything, and to go to the hospital every day for fetal heart monitoring and twice a week for scans.

I was actually never given any specific advice about what to do to prolong the pregnancy or help things apart from to rest. I suspect that nothing is actually properly proven to help, but I did read, as PP's have mentioned, that keeping fluids up can help with low amniotic fluid, so I drank masses of water. I also read that lying on the left increases blood flow to the baby.

At 35 weeks, I was taken back into hospital. Although there were no indications of problems, IUGR babies start to get into danger after 36 weeks' gestation. This is because at that point, babies usually start really 'eating' and laying down fat. IUGR babies can't do that, so they're better off out of the womb. By 36 weeks, organs should be developed and the baby should have a better chance of survival being born than not. So, at 35 weeks I went into hospital to prepare for c-section delivery at some point soon.

The baby was fine all the time - heart trace was excellent - good movements all the time - and I was fine - no high blood pressure, nothing wrong with me at all. At 36 weeks exactly, my son was delivered by c-section, weighing 4lb - exactly what the consultant had predicted.

Had a 3-week hospital stay - never needed oxygen or medication - but had trouble feeding. He had/has hypotonia (low muscle tone) which affected his ability to suck.

The placenta was tested after the birth. It was 'enflamed', but they didn't know why. My son has had every kind of test imaginable - for infections, genetic disorders, MRI scan - but as yet, they don't know why he was IUGR and why he has hypotonia.

Finding out that your baby is small for dates is very scary and stressful. I wish I had known about this site when I went through it. However, it's good that they have caught it early and will be able to monitor you carefully. As you can see from all the replies here, there are lots of us who have been in the same boat and have our adorable kids in spite of the difficulties.

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You'd think with that long post above, I'd have said everything! But I meant also to say that our obstetrician said that placentas sometimes just don't grow right for no apparent reason. She said that it's more common for the placenta not to grow right for a first pregnancy, and also for women at the extremes of the age range, very young and older mothers.

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Scampismum, your story sounds much like my last preemie. I too had bi-weekly BPPs and weekly dopplers as well as growth scans every 3 wks. Baby always looked good on the USs. Was placed on modified activity at 24wks and bedrest at 28wks. Received steroids at 33wks. My fluid dropped by more than half from my 34 to 35wk USs. I was sent to hospital for c-section and she was delivered at exactly 35wks. My placenta was also considered large. How old is DS now and how is he doing?

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Thanks so much for all your responses, it really helps to hear of other similar stories. My doc has pretty much said there is nothing they can do and to wait and see which is incredibly upsetting and frustrating. It looks like the baby just stopped growing so my only hope is that it may start again but nobody knows. He is only the weight of a 20wk baby now at 23 and half weeks so would have to double his weight at least to allow him to have any chance if born.

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GPHope,
Why does the dr think the baby has stopped growing? Did you have a previous growth scan? If this is the first growth scan, then I don't understand how they could say the baby has stopped growing. We knew that my DD would likely be IUGR, but I don't think we even did the first growth scan until after 20 wks. Are you seeing a high risk ob/perinatologist?

I know this is frustrating and upsetting... what's worse is that helpless feeling. I remember how helpless I felt knowing there was nothing I could do to change DD's growth. Bedrest did seem to help for me b/w 28 and 32 wks. She stayed with consistent growth between those weeks, even though she was already behind. Stay positive, rest, and try to do all the things that have been suggested here! I'm sending prayers your way!

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GPHope - I was wondering the same thing as Henrysmom about the number of scans and why the doctor is so certain that your son has stopped growing. How many scans of any sort have you had so far, and over what time frame? Unless the scans have been done for at least several weeks, how can the doctor tell growth has stopped and not simply slowed? With my IUGR daughter, I had the first ultrasound at ~20 weeks, like in most preganancies. When there were questions, I was scheduled again for 28 weeks. Of course by the time I actually reached 28 weeks, I had already been on hospital bedrest for a week and was receiving daily BPPs. I think the bedrest seemed to help a little, as DD gained slightly more on the two weeks I was on bedrest than the two weeks between being diagnosed and going on bedrest. The suggestions made to you may or may not help, but I do hope your doctors are not being as laid back as it seemed to me from your post.

BTW, keep in mind that weight is not always the the final arbiter of how an IUGR baby will do after birth. I have read that, because IUGR babies are stressed before birth, their bodies are sometimes stronger than would be expected for their birth weight. That was the case for DD. She was the size of a 25-26 weeker, despite being born at 29 1/2 weeks. However, she defintely had the NICU ride of a her actual gestational age, not the age that went with her weight. She *was* slower to do things than most 29-30 weekers, in that she took a while to "get" feeding and get off the O2, but we in no way had the ride that most 25-26 weekers seem to have.

Good luck and God bless!

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Henrysmom - hi! I hope all's well with you and your new addition.

DS is 15 months adjusted. He's doing well growthwise. The last time I had him weighed at the end of August, he was 23lb 12oz - about 50th percentile (he was below all the lines on the chart in the early days). His head remains relatively much larger than the rest of him, though! (He's had an MRI scan and nothing untoward showed up.)

He had PT from about 6 months old. He took the longest time to be able to lift his head when prone, not helped by its relative size either. He started crawling at a year adjusted, followed quite quickly by pulling to standing. He can stand for a few seconds without holding on now and walks with us holding his hand(s). It feels like he's fairly close to going it alone - maybe a couple of months.

He can chatter endlessly, but doesn't say too many actual words yet - no mummy or daddy (thanks!) - but he can say duck, clock, hat, boo, quack, baa, roar etc.

We still have follow-up with the hospital team. Actually, we see a new paediatrician for the first time on Monday. DS still has issues - his arms are still quite low tone, I think - and his ankles are quite pronated when he stands so he must have low tone there too (I imagine he may need orthotics, but I think it's probably too early to say).

He won't feed himself many foods (it's the physical act of feeding rather than the taste of the food which is the issue, I think), is not able to deal with regular meals yet (he's been known to take spoonfuls of pie into his mouth, but keep the meat all his mouth without swallowing it, for example! - I mainly feed him stage 3 jars, which he devours) and doesn't like to feed himself milk from his cup although he is able to do it.

We've had all the tests on offer to find out the cause of the hypotonia but nothing has shown up.

What we're seeing so far are some delays, but it seems that when he's good and ready he meets the next milestone, so having seen this happen quite a few times now, we're confident he'll get there on all of it.

Other than that, he's smart, funny and hugely cute - not that I'm biased or anything :0)

I hope Henry's doing well and enjoying his little sister.

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Thanks Scampismum! All our LOs are amazingly cute! ;-)

It sounds like your son is doing well! Henry also has low tone. He also struggled w/ feeding. But like you said, although he seems delayed, we are confident that he'll eventually get there with all his milestones. At this pt, he has accomplished everything except for jumping independently. He gets evaluated later this yr to see if he qualifies for services through the school system since he will age out of EI in Feb. I seriously doubt he's going to qualify for anything. He really has no need for more feeding therapy as he is also eating most everything (still not into purees). He also prefers to be fed versus feeding himself, but I think it largely depends on who is feeding him (he'll feed himself at daycare!)!

Obviously, it's too soon to know w/ Callie if she'll have any PT needs. We can tell that her tone is much better than Henry's was. For being so tiny, she has an amazing grip and is much more capable of holding her arms and legs in than Henry ever was. She hasn't been evaluated yet and I'd imagine it will be several more months before she is... in our state, kids who are dx'd IUGR automatically qualify for EI, so she'll definitely be watched.

It'll be exciting to see how your son changes over the next several months! Henry seemed to take off around 18mo and really blossomed at 2yrs. He is now a typical 2yr old... into everything, temper tantrums, etc! I can't take my eyes off him!

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Check our Dr.Breweres Pregnancy Diet and look under IUGR very interesting wish I had known of it before And realized my diet(that I thought was so healthy)was in fact making the IUGR worse ending in preeclampsia and very early c-section delivery

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I have had lots of early scans so they are pretty sure about the dates. I had a scan at 21 wks where they could see that the baby hadn't grown for a week and a half, there was some fluid around the heart and low AF. The baby does't seem to have any problems it is the placenta that is not giving him enough nutrition. I went for another scan 2 weeks later with a specialist and there was no improvement. I am resting and taking homeopathic remedies, trying to do everything i can really just to try and get the placenta to work.... The baby is still very active but i am finding this whole situation extremely upsetting. I am reluctant to go for another scan as it is so upsetting, did everyone here go for regular scans or did you leave it for a bit? Also do you think bed rest helps? thanks again for your support.

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I will say prayers for you and baby and that there will continue to be growth. My high risk dr did scans every 3-4 wks. They said any more than that would not be reliable. I think bedrest helped me b/w 28-32wks w/ my last preemie. She was in the 13th %ile at 28wks and had only dropped to the 12th by 32wks, so she had "good" growth during those wks. We were experiencing a lot of stress at home b/w 32 and 35wks, plus I wasn't doing a great job staying on bedrest. I'm not sure if that impacted her lack of growth b/w those wks or not, but I would guess so b/c she did not have any growth b/w 32 and 35wks.

As FlorinsMom said, measurements can be off sometimes. They were right on w/ my 31wker, only off by an ounce or so. But they were 1/2lb off w/ my 35wker, unfortunately, on the smaller side. And as z1z2 mentioned, IUGR babies often times act their age and not their size. My 31wker only required one day on the vent after birth. He also was "able" to feed at a very low weight. My 35wker acted much more like her age than her weight. She did not require any oxygen support at all. She could maintain her temp long before most babies at the same weight. In fact, all the nurses and drs would joke that she thought she was a big girl! She did so well that she even came home weighing only 3 1/2lbs.

Stay positive and stay strong. You never know what these LOs can do!

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Hi,
My son was severe IUGR, born at 29 wks 1lb 1oz. I found out he wasn't growing at 25 wks. He is now a big healthy perfect 18 month old with a minimal amount of problems. IUGR babies are little but they're strong and they come out fighting. I went on bedrest on my left side and took lovenox and baby aspirin. Please try and see if you can get lovenox. IUGR is a very scary thing. Bedrest does help. Laying on your left increases circulation to the baby. I didn't get up but to use the bathroom and go to the doctor. Noah gained 100 grams in 4 wks which was good enough to save him in the hospital because that put him at 490 grams. Read the stories on here, yahoo has a support group for IUGR parents. These are ways you can 1. keep yaself occupied while you are in bed. 2. Gain some much needed knowledge of what to expect in your near future. Also you might want to ask your doctors to do a blood clotting panel. Good Luck.

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I love to hear about Henry - sorry not to see his happy smiling face in your profile picture any more - but little Callie is definitely a worthy replacement :0)

Henry sounds a lot like Thomas. It's fantastic to hear how well he's doing. Hopefully, Thomas will follow suit. I think 18 months could be a take-off point for Thomas too. I imagine/hope he will be walking by then and into everything (he already is, but he's going to love being able to get into things higher up!).

Did you do all the low tone tests with Henry (MRI scan, genetics etc)? I imagine if you did they didn't find anything... That's where we are.

I understand that IUGR has been associated with possible white matter issues. I believe white matter acts as the 'telephone cable' between the brain and the muscles, so I'm tempted to assume that this might be what's causing Thomas' low tone. I know it doesn't really matter what the cause is, though - any 'treatment' would be the same whatever. But I always have to have a theory to explain it to myself. This is the one I favour today!

It's great that Callie is not showing signs of low tone. She sounds like a little star - being independent and coming out of hospital so soon. Enjoy every minute with her - if you can between the temper tantrums and the getting into everything of her brother(s)!

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