Brief Answer: Do not worry Detailed Answer: Hello and welcome to HCM, I understand your concern and also it stems from the fact that you have already had lost one baby. The first issue that I must clarify is about your previous pregnancy loss: You mention that it was due to cervical incompetance. It means that the cervix was not strong enough to stay closed until 9 months and opened up early. Hence the baby could not remain inside and was lost. This does not have anything to do with the placenta. So these are unrelated. Now about the grade 2 maturity: The placenta is displaying advanced maturity as compared to what is expected at this gestation. A grade 1 placenta is expected till about 30 weeks or atleast till 25 weeks. This means that the placenta is more aged as compared to the pregnancy. This is found in many conditions in pregnancy. The first thing that needs to be ruled out is weather it was a false positive report. This is a possibility as ultrasound is a subjective investigation and 2 different people may have different opinions. So get a reevaluation form a different radiologist preferably MD radiology. Other causes of grade 2 may be impending IUGR or fetal growth restriction. Here the nutrient supply to the baby may decrease if the placenta continues to age further. As the placenta ages calcium deposition begins in it and interferes with transfer of nutrients from mother to the baby. This is more so if it is a grade 3 placenta when the nutrient depletion begins. Other complications of pregnancy like diabetes, increased blood pressure in pregnancy [ preeclampsia], oligohydramnios [ decreased amniotic fluid], antiphospholipid antibody etc may also show a placenta that is more mature. Having said all this the best way to know if blood is flowing properly from the placenta is by a doppler study. It must be done beyond 24 weeks as before 24 weeks the interpretations may not be proper. The blood supply to the baby is visible by doppler and gives an idea if the baby is compromised. Other things that need evaluation and help in making a call are babies growth and weight as well as amount of amniotic fluid. If these are Ok, there is no need to worry. My advice for you as of now is : 1. You have lost a baby due to incomeptant os. So I want to know if a cervical stitch has been applied this time. It helps in preventing preterm labor and helps continuation of pregnancy. 2. There are no drugs to improve placental aging. However you may try the following measures to aid fetal growth. Get good antenatal care and regular blood pressure examination. Lie on the left side as much as possible to improve blood supply to the baby. Drink plenty of fluids to maintain hydration. Relax and have faith in your doctor and yourself. Stress is not good for the baby. Maintain proper nutrition and have atleast 3 meals a day. Tablets like aspirin low dose help to improve fetal blood supply and can be taken after consulting your gynecologist. Alamine forte provides essential nutrients and can be taken twice a day. Protein powder [ mothers horlicks works best] 2 table spoon with milk twice a day help. 3. Get a repeat ultrasound after 2 weeks to check for fetal growth, if it is growing properly, do not worry. Get a doppler after 24 weeks preferably 28 weeks if growth is ok in the serial ultrasound scan. Continue your medicines and you will be alright. Please do not worry as many times it remains grade 2 till 39 weeks. So it does not mean that a grade 2 report indicates a compromised baby. Hope this satisfies your query. Thanks for using HCM. Feel free to ask any more questions that you may have. I am always here to help. Dr Madhuri Bagde Consultant Obstetrician and Gynecologist

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Brief Answer: baby is fine! Detailed Answer: Hello and welcome back. The babies weight is Ok for 17 weeks. This means that it is showing proper growth. A grade 2 placenta does not interfere with fetal blood supply so it must not be an issue as of now. The cervical stitch has been applied and the length of the cervix is also not very short. Tablet duvadilon has been prescribed so that the uterus will stay relaxed and preterm labor pains avoided, as you have a history of incompetant os. Any contractions may dilate the os so duvadilon helps in preventing it to some extent. Calcium intake is not related to calcium deposition in placenta. So please do not stop taking it. Calcium is important for the blood vessels to stay relaxed. So decreased calcium has been associated with high blood pressure in pregnancy. Unfortunately in medical science things are interlinked and we doctors have to balance benefits versus harm all the time. This is the reason that it is not possible to explain everything to the patient and also logic may not always hold true in medicine as things are complicated and interconnected. So a grade 2 placenta may be bad for one and normal for other. Also it is not possible for us to change it nor prevent its aging. Worry will not help. It may worsen things. So please stop worrying. Progesterone is normally produced in the body during pregnancy. Very few females need its supplementation. If there are no symptoms like pain after stopping progesterone there is no need to take it as adequate amounts are already there in the body. So please do not worry so much. Your baby is doing fine now. Relax and think positively. I understand your concern as a mother. But we must leave some things to nature. You are trying your best. Just have a follow up ultrasound after 2 weeks and mail me the complete report including BPD, AC, HC, FL, EFW and placental grade. Get this done from another doctor and let him provide the report first then discuss placental issues so as to avoid a bias. Meanwhile continue your current medicines and add a protein powder like mothers horlicks and alamine forte tablets to ensure proper fetal growth. Hope this answered your query. Feel free for any more queries and I am here to help. Dr Madhuri

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Brief Answer: Placenta grade and progesterone not linked. Detailed Answer: Hi and welcome back, Even at 20 weeks, the fetal weight ranges from 275 to 387 grams. So yours was still Ok. The baby weight does not increase much until 26 weeks after which it starts to grow fast. Progesterone intake and placental grade are not linked as such. However progesterone is produced by the placenta. There are no studies that have showed correlation between progesterone and placental grade accelaration. Please stop worrying and let the baby relax. Just get an ultrasound after 2 weeks and we will know what is happening. However just think that this is a normal pregnancy until then as stress will hamper the pregnancy. Continue the treatment and you will be fine. Stopping progesterone for a week will not cause the placenta to suddenly grow from grade 1 to 2. It does not happen like that. If you are so stressed about progesterone, take it as it does not cause any harm. Hope this was helpful. You may upload the results to my profile page. I learnt that I am not allowed to disclose my email here. So sorry for that. You may post me at my address in my profile page with a reply envelope with your address. Dr Madhuri Bagde Consultant Ob Gyn

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