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Intrauterine growth restriction - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Pregnancy
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2435 Questions
User :   Hi doctor , my wife is 26 weeks pregnant and is having IUGR, ultrasound diagnosis showed GA of 23 weeks. We had a color doppler ultrasound done which states that "the umbical artery flow velocity waveform shows an absent end diastolic flow" and the AFI 2.She is on bedrest , fetal heart rate is monitored twice a day and is coming out normal till date but her BP is variating alot which is also monitored daily.Also she is taking suppliment medicines ( Ecosprin 75mg , Alphadopa , depin R20, guardian, Argin, Cal 40 and Iron..) once a day and she was on Aminovein 10% intra venous for three days and on fragmin(5000 IU) injection S/C. We are a liitle worried regarding the treatment if its in right direction ? or something else we can quickly opt. Kindly help
Doctor :   Hi,
User :   Hi doctor , my wife is 26 weeks pregnant and is having IUGR, ultrasound diagnosis showed GA of 23 weeks. We had a color doppler ultrasound done which states that "the umbical artery flow velocity waveform shows an absent end diastolic flow" and the AFI 2.She is on bedrest , fetal heart rate is monitored twice a day and is coming out normal till date but her BP is variating alot which is also monitored daily.Also she is taking suppliment medicines ( Ecosprin 75mg , Alphadopa , depin R20, guardian, Argin, Cal 40 and Iron..) once a day and she was on Aminovein 10% intra venous for three days and on fragmin(5000 IU) injection S/C. We are a liitle worried regarding the treatment if its in right direction ? or something else we can quickly opt. Kindly help
Doctor :   Let me read your query for few minutes to be able to have a good discussion here
User :   ok
Doctor :   She is on right treatment
Doctor :   May i know her BP range ?
User :   150/ 100 past 2days in morning and today it was 140 /92 but in evening it comes almost normal.
Doctor :   The antihypertensives she is on are indicated in PIH cases with the BP range you mentioned
Doctor :   Are you there ?
User :   doctor the sonologist which done her doppler gave a professinal statement of salvaging the pregnancy 4 days back... but its our family decision to let the baby revive from the condition. Whats your opnion doctor? was it right to consider the sonologist?
Doctor :   may i know the fetal weight ?
Doctor :   as mentioned in a Obstetric scan
User :   400 gms approx. but the fetal heart rate is normal till date as diagonised by Gynae.
Doctor :   i would consider to take chances
Doctor :   the POG according to the scan and the weight though are low , but too low to opt for termination
Doctor :   but a keen observation over weight of the mother and fetus has to be done
Doctor :   the medication she is on is optimal to bring down the BP in her
User :   doctor whats this PIH i am unable to understand.
Doctor :   also a strict monitoring of the BP and titrating the medication would be necessary
Doctor :   PIH is Pregnancy induced hypertension
Doctor :   Hypertension is increased BP
Doctor :   POG is period of gestation ( age of the fetus )
User :   doctor whats. more would you suggest on my part to take care for ?
Doctor :   I m sorry for using abbreviations
Doctor :   good bed rest and immediate attention if there is swelling of the genitalia
User :   swelling indications of what kind ? can you pls. elaborate !
Doctor :   swelling in the limbs is seen in moderate rise in BP where as in severe cases of PIH ( severe increase in BP ) will result in swelling of the genitalia specially the vulva
User :   Any dietary advice doctor ?
Doctor :   yes, high protein diet is a must ,like giving egg white , protein powders like ENSURE
Doctor :   also reduce the salt intake
User :   on her previous ultrasound @ 19weeks the AFI was 14 and AFI was 2 @ 26 week. Doctor what could be the possible cause for such drop down in levels of AF and Blood flow ?? and can we daigonse any fetal anomaly during this survival procedure she is under now.
User :   are you there ??
Doctor :   Placental insufficiency due to hypertension is the probable cause for low amniotic fluid production
User :   can we daigonse any fetal anomaly during this survival procedure she is under now ?
Doctor :   well 2 is very low
Doctor :   yes, major anomalies can be spotted by the regular obstetric scan
User :   Doctor she is taking mother's horlicks , how this ENSURE powder is to be taken ?
Doctor :   it has to be taken with milk , same as horlicks
User :   Doctor the ultrasound we had at 26weeks( 4 -5 days back) showed no fetal anomaly , now when do you suggest to get it done again and what to look for in the tests ?
Doctor :   the next should be at 30 weeks
Doctor :   and you have to look for Fetal weight , AFI , POG and for anamolies
Doctor :   also repeat a Doppler at same time
Doctor :   to look for the placental insufficiency
User :   As the gynae started her treatment 3days back and suggest us to wait for a week for ultrasound to look for any improvement .
Doctor :   thats too early to see changes , but there is no harm in getting the can done
Doctor :   2 weeks would be optimal
User :   doctor can we expect the improvement till next ultrasound & if we find slow progress what would you suggest ?
Doctor :   it depends on the mothers condition
Doctor :   with the history i got i would consider a improvement in AFI is a important indicator of fetal viability
Doctor :   its just you have to wait and see
Doctor :   some do respond well and other do not
User :   Fetal heart rate which is normal till date is also a indicator of fetal viability ? as the heart beat and the fetal anomaly was the only basis on which Gynae started her treatment !
Doctor :   yes, i do consider the same
Doctor :   the rhythm and the rate of the fetal heart beat also indicates the viability
User :   The Gynae uses a device (Looks like microphone attached to a system) to monitor the fetal heart rate daily and she finds it at Normal.
Doctor :   its a fetal topical doppler , which amplifies the XXXXXXXX sound
User :   the mother's weight @ 26 week was 70.7 kg and How its to be monitored considering IUGR ?
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