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Measuring large on ultrasound? Concerns?

post #1 of 28
Thread Starter 
I had an US this morning (35w3d), and they said that baby was measuring over the 90th percentile--about 7.1 lbs, they say. The funny thing is, my OB sent me in for the US because my fundal height was measuring 3-4 weeks behind. The same thing happened last month--I was measuring small at 30w, went for the US at 31w, and baby was in the 82nd percentile (4.6 lbs). Having such a big baby in there is pretty surprising--people at work keep scolding me for looking tiny and not gaining "enough" (I've gained about 16lbs so far, and I probably *look* more like 5-6 months pregnant than almost 9--I ran into an acquaintance this weekend I hadn't seen in a year, and in my oversized t-shirt, he didn't even notice I was pregnant, lol).

Baby and I are doing great by all other measurements. I don't have GD, blood pressure and urine tests are all good, etc., baby's heartrate is always strong and steady, anatomy all looks good.... You could say we're the picture of health.

Of course, today, the US technician made a comment about possible C-section if the baby is "too big". What's "too big"? I know the US size estimates are often off by quite a lot. And how much do babies grow at this point? Isn't it like half a pound a week? At that rate, even if the estimate is right, the baby should still be under 10lbs by my due date and beyond. I'm pretty thin, but I'm not small--5'8" and medium bone structure--I don't see any reason why I couldn't deliver a 10lb baby. My OB is pretty good, and I don't think she'd be quick to intervene, but now I'm concerned that she's not going to want to let my go past my EDD, etc.

Sigh. I'll bring it up with her at my appt next week, but I really don't want a fight over this....
post #2 of 28
I have no personal experience, but I don't think I would be worried. As you know the u/s can be way off when it comes to weight and like you said, even if the baby is on the big side that is OK!
post #3 of 28
This late in pregnancy, ultrasound estimates can be off by as much as 2 pounds. I wouldn't sweat it. Your body won't grow a baby too big to birth (aside from some obvious extenuating circumstances - i.e. gestational diabetes). Heck, I'm HOPING for a nine-pounder!
post #4 of 28
Whatever. Ultrasound estimates are SO frequently wrong. Like, pounds off. There is no way they can diagnose "big baby" with an ultrasound. And anyway, you can totally handle whatever size your baby happens to be! Don't let them scare you.
post #5 of 28
I really wouldn't let it worry you. Late ultrasounds are notoriously inaccurate.
post #6 of 28
One more way the "system" has found to encourage mothers to be induced or have c-sections to gain control over something they can't control - birth. If you ARE truly growing a babe in the 90th percentile, then good for you. You will be able to birth it just fine. But chances are, you are not growing one that big. I have been told mine could exceed 10 lbs. Docs, u/s techs etc. all go on to say, we might have to bring him early. My home birth mw says "great, maybe we'll break a record!" Don't let their inaccurate measurement change your birth plans at all!!
post #7 of 28
I had a friend in a very similar situation - it turns out her daughter was just tall! My friend didn't look very big, but her DD was folded almost in half in the womb and took advantage of her long-torso space.

Either way, 7lbs and change isn't much, is it? I thought I read somewhere that the baby gains a half lb a week (roughly) until week 37, then it slows right down. So really, another lb or two would get you a nice, normal siozed babe!
post #8 of 28
Not in your DDC but wanted to share:

They said my DS was going to be well over 10lbs at birth.

Yeah, um, he was 7lbs 11oz.

I wouldn't worry and don't let them talk you into a c-section for that.
post #9 of 28
I had a big baby the first time, and I've given in to my provider's desire for a late term ultrasound this time. I'm having the ultrasound next week.

But, in an effort to prepare myself for any arguments towards induction/c-section that come up, I looked up ACOG's standards for suspected large babies.

If you are going to an OB or a more medically minded CNM, they tend to follow ACOG standards pretty closely. It's a CYA thing. Other providers may not put as much stock in the standards, so keep that in mind depending on who your provider is.

But, anyway, what the standards say is that, in a non-diabetic woman, your provider should offer elective c-section if the baby weighs more than 5000 grams (11 pounds) at term. That's it. That's all the standards say. There is nothing that says a big baby should be induced (in fact, it says that you should not be induced solely for "big baby"), nothing that says that you should be offered a c-section for a weight less than 5000 grams. There is a secondary recommendation that says IF the ultrasound says that your baby weighs 4500 grams, AND your labor is long or the descent of your baby is stalled, THEN your provider should consider c-section.

This is the article http://findarticles.com/p/articles/m...64/ai_76414064

I hope that helps.
post #10 of 28
I wouldn't worry and I'm pretty much in the same situation. We had an ultrasound at 33 weeks and our baby was measuring at about 7 lbs.- he's in the 97th percentile I think by their measurements. I'm also not measuring large, don't look huge (other than I'm pregnant) and frequently have gotten comments about being so small.

The only thing that came out of this US telling me how big they thought the little guy was at 33 weeks is a label of "LGA" (Large for Gestational Age) and a headache until I decided not to worry about it.

Here's what I think, especially after talking to the midwife:
1. US measurements can be off by 2 lbs either way. That is a big difference.
2. Look at you: if you're healthy, eating well, don't have GD you're probaly fine. I'm 5'10" and have a long torso so my midwife pointed out that the baby simply has more room.
3. The percentile measurements are based on the 50%'s and one HUGE problem in the United States is declining birth weights. So those percentiles and standards are based on something that is not only going down on avg. but that is unhealthy by many other standards.
4. Very rarely are babies actually 'too big.' I trust my body to grow a healthy baby and that the baby will be whatever size he needs to be to be healthy. There are very few cases when you actually physically can't deliver a baby and those may be due to issues with undiagnosed GD, insulin issues in the little one and what not that cause the baby to grow disproportionately large on top (shoulders, etc.).
5.According to my midwife, Babies to moms who do natural births or home births tend to have larger babies. Mostly due to lack of interventions, my midwife wouldn't dream of telling me about a c-section for a 'large' baby.

Have your midwife feel the baby - does she think the baby feels large? Mine didn't, healthy size yes - but not alarmingly, abnormally large. Yes I have dreamt the baby was born at 11 lbs. but I trust the baby and I trust my body and I actually know a suprising number of people who have delivered 11 lb babies and babies over 9 lbs at home or at birth centers and had great, healthy uncomplicated deliveries. I think our baby will be larger than average - but who doesn't think their baby is better than average.
post #11 of 28
Thread Starter 
Thanks, guys--that does help me feel better. And BetsyS, thanks especially for the link and info--that may prove very valuable depending on how my OB reacts to the US results. Honestly, I think she's good--I've had two separate doulas in the area now tell me that she's a very special doc, has a very good relationship with the doulas, etc. She seemed pleased when I said I wanted a natural birth, and she even recommended I get the Hypnobirthing book and gave me the contact info for a Hypnobirthing instructor/doula. But still, she has to cover herself like everyone else, and I didn't know what the standards are. The one thing she seemed pretty firm about was that I "will have a baby by mid August"--everything else was very much "we'll try to create the birth experience that you want," etc., etc.--so I already know she's not keen on going much past 42 weeks. I was worried these US results might make her want to push that up to 40 weeks or something, but it sounds like I can make a good *medical* argument to her that that's not necessary, if I have to.

Mrforbes, thanks for your story, too. I also have a long torso, and after the first US in the 82nd percentile, my OB even mentioned that that could be the reason why I'm measuring and looking small but growing a big baby. DH and I are both pretty tall--I very well could have a long baby in there, and the US femur measurements could be picking up on that. But I don't think height makes a baby harder to deliver. Also, we both have fairly large heads (), so maybe baby does too, and the US head circumference measurements could be skewing the whole weight estimate way up. I guess we won't know til she's born, right?
post #12 of 28
You are measuring "small" but your baby measures "big"-- it just goes to show how inaccurate both of these measurements can be!
It surprises me that OBs give these measurements so much importance, because we all know how inaccurate they are and most of us aren't even medical professionals.

Please try not to worry and just trust that your body is growing the right sized baby.

post #13 of 28
It just makes no sense for a body to grow a baby that can't be birthed--don't let anyone scare you. The babe will be just the right size FOR YOU.
post #14 of 28
I agree that your body will grow a baby you can birth. And somebody has to be in the 90th percentiles, right? (That always blows my mind, that having a baby in the 90s is such a "deal.")

I've heard some stories of late ultrasounds being fairly accurate, too, so I don't rely SO much on the "they can be off either way" for comfort. (I have a friend whose baby was delivered electively at 37 weeks due to placenta previa. He was estimated at about 9 lbs, and he was born one day shy of 37 weeks, weighing 9 lbs 2 oz.) But even if the estimates are accurate, as they sometimes are, in my opinion there's no reason to freak at that information. (Meaning, I don't "need" to hang on to the idea that the estimates might be off.) However, I do keep that "+/- 10%" thing in mind if there is something disturbing or concerning....to keep things in perspective.

For example: I had a scan at 32 weeks that showed my first twin only gaining 9 oz in two weeks, while twin B had gained a more expected 1 lb 4 oz in the same time period. This widened their growth disparity to a more concerning percentage (25% disparity between them) than their usual consistent tracking at 18-20%, but all signs pointed to fetal well-being and no problem. The doppler cord flow was fine, the fluid levels were fine, both babies were doing the "breathing practice" and moving lots, and even the "small" twin was still tracking in the ~65th percentile ahead of dates, so not small for gestational age at all.

I was concerned just because I had an expectation that wasn't met, and we've had regular ultrasounds (monthly for awhile, then every 3 weeks) to monitor them because they share a placenta & some vascular connections, so even with the plus/minus of ultrasounds we had a pretty good idea of how they were growing, in general.

BUT, I was pretty sure it just was a matter of something being a little off in one or more of the measurements of that twin. And sure enough, we went in to a different facility for a biophysical profile a week later (wasn't supposed to have measurements done then) and the tech went ahead and started in measuring. I let her go (normally, I'd have told her it was just a straight BPP with no measurements, to limit the ultrasound exposure, but I was a little nervous about twin A so I figured since it was happening, it must have been meant to be.)

Based on that measurement, twin A either gained 17 oz in one week (while twin B gained 6 oz ) or the scan from the previous week had been off in its measurements. It really put my mind at ease, though I'd already chalked the "anomaly" up to a measurement error.

At my last scan, it was really challenging for the tech to get good images for measuring (particularly of the heads, for different reasons), and I suspect the estimates were a little off (probably on the low side, if I had to guess) but they were tracking "normally" with just a slightly slower gain at 35 weeks.

If it makes you feel better, my twin B has been tracking in the >97th percentile since about 20 weeks. I don't so much doubt the ultrasound's accuracy, as it's been pretty consistent along the way, but I doubt that it's a "big deal" to be measuring ahead. "Measuring ahead for dates" just means that the baby is not in the 50th percentile. Measuring "spot on" would put him in the 50th percentile. Is every baby going to be there?

And here's another parallel for you: My ultrasound was at 35 weeks 4 days (very close to yours) and my larger twin was estimated at 7 lb 5 oz. The other twin was estimated at 6 lb 6 oz. It really can happen.

Keep in mind +/- 10%, and have faith in your body's ability to birth whatever you grow.

(My last pregnancy, I had one late term u/s and they estimated on the small side. She was supposed to be under 7 lbs, and she was 8 lbs 12.5 oz. Of course, this kept the on-call midwife from pushing certain interventions on me, sort of the opposite of the flip-side, which I think I'd have been hearing if she suspected a "bigger" baby.)

We'll see on their birthdays!
post #15 of 28
Thread Starter 
Wow, AmyC, it sounds like you're doing some excellent baby-growing! Two big healthy twins sounds like a real blessing, although I'm guessing it's not always 100% comfy for you! Anyway, I do agree with the statement that our babies will most likely be the right size for us, and that being in the 90th+ percentile really isn't that crazy, especially when it seems like that will still mean the baby's under 10lbs. Now if they told me I was having a 13 or 15 lb baby or something I might start to freak out a bit, but really, this seems quite manageable. I just hope my OB agrees--I think she will, but I'll feel better once I talk to her about it and get a confirmation that she won't be pushing for early intervention.
post #16 of 28
First of all ultrasounds are notoriously wrong in regards to estimating size.

And second, a large baby is not a reason to do a c-section.

this article is about not inducing for a large baby but the info is still valid for a scheduled c-section

If I had a doctor tell me that my first instinct would be to find a new provider. For me, that would not be someone that meshes with my philosophy.
post #17 of 28
Thread Starter 
Originally Posted by ~Megan~ View Post
If I had a doctor tell me that my first instinct would be to find a new provider. For me, that would not be someone that meshes with my philosophy.
Thanks for the article--very good reading--and anything that references actual scientific studies is always good when dealing with doctors.

And just to clarify, it wasn't a doctor who said that, it was just the US technician who probably needs a little more training on when to keep her mouth closed. She was very nice, but she's not qualified to be offering opinions like that, and somebody should probably tell her that pregnant women are sensitive to off-handed comments about how they might need a c-section because of their "too big" babies. I'm still waiting to see how my OB will deal with the news, but I'm even more optimistic now that I've talked to my doula, who has worked with my OB a lot, and she doesn't seem to think it will be a big issue.
post #18 of 28
With my last baby, the US kept telling us the baby was in the 95% for weight and the MDs were freaked that I was going to have some huge baby and wanted to induce--I refused. My dd was exactly 8lbs. Smaller than my ds and shorter, too. US measurements are seriously unreliable. Hang in there!
post #19 of 28
post #20 of 28
With my last I had the opposite problem. US was only off my 1.6 ounces and my midwives were off by 2-3 pounds. You are taller and a 10 lb baby would fit probably just fine! I am 5' 4" and pushes out a 10 lb baby.

Has anyone had the dumb midwife shoe size thing thrown at them? I wear a 5.5 and was told that I could deliver a 7-8 lb baby...I delivered a 9 lb 13.6 ounce baby.
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