IUGR Again?

The one or two readers that still read my blog from back in my first pregnancy might remember that they were worried that my son had Intrauterine Growth Restriction (IUGR). You can read more about my experience here, here, and here.

Story Summary: My fundal height was only 30 at 34 weeks (if there is more than a 4cm lag this is an indication of IUGR). Nugget measured less than the 5th percentile in a week 35 ultrasound with a perinatalogist. I went in for twice weekly non-stress tests and bi-weekly ultrasounds until Nugget was born to monitor his progress. Nugget ended up being born full-term at 6 lbs 2oz, which is outside of the IUGR range, and was just a small baby. No need for the IUGR drama.

A little education on the issue.

IUGR also known as intrauterine growth restriction or small for gestational age (SGA) occurs when the fetus is less than 10 percent of predicted fetal weight for gestational age. There are two types of IUGR.

• Symmetric--head and stomach are both behind. Could be associated with a chromosomal problem, like Down's or Trisomy 21, or just a "constitutionally small" baby: i.e., just a small baby. Nugget had symmetric IUGR; his body and head were proportionally small.


• Asymmetric--head is larger than stomach. Indicates maternal causes such as chronic hypertension or placental problems.

Indications of IUGR:

• mother's fundal height lags by 4 cm


• baby's ultrasound measurements indicate that baby is less than 10th percentile in weight, height, etc.


• at full-term birth, baby weighs less that 5 lb 8 oz

If you have had IUGR during a previous pregnancy, you are more likely to have it in subsequent pregnancies. Therefore, my doctor has been having me come in for ultrasounds every 4 weeks to see how the baby is doing. IUGR typically doesn't present itself until after the 30th week in pregnancy.

Yesterday, I had our 28 week ultrasound. At first, I was reassured because Baby Girl was measuring in the 50th percentile overall, although I did notice that her head circumference was in the 3rd percentile. I assumed that since the rest of her measurements were in the 50th percentile that we wouldn't worry about the head circumference. Plus, my fundal height is 27, which is only 1 cm off and within the normal range (i.e., within 4 cm).

Wrong.

My doctor wants me to go the the fetal specialist in two weeks to get another look at the baby. At first, I wasn't worried. I've been through this before and spent weeks 35-39 of my last pregnancy (he was born at 39 weeks) worrying about whether there was something wrong with beautiful Nugget. I vowed not to make the same mistake again. But, then I realized that Baby Girl doesn't have the same potential type of IUGR. Nugget had symmetric. Baby Girl has asymmetric, which usually presents with a larger head as the blood flows to the most vital organ, the brain. However, Baby Girl's head is much smaller than the rest of her body. The only reason I could find for this is microcephaly, which I don't even want to entertain. I talked to my doctor about this and she said that the 20-week scan did not show any sort of abnormalities in brain development (or any other organs for that matter), so she was not concerned that this might be an issue for Baby Girl. She emphasized that just as there is variation in the human population in size of limbs, heads, etc., there is also variation in babies sizes in utero. And, as I've mentioned previously, my husband was told that his head was "out of regulation" when he was in the Air Force ROTC in college (i.e., SMALL!). So, Baby Girl could just have a small head like her daddy.

I'm trying to pack away any concerns I have about Baby Girl and buckle down to get my nesting projects complete. But, the OCD part of my brain wants to spend hours and hours on every so helpful internet research!

Week 27 Running Stats

Thursday, October 13, 2011: 70 minutes elliptical, Body Flow, 2 mile walk

Friday, October 14, 2011: 9 miles

Saturday, October 15, 2011: 11 miles

Sunday, October 16, 2011: 9 miles

Monday, October 17, 2011: 6 miles (running and lots of walking, Baby Girl was in awkward position that made running hard)

Tuesday, October 18, 2011: 10 miles

Wedensday, October 19, 2011: 60 minutes elliptical, Body Pump (the beauty of not "training" for anything is that I can skip running when it is raining! )

Total Mileage: 45 miles + cross training

Comparison to Pregnancy #1: 32.5 miles + cross training

Pictures from Week 28 and 1 day!