IUGR question - Mothering Forums

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#1 of 17 Old 06-10-2009, 07:55 PM - Thread Starter
 
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This is kind of a random question since I don't have this problem. I'd like to hear perspectives on Intrauterine Growth Retardation. Is this a real problem or just another scare tactic the medical profession uses to scare women into induction? We are UCing and in all of my research I haven't found anything that addresses IUGR and UC. It makes me wonder what gives.
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#2 of 17 Old 06-11-2009, 04:20 PM
 
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ummm....IUGR is very serious problem and it does happen. IRL I have only seen it happen w/friends and colleagues that had other problems w/their pregnancies. I'm not sure if it happens by itself or not. Maybe others will chime in.

One real life example I have is a friend of mine had the same EDD as myself, we both ended up developing pre-e, I had to be induced. But, she had to have an emergency c-section a day before I was induced b/c the babe was in such bad shape b/c of IUGR. In the end, DS and I left the hospital 36 hours after birth. He weighed 6lbs 8oz. My friends baby was in the NICU for a month and weighed 3lbs 4 oz or exactly half of what my son weighed.
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#3 of 17 Old 06-12-2009, 06:11 PM
 
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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.
(If you watch BOBB, they comment several times about Abby being so tiny)
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#4 of 17 Old 06-13-2009, 05:03 PM - Thread Starter
 
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I'm measuring right on target. I'm a moderator on another birth board and noticed there were a LOT of women who were being diagnosed with IUGR so I didn't know if this was an over-diagnosis or if there really are that many ppl who have this.
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#5 of 17 Old 06-13-2009, 05:21 PM
 
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In my experience... I have seen several women misdiagnosed with IUGR. I know it is a real thing but I think it is FAR less prevalent than it seems.

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#6 of 17 Old 06-15-2009, 06:47 AM
 
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Originally Posted by gossamerwindweb View Post
In my experience... I have seen several women misdiagnosed with IUGR. I know it is a real thing but I think it is FAR less prevalent than it seems.
Yeah, and I wouldn't be surprised if some call "measuring small for dates" IUGR. And we all know how accurate ultrasounds are in predicting birth weight

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#7 of 17 Old 06-15-2009, 09:49 AM
 
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Yes, IUGR is a real thing....

And YES, it is one of the 'latest trends in pregnancy diagnostics'--just like low AFI, 'baby too large for your pelvis', etc. It's way over-diagnosed these days.

Measuring small for dates does NOT mean your baby is too small though.
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#8 of 17 Old 06-15-2009, 10:29 AM
 
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Originally Posted by rhiandmoi View Post
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.
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#9 of 17 Old 06-15-2009, 10:40 AM
 
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Yes, I know it DOES happen. But I think it is just far less often than they diagnose it. And like everyone has said, ultrasounds are notoriously incorrect about birth weights. They told me the day before my daughter was born that she would be 10+ lbs (this was after a level 2 ultrasound) ... she was born like 12 hours later under 8 lbs. So ultrasounds just aren't necessarily correct. There needs to be a TON more studies done to see if they actually HAVE IUGR. But it seems that the moms I have heard from who had IUGR diagnosed were only told that by a couple ultrasounds... and the vast majority of the time it was wrong.

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#10 of 17 Old 06-15-2009, 01:15 PM
 
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Originally Posted by gossamerwindweb View Post
Yes, I know it DOES happen. But I think it is just far less often than they diagnose it.
I think one problem is that some people act as if IUGR means the same thing as "small for gestational age" (smallest 10%), which doesn't make sense. In the same way, it's silly to describe all babies who are large for gestational age (biggest 10%) as "macrosomic" -- but having also had a big baby and a jackass ped, I know that this happens a lot too.

In reality, IUGR and macrosomia are actual disorders, with specific signs, symptoms, and associated risks, whereas SGA and LGA just mean "smaller than most" and "bigger than most." A large majority of SGA and LGA babies are that way due to normal genetic variations. The trick is to figure out which ones are actually that way due to underlying problems, and are likely to need medical intervention.

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There needs to be a TON more studies done to see if they actually HAVE IUGR.
Given that we opted for minimal prenatal testing without routine ultrasound (as do most folks here), and there was no outward indication that anything might be going wrong until things were already at a critical point, I'm not sure when we could have had these "tons of studies" done. Certainly, we were hoping that the u/s underestimated her size, but given that it appeared to be such an extreme situation, we weren't going to risk her future on that possibility. As it turned out, the estimates were accurate within 2 or 3 ounces.

Of course, if it had appeared to be a milder case -- i.e., baby "just a little on the small side" -- with no evidence of cord problems, that would likely have been a different scenario, with more time to consider our options. I don't have any experience with mild IUGR, so I can't comment on what those might be. But my main reason for posting was to point out that even the severe and dangerous kind can happen in an apparently healthy pregnancy, and can go undetected for a very long time. I guess it's kind of like pre-e that way.
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#11 of 17 Old 06-15-2009, 03:38 PM
 
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Hummingmom, hugs to you and your little one. I've always heard that babies who are full term and "small for term" usually have serious issues. Thanks for sharing your info, it was interesting. DS2 was born at home (with a MW) at 40w 1d weighing 6lbs 4 ozs, when he was 2 weeks old he started going into distress and we learned soon after that he had a life-threatening heart defect. So "small for dates" babies do tend to scare me and it is something I would not take any chances with.

IUGR can be caused by amniotic band syndrome and babies with ABS can have serious issues. The bands can cut off limbs and even compromise organs. I'm a big supporter of HB but if I suspected IUGR I'd birth in the hospital for the safety of the baby. I'm pretty sure that a lot of IUGR babies are also born early.

Zen doula-mama to my spirited DS1 (2/03), my CHD (TAPVR) warrior DS2 (6/07) & a gentle baby girl (8/09)
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#12 of 17 Old 06-15-2009, 04:46 PM
 
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IUGR does exist and is usually caused by placental abnormalities, decreased nutrients to the fetus or fetal abnormalities. With that said, babies come in all sizes and the size of the baby varies with maternal history (size of baby typical for individual mom, racial background, diet, ect...) and the fetus' genetics.

During my second pregnancy (1993), I had TERRIBLE nausa and vomiting. I was REALLY young and the midwives I was going to (a clinic at a local hospital) just kept saying "eat smaller meals," "it should get better by your second trimester" or asking "have you tried saltine crackers?" I started that pregnancy at 141 pounds and days before I delivered was 129 pounds! Whatever I ate I threw up, trying to eat and drink became an overwhelming challenge. I was not surprised when later in my second trimester they diagnosed me as being small for dates! They pulled me in and asked me about drug use, I was so upset! I of course tested negative although if I had to do it all over again I would have just taken the hit of pot! Anyways my daughter was born on her due date (only baby I had that was not over a week late!) weighing 5 pounds 4 ozs, all my other children were over 8#! I do believe she was growth restricted due to decreased nutrients!

If however it is due to placental pathology there is NOTHING a doctor or midwife can do! I am not worried about my childs size, I am eating OK she is growing OK and I do not have maternal diabetes (which can cause increased fetal size) so I trust my body will produce an appropriatally sized baby if there is someother issue beyond my control like problems with the baby or the placenta then there is not a whole lot that could be done anyways so why worry about it?

Ultrasounds can be 2 pounds off either way! I would not even consider doing a section for a baby an ultrasound said was small unless there was some major fetal abnormality noted on ultrasound.
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#13 of 17 Old 06-15-2009, 05:49 PM
 
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Originally Posted by kupoliveson View Post
If however it is due to placental pathology there is NOTHING a doctor or midwife can do!
There's nothing they can do until the baby can survive outside the womb. After that, there's the option of delivering early, by induction or c/s, in a hospital with a good NICU. If the baby isn't getting adequate nutrients or oxygen in utero, then it's often better for them to be born already, especially once they're old enough not to have a significant risk of major "preemie issues."

I used to be skeptical about this -- surely it would be better for the baby to stay inside?? -- until it happened to us. I was eating well, I felt fine, and I gained a healthy amount of weight, but still, unknown to me, my baby was starving for nutrients. We never got a full report on the placenta, but the umbilical cord turned out to be the size of a couple of pipe cleaners twisted together. It's amazing that it was able to sustain her for as long as it did. And until she was delivered, there was nothing any of us could do to help her, apart from praying that she wouldn't die or suffer brain damage. While the NICU experience was no fun, at least she was able to breathe and nurse, which was a huge improvement on her previous situation.

I likely won't be checking back in here soon; baby #4 is due to appear any day now, and I don't think it's wise for me to spend too long thinking about what happened last time. Unless the latest ultrasound is off by 5 pounds or so, we're not going to have a repeat of that situation.

Meanwhile, I wish you all the best in your pregnancy and birth.
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#14 of 17 Old 06-15-2009, 10:57 PM
 
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True a section can be done BUT again unless there is some REALLY compelling reason based on fetal or placental abnormalities just the fact that a baby is smaller than it should be based on a arbiturary date (ie due date) is not reason enough to section (at least in my opionion).
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#15 of 17 Old 06-17-2009, 05:06 PM - Thread Starter
 
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Wow, thanks, that's a lot of really interesting information.

hummingmom: I'm very sorry that you had to go through such a heart-wrenching experience with your last baby but it's wonderful that there was a happy ending. I can only imagine what that must have been like. I'm also due with #4 yesterday and just sitting here paying attention to every little twinge, gurgle, and bump as I'm impatiently waiting for this LO to arrive.
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#16 of 17 Old 06-17-2009, 05:48 PM
 
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Just to clarify, though each situation is unique, much of the time a diagnosis of IUGR (without other obvious indicators like cord flow issues viewed with color doppler) would not be made based on one u/s but multiple u/s's. It's not just absolute size that matters but a significant lack of growth in between u/s's.

One other thing that can be done that has not been mentioned above has to do with clotting issues. Clotting issues are one possible cause of IUGR (which can also lead to stillbirth), are usually easily identified IF they are tested for (many of them are genetic, thought the results may take a lot of time to come back), and treated - going forward anyway - with anticoagulants. Often though it's knowledge that's more useful in a future pregnancy since clotting that has already occurred is not easily reversed (not something that can be seen on u/s, but microclots in the placenta, sometimes so small that they can't even been seen unless the placenta is sent to pathology). Just thought I'd throw that out there since it seems to be a common cause of IUGR that is often overlooked, even by doctors.
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#17 of 17 Old 06-17-2009, 05:53 PM
 
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My DS was an IUGR baby. 4lb 8oz at 37 weeks, which in itself isnt IUGR at all. but his actual SIZE (not weight) indicated serious IUGR. He was very out of proportion at birth, his legs somewhere around expected for 27 weeks, abdomen 31 weeks, and head 35 weeks. He also had very VERY low blood flow - which is why he was IUGR.

Its definatley far overdiagnosed these days...its kinda stupid when people are upset because their 8lber is IUGR *insert eyeroll emoticon here!*
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