Intrauterine Growth Restriction and EIF.


#1

Some background…my daughter is 25 and 19 1/2 weeks pregnant with her 2nd child thru donor IUI. She was carrying twins up until 11 weeks when one of the babies started to regress and she ended up with a vanishing twin by 12 weeks. She was being followed by an MFM due to twins and then after the loss because of a LEEP procedure done after the birth of her first child. At her visit at 19 weeks the u/s tech spent ALOT of time taking pics and the MFM told her that her little girl Lila Rae is measuring small…she’s below the 10 percentile. She also has an echogenic intracardiac foci. The EIF doesn’t worry us as much because we know that is a very soft marker, but combine that with the IUGR and we’re worried.

IUGR is related to chormosomal anomalies and we’re more worried that it would be T18 or T13 where the baby may not even make it to term. I have 2 boys that I adopted that have special needs (asberger’s and moderate MR) so my daughter is not a stranger to children with special needs. Her worry is more to do with the health of the baby as opposed to any delays the child may have down the road…she knows we can deal with them as a family.

Her MFM offered an amnio (which concerns me since they do not offer them unless the risk is high) but she declined as she doesn’t want to stress over the risk of losing this baby after all she’s been thru. She goes back on Dec. 17th for another ultrasound to take another close look at Lila…and then go from there to see where we go next.

Does anyone know anything about early onset IUGR and the risk that the baby will have a chromosomal anomaly? They did say that amniotic fluid was good right now and cord flow was good also. Could there be any correlation between the fact that the one baby didn’t make it…it’s also crossed our mind that maybe Lila was the stronger of the two, but they both had/have a problem and that’s why she made it this far. So much goes thru your head. She has her regular OB appt next Tuesday so we’ll be asking alot of questions there…she was taken so off guard at the MFM that she didn’t think what to ask.
Also, her first child was in the 7lb range at birth and she is 5’2" and 130 lbs and the donor was 5’10" and 185 lbs, but his sister and mother were over 5’6" and his dad was over 5’11".

We’re hoping for just a constitutionally small little girl…but it just seems like that may not be the case.

Thanks for listening and sorry for the loooooong post!


#2

I forgot to say that due to the vanishing twin being late in the first trimester, my daughter was not able to get the blood work that goes along with the nucal translucency test. The twin that was lost was still visible on the ultrasound…measuring approximately 6 weeks at the time adn the doctor felt that they would not give a true reading and would be skewed by the vanishing twin.


#3

One of my twins was IUGR. It was discovered at her 20 week u/s with the MFM. My first visit with the mFm. They are faternal twins. It was caused by restricted diastolic flow in the umbilical cord. At birth we also discovered she had ABO imcompatability. Some how her blood got into me and my antibodies into her. I am O+ twin A was A+ and my littlest was B+. They ended up delivering them at 30’weeks because twin Bs blood began flowing out of her to the placenta. She was about 5 weeks behind in growth. She is now a healthy 14 month old with out any delayments. Also make sure her thyroid is normal. That can cause IUGR also.


#4

One of my twins was diagnosed with IUGR. He was about 30% smaller than the other twin at the 18 week ultrasound. During the pregnancy there was a lot of concern about his viability because they found echogenic bowel on the 12 week ultrasound then the growth restriction. I opted to do the amnio and was also tested for CMV to rule out any infection or chromosomal issues. Both were negative and we never really figured out why he was so small, maybe early onset pre-e or placenta problem? I had growth scans scheduled every 3 weeks and he doubled in size between 19 and 22 weeks but still measured small at 12 oz.
I did end up delivering my twins early due to severe pre-e and placenta abruption. At this point, he is still way below 3rd percentile for weight but he is doing well otherwise. With no other answers, I choose to believe he was just meant to be small and things would work out for us and I pray that’s the case for your daughter.


#5

IGUR Twins

Hi there - I am 34 weeks pregnant with twin boys- and this last week we had an ultrasound that showed baby A < 3% and baby B =22% - the umbilical artery dopplers were normal as was the amniotic fluid. I will now get NSTs twice a week and dopplers each week. The doctors think I will make it to 37 weeks. I am so worried- anyone with a similar story with a great outcome that they want to share? I just want to know that they will be ok -

Merry Christmas to you all! Thanks in advance for your help.


#6

My girls were born at 30 weeks due to a 54% weight difference. My smallest was almost 1 lb 11oz (she dropped to 1 lb 8 oz) and my biggest was 3 lb 1 oz ( dropped to 2 lb 8 oz) the one without IUGR had more problems than the one with it. They say that when they have to struggle intero they come out fighting. My littlest needed no breathing support. And had few apneas. She was just small. Now she is 15 months at 18 lb 28-3/4in. Very small but chunky without any delayment. She is walking and knows 15+ words. Their weight isn’t A’s important as how long they have been able to develop. Your boys have made in very far so I wouldn’t be too worried. They would like to see them over 4 lb to leave the hospital. If mine made it A’s far A’s yours they probably wouldn’t have needed a NICU stay either. My littlest just had to stay to meet the 4 lb mark Which didn’t happen until she was 38 weeks. (8weeks post birth) good luck with your boys:-)


#7

Thanks!

Thanks Lovelyrose! It does help to hear success stories - everything I read on the Internet is doom and gloom. Congrats on your new pregnancy!!

A


#8

Thanks:-) We try so hard to get pregnant and bring these babies into the world healthy. We think they are so fragile, but they are so resilient. The last thing affect Is the brain. The body had a brain sparring effect. If is lacks nutrients or blood it bypasses other organs so that the brain is not effected. The doctors will notice the kidneys start to fail and a problem with low amnionic fluid before the brain is even effected. I had a high def ultrasound with cardiac Doppler twice a week for 2 months so really got to understand the whole process. You have carried those boys for a long time. Their bodies are maturing they just are small. Let me know how they are once you see their beautiful faces. Good Luck:-) twins are wonderful.


#9

LovelyRose27…I was the original poster and I too found your words encouraging, but still stress over this. My daughter has had u/s every 2-3 weeks and we found at the last one that her baby girl, Lila has dropped down to the 3%. She goes back January 3rd so we’re hoping this can get turned around as she won’t even be 24 weeks until this Monday, December 27th. Even though Lila’s IUGR started early on in the second trimester it and she was symmetric with no brain sparing, it does seem like the abdomen is starting to measure further behind the rest of the body. The MFM stated that it is very possible that we could start to see placental problems in the next few weeks. If anyone has had IUGR happen this early on I would love to hear how things went. While they said there is still a small chance of downs, she did have the quad screen done and that put her risk at over 1/300. We’re more concerned about Lila’s size. She’s only 390 grams, so we just want her to grow grow grow!!!


#10

IUGR was detected at 20 weeks in the twins. The dr had me come back at 23.5 weeks. I was admitted to the hospital. The flow in the placenta was absent end diastolic. This means that no blood flowed through the umbilical cord when the heart muscle relaxed. I was told it was inevitable that the flow would change to reverse diastolic. This is when the pressure is so High that the blood flows from her to the placenta. Once this occured frequently she had on average 24 hrs to live and would be delivered that day. This happened at 30 weeks on the dot. She has absent end diastolic flow intermitent from 26 weeks on. I stayed on bed rest in the hospital the woile time. She measures 3 weeks behind at 23 weeks 5 days. At delivery she was over 5 weeks behind in growth. At 20 weeks she was 1-1/2 weeks behind. This is a scary time but all I could do was not to stress and crazy as it seems I didn’t. I went into almost a trance and just focuses in spending every minute enjoying my girls. It changed the way I see everything. Please keep me up todate on your grand baby and daughter. I will be thinking of you all.


#11

Thyroid and IGUR

Hi Lovelyrose- you mentioned something about thyroid - are IUGR babies hypo or hyperthyroid? Does it matter what the mom is? I was diagnosed with hypothyroidism as part of my infertility work up and I have been on Synthroid since April 2010. Lately I have been having a fast heartrate and feeling overheated all the time - do you think I should get my TSH checked?


#12

I would def have your thyroid checked. Hypo and hyperthyroidism can cause IUGR. Since mine was never tested I do not know if my thyroid issues began after pregnancy or during. The cause my my IUGR was never determined. It could be several things or a combination. I didn’t realize thyroid played a role until after my girls were born when I was doing research trying to find a cause. One of my girls was born with abnormal through values so we really don’t know. I think it should be standard work-up if IUGR is diagnosted. It is a cheap test and easily treated. I don’t know why they don’t test it dueling pregnancy. Good luck with your twins. You’ve made it so far. That is the best thing you can do for them.