Brief Answer: Detailed explanation given below Detailed Answer: Hello and welcome to HCM, I am Dr Nilajkumar a consultant gynecologist and I will be helping you in your queries. I understand your query. The report that you have typed out only shows the dimensions. It does not mention if how much weeks a BPD of 77 mm correspond to on that sonography machine. Also there is no mention about the amniotic fluid or liquor. So please upload the complete report, previous reports if any and also the date of the last menstrual period. It seems the doctor has prescribed an amnioinfusion for a small baby. Being a gynecologist myself, it is my experience that many times there is a difference in the estimated weight and growth of baby as determined by sonography versus that determined by examination. I believe more in my examination findings and so do many doctors as the machines have inherent errors. Many a times it happens that we feel the baby is small and the amniotic fluid is less on examination, but sonography does not show it. I have seen this in cases where examination revealed severe Oligohydramnios but sonography showed everything normal. Palpation detects less liquor and lower side baby weight with more ease as we see the baby's development in every visit and understand the amount of progress. By the time ultrasound detects IUGR and less liquor, it is already in the severe category by examination findings. We also tend to judge if the baby will deliver easily with this weight and liquor or it needs more. This judgement is lacking in the ultrasound report. The charts are not always standard and may not even follow Indian standards. Also the weight is near the 15 percentile in the chart. So it is on the lower side of the normal. Ideal weight is at the 50 to 75 percentile. The reason for this explanation was just to show you that things are not always as the reports show, and medical science is not very accurate even now. If you feel that the reports are alright and are in doubt about the infusion, it would be wise to have her examined by another doctor. Please choose someone with experience. Do not show the current report and just see if the other doctor also feels if the growth is less. If she too feels the same, then most likely the baby weight is on the lower side and your wife may need additional treatment. For me the weight is within the limit but is on the lower side of the expected. At 32 weeks many babies of well to do families in India have a weight nearing 1800-1900 gm. So 1618 is on the lower side though not an IUGR weight. If you do not want to go for an amnioinfusion, drugs like alamine forte tablets, protein powder supplements twice daily with milk, iron, vitamin tablets, arginine XXXXXXX must be used with a doctors advice and yield similar results. A proper nutritious diet containing green vegetables, sprouts, 2 fruits a day, one egg a day, cereals, pulses and a few serving of meat or fish [ if non vegetarian] are very helpful. She must take at least 2 big meals and 2 small meals during the day as the baby will grow fast now. Sleeping on the left side as much as possible, morning walk and avoiding heavy work also help in fetal growth. So please mention the full report and also any earlier reports. And do not worry as the baby is still within its limits of growth and with a little improvement in diet and lifestyle may pickup growth fast. Hope this was helpful. Feel free to ask any further queries and I will be happy to help. Thanks for using HCM. Have a good day. Dr Nilajkumar Bagde Consultant Obstetrics and Gynecology

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Brief Answer: Please get a repeat scan Detailed Answer: Hello and welcome, I have seen the reports. I have already said that I believe more on clinical judgement than scan. The scan report does not follow a normal pattern that we see in babies that are growth restricted. It does not mention what gestation the BPD, AC, HC and FL corresponds to. Another thing in it is that if you see the percentiles: In growth restricted babies, normally the body tries to spare the brain and so the head parameters are usually normal. What is affected is the abdomen where fat is stored. As the baby is deprived of nutrition, this fat is not stored and hence it has a thin abdomen. [ you must have noticed this in malnourished children, their heads are normal but the stomach is absolutely fat and limbs are thin.]. Babies follow a similar pattern. In your report if you see the HC [head circumference ] and BPD [Biparietal diameter] both the head parameters are on the lower side in fact HC is below normal while the abdomen [ AC] is better. So this is in contrast to what happens in growth deprived babies. Also with such growth restricted parameters, most of the time the Liquor [ fluid around baby] is many time low. Here this is normal. So as of now I suggest that you get a repeat sonography from a doctor who is an MD radiology. Just search for one and you will find. It is better to let them scan first and then show the old reports to avoid bias. Also consult another gynecologist let her examine your wife and get a second opinion. After both the scan results compare them and see if they match. If it still goes in favor of growth restriction you may go for amnioinfusion. Meanwhile please start alamine tablet and protein powder [ preferable mothers horlicks] diet and plenty of water intake as it will have same effect as the infusion. I hope that I was able to explain things. Please feel free for any more queries. Dr Nilajkumar

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