What Causes Decreased Blood Flow Pattern In The Placenta During 36 Weeks Of Pregnancy?

Posted on Wed, 1 Apr 2015

Question: My wife is 36 week pregeneat. During our last two visits our gynac had a observation that looking at tummy the baby looks like 30 week at 33 weeks and 32 weeks at 36 weeks. So she casked us to do a droppler test to see if blood flow from Cord, Heart and Brain is proper. During the test Dr measured the length in various parameters which was coming 32 weeks + some days in all parameters.

But still during the second visit Dr was the opinion the growths looks slower and asked my wife to monitor the movements of baby very closely now.

Question is
Should we be concern if Dr concludes something basis physical examination
Is it normal for a Dr to ask to look for babay movements after 37 weeks

Answered by Dr. Sameer Kumar (16 minutes later)

Brief Answer:
IUGR surveillance required...

Detailed Answer:
Hello,
Thanks for the query to HCM,
If on clinical examination at 36 weeks your doctor found that the growth was 32 weeks clinically then it is likely that the suspicion would have been a case of intrauterine growth retardation or IUGR. This has to followed now with weekly fetal growth parameters and NST along with umbilical artery Doppler to look for ant decreased flow pattern or reversal of flow , which would be an indication of termination of pregnancy.
The interval growth of the fetus between two scans 2 weeks apart should be more than 10mm in ABDOMINAL CIRCUMFERENCE DIAMETER on ultrasound . If it is less than that , the growth is inadequate and there is utero-placental insufficiency not allowing enough blood flow to the fetus leading to growth retardation.
The fetal movements are a guide that the baby is fine. Anytime the fetal movements are less than 10 in a day , you should report to the hospital and get a urgent Doppler study and USG with a biophysical profile & a Non stress test done to check for fetal well being. If at any moment the umbilical artery Doppler is deranged then immediate delivery by cesarean section should be performed.
Ideally , established IUGR cases should be delivered by 37 weeks as per the guideline as chances of still birth increases after that with each week. The catch up growth for the remaining 3 weeks can be achieved after delivery and is healthy for the baby.
As the USG ascertained growth to be 32 weeks at 36 weeks, IUGR SURVEILLANCE has to be established and weekly monitoring is must.I hope i have answered your query in detail,
Wishing her safe delivery,
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sameer Kumar (16 minutes later)

USG ascertained growth to be 32 weeks at 33 weeks (we didi USG on 21 Feb). But when we went agian on 13th XXXXXXX Dr Checked the tummy and said it still looks like the growth is slow. On 13 XXXXXXX 2015 she did a Non stress Test. The test results were normal.

In a nut shell what your view on recommending a immediate delivery by cesarean section. Is it required and a safe approach ?

Answered by Dr. Sameer Kumar (7 minutes later)

Brief Answer:
answered

Detailed Answer:
As i mentioned early, the decision for immediate delivery shall depend on the umbilical artery doppler study if there is a reversal of flow in the pattern.
Nextly , if the USG growth is normal at 33 weeks ( fetal growth 32 weeks), and just by clinical examination , one can suspect IUGR but confirmation can be done only be serial interval abdominal circumference growth at interval of 2 weeks which should be more than 10mm.
If NST is normal , even with a clinical suspicion umbilical artery doppler and biophysical profile should be done to rule out or establish IUGR.
Clinically, a decreased AMNIOTIC FLUID INDEX or sometimes a tall woman, the uterine growth appears less.
So in my opinion, there is no hurry if lab and ultrasound with doppler parameters are normal, then she is not an IUGR , but daily fetal movement count is necessary.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar