Late stage u/s & small babies - Mothering Forums

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#1 of 23 Old 07-18-2007, 09:42 PM - Thread Starter
 
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So at my 36 week appointment the OB finally picked up the tape measure and measured me. I was about 3.5 cm behind, according to him. So he ordered an u/s for 38 weeks (Friday) to see if the baby is really measuring small.

From what I've read, u/s in later pregnancy is very unreliable for sizing. So what can they actually tell from doing an u/s this late in pregnancy. I had a NST earlier this week and the baby had plenty of movement & the appropriate cardiac response in the 20 min. I was there. I also have plenty of robust movements still.

I don't want to do any tests that might lead them to force me into an induction or anything like that. Can they really tell if the baby is "too small" at this point? Or if there is some other problem?

FWIW, I did have an u/s at 20 weeks and everything looks ok then.

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#2 of 23 Old 07-18-2007, 09:48 PM
 
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i've never read or heard of an ultrasound being even close to correct in late pregnancy. what is your gut telling you?
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#3 of 23 Old 07-18-2007, 09:52 PM
 
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i had the same thing happen to me, but a little earlier. at my 30 week appointment Dr#2 (i have 2..) "kindly suggested" that i have another ultrasound done. k whatever i did about a week before my next appointment. saw Dr#2 again after 5 weeks and he not so kindly told me "you NEED another ultrasound". i was like uh, i had another one. he didn't have the results back. so a week later at 36 weeks i see Dr#1 (who i like better) and he said i was measuring fine, and the US came back fine.

this week Dr#2 double checked his measuring since Dr#1 had said baby was fine. *rolls eyes*

but anyway, sorry for the vent. haha. for your question, from what i've heard late US aren't very dependable. all babies grow different anyway. you get 5lb full term babies. and you have 10lb full term babies. i think it's rediculous for a dr to try to say a baby is "too small".
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#4 of 23 Old 07-18-2007, 09:54 PM - Thread Starter
 
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Well I don't really know what to think. I wish he had been measuring all along so he would have known if I was measuring small the whole time. I can't, for the life of me, remember how I carried with my daughter. And the ob didn't seem that concerned. He scheduled the u/s for 2 weeks after that appt. He also said he thinks that I just carry small. But I have to tell you that when I was at the NST I saw another mom due around the same time and she was much larger than me and it sort of freaked me out.

Are there other things they can figure out from a late stage u/s? I certainly don't want unnecessary test but I also don't want to jeopardize the baby.

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#5 of 23 Old 07-18-2007, 09:58 PM
 
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I think an U/S can tell if the baby is in distress or is OK. I think repeated U/S would tell you whether the baby was growing or not. I wouldn't agree to an induction for a small baby that was doing fine. Logically, he or she would do better with more time in the womb. But I suppose if the baby suddenly just stopped growing, there might be a problem.

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#6 of 23 Old 07-18-2007, 10:20 PM
 
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I had to go for an u/s at 36 weeks b/c I was measuring small. They weren't JUST looking for a measurement on the baby. They also check the amniotic fluid and look at the difference in measuerment between the babies head and stomach (which might show signs of IUGR). The tech checked the placenta, noted the baby making breathing motions and movement... all just a check of general well being. My LO was measuring a little small but was otherwise okay.
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#7 of 23 Old 07-18-2007, 10:52 PM
 
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i've never read or heard of an ultrasound being even close to correct in late pregnancy.
They did an u/s on my dd just before inducing and said she was 5 1/2lbs, she was 5lbs 9ounces. They did an u/s on my ds exactly 1 week before he was born and said he was 7lbs, he was 7lbs 7ounces...which is pretty standard for a week of growth (1/2lb per week). So mine were pretty accurate, and the hospital keeps statistics on how accurate their size ultrasounds are, and they are pretty dang good, like 80% accurate within 8ounces.

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#8 of 23 Old 07-18-2007, 10:58 PM
 
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They did an u/s on my dd just before inducing and said she was 5 1/2lbs, she was 5lbs 9ounces. They did an u/s on my ds exactly 1 week before he was born and said he was 7lbs, he was 7lbs 7ounces...which is pretty standard for a week of growth (1/2lb per week). So mine were pretty accurate, and the hospital keeps statistics on how accurate their size ultrasounds are, and they are pretty dang good, like 80% accurate within 8ounces.
maybe it's just that the people who talk about their late ultrasounds are the ones who had grossly inaccurate ones...
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#9 of 23 Old 07-19-2007, 12:23 AM
 
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...They weren't JUST looking for a measurement on the baby. They also check the amniotic fluid and look at the difference in measuerment between the babies head and stomach (which might show signs of IUGR). The tech checked the placenta, noted the baby making breathing motions and movement... all just a check of general well being...
All of those things
--AFI (amniotic fluid index)
--The ratio of head to abdomen measurment
--length of femur
--size of placenta
CAN indicate possible IUGR...or totaly ease your mind.

The other things they are checking for help to give a picture of how baby is doing (thriving, or just making it)

IUGR exists on a spectrum, and in a vareity of ways.
The form my little guy has is not the more common version. I am currently receiving twice weekly NST's and I have an appt with the perinatologist on Monday to re-measure and see how he is doing growth wise.
Despite some ocasional decels in his heartrate at the NST's no one is pushing me to induce...But if we find on monday that his belly has not grown over the past 3 weeks, I will ask if they think I should induce. IUGR is not a 'normal' thing and it may be that he is at the point now that he [U]would[U] do better out than in. I know I make creamy milk.

These are the best articles I've found on IUGR
http://familydoctor.org/online/famdo...fetal/313.html
http://www.aafp.org/afp/981015ap/vandenbo.html

Joy

DH&Me  Christ follower, homeschooler, gardener, (insert lots of additional crunchiness here) chicken mama, & occasionally blogger. intactlact.gifMama of  boys 9,7,3.5,&11months....& SURPRISE jaw2.gif  expecting a BOY in November!  7 sweet-babes gone too soon.

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#10 of 23 Old 07-19-2007, 04:46 AM
 
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The thing that bothers me is how does he know you are measuring behind for your body if that is the first time he measured?! I would expect to be measured every visit to see a good growth curve. The cm per week thing is just the average or whatever, some people measure on that and some don't.

That is part of the reason I left my mw practice...they didn't palpatate my stomach or measure me til like 34 weeks.

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#11 of 23 Old 07-19-2007, 10:10 AM
 
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I do think they would need to measure you from one time to the next to judge how much the baby had grown in that time period. Not one u/s and one measurment with the cm tape.
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#12 of 23 Old 07-19-2007, 10:30 AM - Thread Starter
 
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I do think they would need to measure you from one time to the next to judge how much the baby had grown in that time period. Not one u/s and one measurment with the cm tape.
This is the thing that concerns me. He has no frame of reference. So I'm not sure if the u/s will make me alarmed or put me at ease. But at this point I guess I'll go ahead and do it. And like I said, if he was really concerned, shouldn't he have ordered an u/s right away so they had a baseline at 36 weeks and then could do another one later? The whole "quality" of care I've gotten at this office has been sketchy, at best.

Also, if it turns out to be IUGR shouldn't that have been something he had an eye out for earlier in the pregnancy? We're pretty late in the game now.

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#13 of 23 Old 07-19-2007, 10:40 AM
 
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So all he has to go by is the 3.5 cm on the tape? From what my mw said, this can vary day-to-day (maybe not 3.5 cm but 1 or 2) due to the position of the baby. Last time I was over by 1, this time under, but the baby is in a weird positon... Is the US you're scheduled for a level II?
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#14 of 23 Old 07-19-2007, 11:32 AM
 
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They did an u/s on my dd just before inducing and said she was 5 1/2lbs, she was 5lbs 9ounces. They did an u/s on my ds exactly 1 week before he was born and said he was 7lbs, he was 7lbs 7ounces...which is pretty standard for a week of growth (1/2lb per week). So mine were pretty accurate, and the hospital keeps statistics on how accurate their size ultrasounds are, and they are pretty dang good, like 80% accurate within 8ounces.
Huh. My dd2 was estimated the day before her due date as 11+ pounds, she was 9 exactly. A childbirth student of mine recently had her baby estimated at 11lb 2oz, he was 9lb 11oz. A mama of twins who had a c-section at 38 weeks had baby b estimated at 7lbs, she was 5lb2oz. I'm sure we could through numbers back and forth all day...but everything I've heard is that late stage ultrasounds are + or - two pounds.... And that's certainly been the reality that I've seen...


To the OP: I agree with the others that there's no baseline, so be prepared. I think the most important thing is for you to educate yourself, know what the ranges of "normal" and "abnormal" are, and fight for what you want. If they don't have a baseline now, and the u/s shows "small" but not IUGR (which I think in part has to be measured over time anyway), get another u/s in a week. Don't forget, you DON'T have to do what they want you to do...especially when they haven't even been doing their own job :

As for how mamas carry...I wouldn't stress about it too much, mamas all carry differently, just check out the belly pics thread!!

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#15 of 23 Old 07-19-2007, 12:34 PM - Thread Starter
 
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The u/s is not a level II. In fact its in the OBs office. I think he's just trying to cover his butt.

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#16 of 23 Old 07-19-2007, 12:35 PM
 
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I posted in your other thread ...

But, one measurement doesn't seem to be useful for anything. Most likely your baby's position is what affected the measurement. I've measured 3 cm ahead at one appointment and right on at the next. Sometimes he just stretches out more, that's all. Plus, at 36 weeks your baby very well may have dropped.

I think your doctor's methods are questionable at best, and by methods I mean taking only one measurement and causing you alarm when he has not established a baseline for comparison throughout your pregnancy.

And as for how mamas carry ... I went to a 4th of July party with another woman who is due within 2 days of my due date. I look like I have a whole basketball under my shirt, and she looks like she has a half a watermelon strapped to her belly. We look like we must be a couple of months apart. I'm sure our fundal measurements are different too.
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#17 of 23 Old 07-19-2007, 01:48 PM
 
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This is the thing that concerns me. He has no frame of reference. So I'm not sure if the u/s will make me alarmed or put me at ease. But at this point I guess I'll go ahead and do it. And like I said, if he was really concerned, shouldn't he have ordered an u/s right away so they had a baseline at 36 weeks and then could do another one later? The whole "quality" of care I've gotten at this office has been sketchy, at best.

Also, if it turns out to be IUGR shouldn't that have been something he had an eye out for earlier in the pregnancy? We're pretty late in the game now.
yes in fact a friend of mine who had suspected IUGR they did an ultrasound each week for the last 3 weeks to see what his progress was. The point was to keep him in as long as possible and only induce if it became necessary.
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#18 of 23 Old 07-19-2007, 03:50 PM
 
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So at my 36 week appointment the OB finally picked up the tape measure and measured me. I was about 3.5 cm behind, according to him. So he ordered an u/s for 38 weeks (Friday) to see if the baby is really measuring small.

From what I've read, u/s in later pregnancy is very unreliable for sizing. So what can they actually tell from doing an u/s this late in pregnancy. I had a NST earlier this week and the baby had plenty of movement & the appropriate cardiac response in the 20 min. I was there. I also have plenty of robust movements still.

I don't want to do any tests that might lead them to force me into an induction or anything like that. Can they really tell if the baby is "too small" at this point? Or if there is some other problem?

FWIW, I did have an u/s at 20 weeks and everything looks ok then.
Small compared to what? Are you and your DH 6 feet tall or something? I am being totally serious. There are things that could inhibit growth but the normal range of baby size varies enormously. A friend of my measured huge, her doc said she had unusually large uterus, and her son was born 6-14. Certainly smaller than what her stomach appeared to be carrying.

To answer your question sizing in a late term of pregnancy is not accurate at all. I wouldn't use it as an indication of anything. The thing is U/S does not change the out come of low risk pregnancies and it is very difficult to see a lot of things good or bad on a U/S.
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#19 of 23 Old 07-19-2007, 03:55 PM
 
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That is so true! U/S missed my firstborn's rib deformities, 3 spleins, and heart being shifted over. Everyone was shocked when he came out.

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#20 of 23 Old 07-19-2007, 04:05 PM
 
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Well I don't really know what to think. I wish he had been measuring all along so he would have known if I was measuring small the whole time. I can't, for the life of me, remember how I carried with my daughter. And the ob didn't seem that concerned. He scheduled the u/s for 2 weeks after that appt. He also said he thinks that I just carry small. But I have to tell you that when I was at the NST I saw another mom due around the same time and she was much larger than me and it sort of freaked me out.

Are there other things they can figure out from a late stage u/s? I certainly don't want unnecessary test but I also don't want to jeopardize the baby.
What is he looking for exactly? The fact he hasn't measured you before and is now ordering tests kind of : 's me. My MW stopped measuring me at 36 weeks because it really doesn't matter after a certain point. I must have missed something why are you doing NST's? Are you a high risk pregnancy?

As far as how people look some people just look different. I carry high and I look like a freaking weeble wobble with legs. I look HUGE. If you look at the belly pics at the top of the forum we all look so totally different in the way we carry. I was measuring 41 weeks at 34 if that gives you an idea of how big my stomach is.
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#21 of 23 Old 07-19-2007, 05:15 PM - Thread Starter
 
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My only risk factor for this pregnancy is age. And the OB I go to requires NST every week after a certain point. Some OBs that deliver at the same hospital require 2 NSTs every week.

The only reason he ordered the test was because I was measuring "small" vs. what is supposed to be standard. He even said he thinks I just run small but still ordered the test.

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#22 of 23 Old 07-19-2007, 05:38 PM
 
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My only risk factor for this pregnancy is age. And the OB I go to requires NST every week after a certain point. Some OBs that deliver at the same hospital require 2 NSTs every week.

The only reason he ordered the test was because I was measuring "small" vs. what is supposed to be standard. He even said he thinks I just run small but still ordered the test.
Are you older than me? I'm 37 and not having to do all this extra testing. (Of course I"m in another country ...) But, the OB can't require you to do all this extra stuff. Your health, your decision. You only have to submit to the tests that you agree to. And it sounds really counterproductive in your case, because all he is doing is stressing you out!
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#23 of 23 Old 07-19-2007, 05:55 PM
 
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Wow. There are so many varibles when it comes to measuring fundal height including: practioner's style (Does he measure from the top of the pubic bone, or starting at the bottom of the uterus--as many OBs do? Does he really get in there and cup down the fundus w/ his hand, or does he just measure to the top, period? If baby is leaning, does he follow the line of the baby, or measure strictly straight up?), baby's position, measuring during a contraction will change the measurement, an engaged baby will measure smaller than it would normally... I could go on...

As other posters have said, I can't believe that this guy hasn't been measuring you all along to get some sort of baseline. I've been UPing for my own pregnancy, but I've had a mw friend measure me every couple of months or so just to make sure that what I'm getting myself is pretty close. (And out of sick fascination--I'm measuring 11 cm ahead at last count.)

So anyway, just take his CYA obstetrical practices w/ a grain of salt, and try not to worry about the baby. BTW, I've seen your belly in the pics sticky, and you carry your baby beautifully. :
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