AHHHHHHHH!

Seriously this is getting ridiculous! Today I had a prenatal appointment and my measurements were "ok" and the heart rate was good. When I asked him about the ultrasound results he told me she measured in the 45th percentile. I'm not sure if that means weight, height or both. Anyway, that is a decent measurement. Then as I was waiting for the nurse to schedule my next appointment he called me back into his office and told me that while her head had measured fine, her abdomen had been small. What in the world!? Then why did the nurse call me and tell me that everything looked good?? She even said that she had a perinatologist look at it. She assured me several times that everything was good. So WHAT IS GOING ON? Again, I didn't have the wherewithal to ask him any of that or how small her abdomen was. All I know is that it's small enough to cause him some concern. And not sure if that's a serious concern or a "just in case" kind of concern like last time. Anyway, he did tell me that this could mean asymmetrical IUGR which is usually a problem with the placenta. Because the brain is a vital organ it gets the majority of the blood so the head grows, but the lesser organs (aka bowel, liver, skin, etc) get placed on the back burner and she doesn't develop as much fat. Another term is "chronically starved." Isn't that a lovely phrase? I'm gaining weight like crazy, but she isn't! Anyway, he ordered another ultrasound to check the growth of the abdomen. The poopy part is that you need at least 3 weeks between ultrasounds to get an accurate rate of growth so it won't be for about another 2 weeks. That is a much longer wait then last time.

The good news is that asymmetrical IUGR is better than symmetrical IUGR. Symmetrical IUGR is usually a problem with the baby and it develops during the beginning of pregnancy, while asymmetrical IUGR is a problem with the mother/placenta and it develops during the third trimester. Basically, her brain and major organs should be ok it's just me starving her and her poor lesser organs aren't developing like they should! Most the time the babies catch up in weight and height within the first year. As far as I read there are little to no developmental delays (since the brain is spared - actually it's called the brain sparing effect) and that most asymmetrical babies have an excellent long term prognosis. Labor and right after delivery for these babies is the scariest part. Because the placenta isn't working well, these babies have a higher chance of all sorts of complications and labor has to be monitored very closely. Apgar scores can be lower, they have a higher chance of spending time in the NICU and all sorts of other things. Sometimes, depending on severity and what not, a c section is the better option. Even then these babies have a harder time right after birth. Still birth and post birth mortality rates are also higher, but not by too much. I think as long as they monitor you closely you're fine. There are obviously chances that the organs that got kind of left out will have problems too, but over time those generally catch up and gain all normal function. Some studies show babies with asymmetrical IUGR have a higher chance of developing hyperactivity, diabetes, hypertension, and obesity, but if that is the case its just a higher chance and we can combat that with good eating habits and exercise. The other good thing is that if this next ultrasound does give her a diagnosis of asymmetrical IUGR I will be 36 weeks and some days so even if they do have to take her I'll be practically full term. Much better than the 32 weeks I was last time. I think induction is the usual course of action depending on the severity of the IUGR since she isn't getting the nutrients she needs from me and can get them better from the NICU. Sometimes I think they prescribe bedrest if it's not too bad. UGH! But being as far along as I will be it wouldn't be for too terribly long. All in all, it isn't the worst diagnosis in the world and for the most part babies with asymmetrical IUGR end up perfectly healthy and normal. I don't have ANY of the risk factors that can contribute to asymmetrical IUGR so hopefully this is nothing. I'm trying not to worry and I'm praying that her abdomen catches up and that this ultrasound shows normal growth and that this was another "just in case" from a very careful doctor. I am grateful that he is so careful and double checks everything. I'd much rather have these extra ultrasounds and deal with a little worry then have a serious problem get overlooked. She may be here sooner than we think - or may not. I'll know in a couple weeks.