Abnormally large abdominal circumference - Mothering Forums

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#1 of 4 Old 04-24-2008, 11:11 AM - Thread Starter
 
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I'm not sure where the best place to post this is, or if anyone will have any insight, but I'm hoping for some thoughts...

First, I'm a Type 1 diabetic, so I have had a more medical pregnancy than I would like, but I feel much of it is justified. I am well-controlled on a pump and my blood sugars are generally in the range of a non-diabetic.

Also, I am planning and HBAC, but have a back-up Dr. that is aware of my plans and doing my parallel care so that it's easier for me to have u/s, NSTs, etc.

I'm 38+3 (yes, we're sure of dates) and have been having prodromal labor non-stop for 6 days.

Due to the medical side of things, I've had several u/s that indicate that the baby has one moderately to severely enlarged kidney and ureter. His bladder and stomach are both normal in size and my AFI is always pretty much right in the middle of the normal range.

However, at my last u/s on Tuesday I ended up with a really bizarre report - the kind that makes you understand why no one trusts u/s at all. He was estimated in the 65-85% in most things - head circ, femur length, etc. But, his abdominal circ was off-the-charts. From what I've read, 35cm is considered macrosomic in most circumstances, but this one read 43cm. The tech didn't really believe it and measured several times. This unfortunately led me to have a piece of paper in my chart estimating a currently 11.5 pound baby.

Now, none of us (u/s tech, Dr, MW, me, or husband) actually believe he's 11.5 lbs, but we are expecting a reasonably sized baby both from palpation and the fact that my son was 9'2" at 40w. And, 43cm is definitely way larger than even the estimated range of error of u/s measurements.

Now, if you've read through all my background, congrats! My actual question is if anyone is aware of possible birth defects/conditions that would lead to such a disconnect between abdominal circ and the other measurements? Especially in light of the known kidney defect. I don't really want to ask my back-up Dr. because his support for my HBAC is starting to wane (and he was genuinely supportive until this) and I fear this will just give him an excuse to further encourage me to head to the hospital. My MW doesn't really have any experience to know. But, if my child is in danger, I'd definitely not be foolish enough to want to birth him at home. My google-fu hasn't brought anything up that really seems relevant. I guess my concern is some sort of possible fluid overload in the periteneum or something similar.

Thoughts, support, words of wisdom?
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#2 of 4 Old 04-25-2008, 12:22 AM
 
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Maybe I'm the only clueless one, but this is way above me. Have you tried cross-posting this in the Birth Pro subforum?

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#3 of 4 Old 04-25-2008, 09:10 AM
 
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Well, I was coereced into a c-section for fetal macrosomia (dd was 9lb8.5oz) and I know they were greatly concerned about the AC:HC ratio. They tried to tell me that they had missed GDM in my pregnancy (which from getting my records I do not think this is accurate, I just make big babies). From what I have read, diabetes or GD that is not well treated can result in a barrel chested baby (which can increase risk of Shoulder Dystocia). However, it sounds like you were well monitored during your pregnancy and your diabetes was controlled. It probably is related to the kidney issue.

Good luck and I hope you find answers and that you have a healthy baby and mom, and a peaceful birth.
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#4 of 4 Old 04-25-2008, 10:42 AM
 
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Just 3 weeks ago I sat in on an OB appointment with a GF who sounds just like you -- Type 1 diabetes, 2nd child, and "off the charts" abdominal measurements. The OB sat there and completely tried to freak my friend out -- your baby will DIE was mentioned at least 3 times. The OB was telling her the link between abdominal size and shoulder width meant that her baby was going to have these HUGE shoulders which would lead to should dystocia. And when that happens, the baby will get stuck and could die.

I was appalled at how my friend was spoken to. I was appalled at how they look at those U/S and say "your baby WILL be this size with these problems...". It is all utter speculation...and speculation can scare the be-jeebers out of anyone!

2 weeks ago, when she had her DS, he was 7 pounds 11 ounces with perfectly normal width shoulders. And no one has mentioned his "off the charts" abdomen. In the end, he came via c-section (little dude turned breech and no one was willing to wait for him to turn back).

Blah, blah, blah. I'd say -- try not to doubt yourself. And, if your MW is versed in shoulder dystocia (and has you get on your hands & knees if it occurs) then I'd still stick with that. All the OBs will see is "high risk" written on your forehead...and then all the interventions will begin.

~Alison

Mummy to Miss I (3/05), Miss A (5/08), and #3 (EDD 9/12)

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