Originally Posted by rhiandmoi
IUGR is a real thing. I new a woman whose 37 weeker was 3 pounds due to mild IUGR. If you are measuring small for dates, I would definitely get it checked out.
My own third child was barely 3 lb. when she was delivered at just shy of 37 weeks. According to her doctors, that qualifies as severe IUGR, not mild. She was emaciated, and looked like a tiny, wizened old person. (By comparison, my two older children were 8 and 9 lb. at term.)
After much testing of both of us, we still don't know what caused DD's growth restriction. She did turn out to have a significant heart defect, but though babies with heart defects are often a bit smaller than average, it's very rare for them to be THAT small. The scary thing is, despite her being so tiny -- which was obviously something that had been going on for a while, likely since 25 weeks or so -- I'd been measuring within normal limits right up until the week she was delivered, and the pregnancy seemed to be totally uncomplicated. Even when I started measuring 4 cm small, my HB midwife (who was very laid-back and low-intervention) was kind of hemming and hawing, and left it up to me as to whether or not to get an ultrasound. We decided to do it, but to be honest, at that point, my "instinct" was still telling me that everything was okay and it was no big deal.
If I'd blown it off, DD could well have been born at home, and that would not have been good. Not just because of her size, but even more so because her cord blood flow was compromised, and oxygen deprivation would have been a very real risk.
When the U/S was done, we were all shocked by the results; it wasn't what we were expecting at all. The MW referred me to a perinatologist, and by the time I was able to see her a few days later, she found that DD's overall condition was going downhill: no fluid to speak of, and cord blood flow getting much worse. She sent me straight to the hospital for an immediate c/s, which I agreed to 100% (we'd done enough reading in the intervening time to realize that it was the best thing in this case). When I got there and they put me on the monitor, it turned out that I was having contractions -- really mild ones, I didn't even feel them -- and she was having lots of late decels even with those.
All the evidence I've seen on this subject suggests that "letting nature take its course" would have been dangerous in my DD's situation. IUGR babies are survivors -- after enduring so much stress in utero, they tend to be tough -- but these little ones can only take so much. The very end of pregnancy tends to be the hardest time for them, as the placenta and cord, which are already marginal, tend to become dangerously inadequate. A lot of these babies tank around 35-37 weeks or during labor, and stillbirth is a very real possibility.
Knowing this, we're glad that our DD has been able to get the best of what modern medicine has to offer, first with her birth, and then with her heart surgery (and even though c/s is invasive, it's absolutely nothing compared to cardiopulmonary bypass). Since we started down this road, she's gone from looking like a little bundle of "ominous findings" on an ultrasound screen... to a miniature, slightly bluish-tinged famine victim in an incubator... to a tiny baby with her chest cut open, hooked up to dozens of tubes and wires... to a thriving, cheerful little 21-month-old love-bug, who just measured at the 40% in height and 25% in weight, is on time or ahead with all her milestones, and whose biggest challenge right now is figuring out how to hug all of her stuffed animals at once.
Anyway, hope that helps. I know our experience is rare, but it's something that really happens, and there's a reason why all these measurements are done. Having gone through it, "measuring small" isn't something I'd ever take lightly again.