Category Archives: IUGR

A Cause for the IUGR

I had my 6 week postpartum appointment yesterday. Baby A came with me and screamed a lot. I ended up breastfeeding her while walking into the appointment room and during my pelvic exam…surreal. Everything looks good on my end!

We discussed several things throughout the appointment. 

•I expressed to her that I do not wish to be on birth control. Firstly, I am not convinced that it didn’t contribute to our difficulties TTC. Secondly, we plan to try again (although I cannot imagine that right now…more on that in another post). Lastly, I have switched to all natural products and I am not interested in introducing hormones into my body at this point. 

•She said that since I had an uncomplicated vaginal delivery we could try again as early as 6 months (I think that’s crazy).

•When my cycle returns and is regular, she can order a follow up FSH, AMH, and E2 so I don’t have to go back to my HMO fertility clinic right away. I am relieved about that (even though I had a pretty great experience with our RE). I’m wondering how those numbers will have changed a year or so after having them drawn. I also hope it will give us an idea of what to expect. 

•And now the main point of this post. The results of my placental pathology. It was small (as we already knew from looking at it after delivery). This could have been due to the UU (meaning the smaller size of my uterus) or uteroplacental insufficiency. The placenta showed signs of chronic uteroplacental insufficiency. Basically this means that the blood flow from my uterus to the placenta was insufficient for a good chunk of the pregnancy. Thus the IUGR diagnosis. I have lots of thoughts about this. 

Firstly, the baby was in the 38th percentile at the 20 week anatomy scan. That is normal. Then, right before 30 weeks at our growth scan, she was less than 3rd percentile. So things went wrong somewhere between 20-30 weeks. I stopped taking the baby aspirin at 28 weeks (which I was taking to hypothetically increase blood flow to my uterus…who knows if it helped. I feel it did help). I don’t think that would have affected growth that drastically in 2 weeks but I can’t help but wonder if I had stayed on it (or restarted it) if her growth would have been less restricted. 

Secondly, I wonder if the less than ideal blood flow had anything to do with my 3 miscarriages. I did not take aspirin until before the 4th pregnancy (which actually worked). I do have signs of poor egg quality with high FSH and boarderline AMH. All the miscarriages were missed, with no growth each time past 6-6.5 weeks. Could that have been due to poor blood flow and not egg quality? My gut says its egg quality. I guess we will never know but I wish we could. Too bad we were unable to test the embryos that miscarried.  

Thirdly, I wonder if the pregnancy being successful is because the embryo implanted in an area of the uterus that had better blood flow and the majority of my uterus has poorer blood flow. Those with a unicornuate uterus can have poor blood flow due to the abnormal formation of the uterus. Am I doomed to have tons of miscarriages? That remains to be seen.

Lastly, I wonder if I am lucky enough to get pregnant for a second time (and not miscarry) if this will happen again. And if not, how much more will my uterus grow? Can I make a bigger baby in my half uterus? It obviously stretched a ton this time but not like a normal sized uterus did. 

I made my OB cookies and wrote her a thank you note because she was so incredibly kind and supportive throughout the entire pregnancy. I know I was a high needs patient (for good reasons I think) and I wanted to let her know how thankful I am for her care. I ended the card saying “I am so thankful for my beautiful baby”, and I teared up as I wrote that. The gratitude I feel toward having her is immense and I don’t think I could put it into words. 

She grew!!!

I had my growth scan at 34 weeks 5 days and baby girl put on 1 lb 3 oz in the past 2 weeks! Now she’s estimated to be 4 lbs 3 oz. still tiny but up to the 3rd percentile. I’m hoping she can break the 5 lb mark by our induction at 37 weeks. Blood flow through the cord still looks good, as do my fluid levels, and she’s still passing her NSTs. My BP was slightly higher than my normal but still ok (128/88), and I had trace protein in my urine. My MFM wasn’t concerned so I guess I’m not either. 

My MFM scheduled our induction for October 1! That’s 37 weeks exactly. Less than 2 weeks from today. For some reason having this scheduled finally got me excited! The hospital will call us sometime after 4pm to let us know what time to come in to get started. I’m assuming this is because they do the scheduled c-sections earlier in the day and then the scheduled inductions happen afterward. From what I understand, they will give me medicine to ripen my cervix, and possibly use a foley balloon to help dilate me. Then I’ll probably get some pitocin. I’m not super excited about the possibility of a balloon to dilate my cervix or pitocin as I hear both can be painful, but I guess we do what we gotta do to get the baby out safely. I know the nerves about being induced will hit eventually but for now I’m just going to enjoy this incredible feeling of excitement! 

Now I’m nesting like a mad woman. My hubby set up the crib and changing table yesterday, and I bought the rest of the necessities off of our registery. Tomorrow is baby laundry day and then I’ll put everything away in its rightful place. I am a terrible decorator and I’m not into themed things but I had a ton of fun picking out cute crib and changing table sheets. Nothing is matchy but I love them all. Once I’m finished getting everything together I’ll try to remember to post pictures so you can all see my valiant attempts at nesting!

I had my friend-thrown baby shower yesterday, and it was so fun to celebrate the baby with my girlfriends and family. My aunt (who is an artist) gave me some incredible illustrations that I’m going to frame and hang by her bed. Everyone gave her a book to add to her library. My husband and I love to read so it’s great to have so many books now. Some of the books we got are from our friend’s childhood collections (used) and I think that’s so cool!

I also had my last day of work this past Wednesday and yesterday was my first official day of maternity leave. I’m so happy to be off now, as it was getting really hard to be at work on my feet all day, and sitting in the car for long periods of time commuting has been torture!

I hope everyone is doing well!

IUGR Update

I had my growth scan yesterday at the MFM’s office. Baby girl only gained 5oz and now weighs 3lb 1oz. Now she’s less than the 1st percentile. It’s great that she gained some weight, however tiny the amount, but I’m just so sad at how tiny she is. If she gains 5oz every two weeks and we are being induced at 37 weeks, I’m on track to have a baby who weighs around 3lb 11oz. That’s a TINY baby. I really hope the scan is off and she’s actually going to be bigger (not smaller). I also hope we can make it to 37 weeks without any issues. My MFM keeps telling me that it’s the gestational age that determines outcome, not weight. He’s glad we made it this far already (33 weeks tomorrow) and we are hoping everything continues to look good until induction. I’m still incredibly scared and sad that my body cannot nourish my baby appropriately. I’m so scared to have made it this far and then she doesn’t make it. My MFM also reassured me that with the close monitoring the risk of a still birth is quite low. I’m still scared, though. 

Thankfully, she’s still passing all of her NST’s, blood flow to the baby looks good, and the fluid levels are good. You could see her practice breathing on the ultrasound. It was really cool! 

We are looking at induction at 37 weeks, which we will schedule at my next appointment in 2 weeks. I’m scared of the induction itself, as I know labor that is induced has a higher risk of c-section. That, coupled with the fact that IUGR babies tend to tolerate induction poorly, makes me think I will end up with a c-section regardless. Ugh, I was really hoping for an unmedicated vaginal delivery but obviously whatever is best for the baby is what I want. I just know that pitocin contractions are supposed to hurt more and if I need a c-section right away for a problem it may be better to just have the epidural in place so I can be awake for the birth. So many things to consider. 

I’m really struggling with feelings of guilt and sadness. There has been lots of tears and I am really feeling blue. I know we all have our battles to fight but I just wish this wasn’t mine. I feel like my body sucks in general, with the poor egg quality, recurrent miscarriages, and the unicornuate uterus, and now it’s potentially contributing to lifelong issues for my little girl. 

In other news, I had my first baby shower, thrown by my husbands family. It was a joint baby shower as my SIL is expecting in December so we figured it made sense to combine them. It was wonderful to celebrate our baby, no matter what the outcome. I only got one “you’re so small” comment that I just brushed off. My SIL was 26 weeks to my 32 weeks and her bump is the same size as mine. Really great for my self esteem. We got a ton of clothes, and a lot of the stuff off of our registery. 

Speaking of the “you’re so small” comments, I really struggle hearing them. It just makes me feel bad about myself. I am also concerned about getting the “your baby is so tiny” comments after she is born, so much so that I don’t want any visitors after she is born. I’m sure this is unrealistic but it’s just how I feel. I don’t want to be judged as a poor mother because my baby is tiny. I already feel horrible about myself. These feelings concern me in general because I am concerned about post partum depression and anxiety and I feel like this may put me at a greater risk. I guess it’s good that I’m aware of the feelings already but it’s still scary. 

Thank you for reading if you made it this far. I hope everyone is doing well.

First MFM Appointment

This past Thursday was my first meeting with the MFM. I had a full on anatomy scan to go with the growth scan, and they also checked my cord flow from the placenta to the baby, and my amniotic fluid levels. 

Dr. C is awesome. He says that the most likely cause for the IUGR is my unicornuate uterus (as expected). My fluid levels are normal, blood flow to baby looks good, no markers for TORCH infections, no hypertension or diabetes, and completely normal-looking anatomy (so low risk for a chromosomal issue). I am relieved that everything looks good, but at 30w4d she weighs 2lb 12oz, which is the 3rd percentile. She’s incredibly small. The biggest risk here is stillbirth, which he says is a very small risk since I will be monitored so closely. I hope that’s true. 

The plan is for me to have twice weekly non-stress tests (NST), once weekly ultrasounds to measure the flow to the baby from the umbilical cord, and to check my amniotic fluid levels, and every other week growth scans/appointments with him. He says even if she doesn’t grow, as long as everything still looks normal we plan for an induction at 37 weeks. He also said that if things still look good at 37 weeks we can discuss pro-longing the pregnancy. I am also able to try delivering vaginally if the baby stays head down (I think she will stay head down since I’m pretty sure she had no room to turn). However, IUGR babies tend to get stressed during labor so I may end up needing a c-section anyway. 

I have had 2 scheduled NST’s so far and she passed both of them. For the first one I had contractions registering every 1-5 minutes the whole time, and I could even feel them all. I also went into labor and delivery last night because the baby had reduced movements all day. Luckily everything looked great on the NST there and she is moving back to normal today. I also had a few mild contractions I couldn’t feel. Apparently that’s my new normal. 

So how am I feeling after all of this? Honestly, I’ve been a bit of a mess. I’m incredibly scared that my body will be unable to continue growing her and I’ll give birth to a tiny baby with a whole host of problems. I don’t think I could forgive myself if that happens. I just keep wondering if it was selfish for me to try carrying a pregnancy with this known uterine anomaly. But then I have to remind myself that we don’t know the outcome, and we took a calculated risk. I am just hoping for the best. 

Thank you to everyone for your support. If all goes well I get to meet my little girl in about 6 weeks. I am so excited (and scared). A year ago, I could have never fathomed that. 

IUGR

I had my growth scan yesterday and my baby girl is measuring about a week behind at only 2.5lbs at 29w5d. That’s less than the 4th percentile, and we have officially been diagnosed with IUGR. Other than the low weight, everything else looks normal. 

I have been incredibly sad about this, even after talking to my OB, who seems fairly confident that everything will be ok. She wants me to have twice weekly non-stress tests where they will measure the baby’s heart rate and check my amniotic fluid levels. I start this on Monday as I am currently on a plane to Colorado for one of my husbands best friends weddings.

As of my scan yesterday, my fluid levels are normal and the blood flow from the placenta through the cord to the baby looks normal. So the most likely cause of the IUGR is my unicornuate uterus. I wonder if my uterus will continue to grow or if we have reached our maximum size. I will also have a more detailed growth scan this upcoming Wednesday with a maternal-fetal medicine Doctor to double check the baby. Then I think I get followed up there in addition to my OB. I will have more answers on Wednesday.

My husband is my rock, he is so optimistic that everything will be fine, and she’ll just be small. I’m so lucky that he thinks that way. On the other hand, I am trying to stay calm and positive, as I know what IUGR looks like in premature and term babies. I am really hoping to avoid a NICU stay, but even if we can make it close to term, we may be stuck in the NICU anyway so she can gain weight, we know she can maintain her temperature and breathe correctly. Sometimes ignorance is bliss, and my job can be a curse. But at least I’m prepared for what the NICU entails (although it’ll be so strange to be on the patient/parent side).

I am so sad that my body can’t grow my baby correctly. While I know I did nothing to cause this, it’s still hard not to feel incredibly guilty. My poor baby did nothing to deserve this and I am so sorry to be putting her through this. I really hope she continues to grow and develop inside me and there are no lasting long term problems from the IUGR.

She is always moving and reminding me she’s there and I am so grateful for that. I never thought I would get the opportunity to be pregnant and now I am almost 30 weeks. It’s amazing how you can love something so much that you haven’t ever met.

On the ultrasound you could see little tufts of hair on the back of her head. She was also super stubborn like her Daddy and wouldn’t move into a position where we could get a full profile shot. She’s super deep in my pelvis (head down) and my hip was in the way. But we got a cute picture of her. She seems to have a small nose and big lips (those are probably from me). I can’t wait to meet her, and I hope I have the opportunity to be her Mommy for a long time.