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What does early diastolic notching means?

Mar 2013
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Answered by
Practicing since : 1998
Answered : 5621 Questions
Hi I went for my 30 weeks interval growth scan and the report says AFI as 10 and AC and FL 2 weeks behind and they have mentioned that AC and FL are at 5th percentile. They took doppler of which, umbilical artery has PI 1.0 and RI 0.61 The middle cerebral artery has PI 2.0 and RI 0.86. right uterine artery seems to be normal but they have mentioned left uterine artery has early diastolic notching noted. I am scared now. What are the complications here.? What does early diastolic notching means.? How to increase the femur length and abdominal circumference. ? Will the baby be very small only at the time of birth or thru out life.? I see drawfts,IUGR and down syndrome as consequences. Please help.
Posted Wed, 26 Mar 2014 in Pregnancy
Answered by Dr. Aarti Abraham 14 minutes later
Brief Answer: PLEASE UPLOAD REPORT. Detailed Answer: Hello THanks for writing to us with your health concern. Can you please upload the ultrasound and doppler scan report. I do not mean the images, but the typed out report, that will enable me to guide you in a better and more specific way. Looking forward to hearing from you. Take care.
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Follow-up: What does early diastolic notching means? 26 minutes later
Hi.. I have uploaded the report. . Please check and let me know
Answered by Dr. Aarti Abraham 7 hours later
Brief Answer: EXPLAINED BELOW Detailed Answer: Hello Have you had ultrasounds earlier on in this pregnancy ? Were they normal - can you upload those reports too ? This ultrasound is definitely suggestive of IUGR - intra uterine growth restriction. There can be two types - symmetrical IUGR, where all parameters are less, and this is due to chromosomal anomalies or defects in the baby, and hence all systems are affected. In case of asymmetrical IUGR, it is late onset, due to less nutrition to the baby, and only the abdominal circumference ( AC ) is decreased. In your case, it is pretty unusual because both the AC and FL ( femur length ) are decreased drastically. Yes, the causes could be decreased nutrition, hypertension, decreased blood supply to the baby , or defects within the baby. Only detailed anomaly scan which is ideally done at 20 weeks of pregnancy can rule out dwarfism, Down syndrome or other abnormalities. At this stage, these anomalies cannot be reliably ruled out now. What you can do, is keep monitoring the baby every week with scan and Doppler Take lots of fluids, atleast 5 litres per day as the amniotic fluid is borderline. If the fluid further declines, you might need intravenous fluid therapy and intravenous amino acid infusions. Early diastolic notching is the very beginning of a problem in blood supply to the baby, this could be because of less amniotic fluid. If further Doppler parameters deteriorate, early delivery of the baby would be indicated. Strictly monitor fetal movements. Keep tab on your blood pressure and blood sugar levels. All the best Please do feel free to discuss further.
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Follow-up: What does early diastolic notching means? 7 hours later
Thanks for the reply. I have uploaded the anamoly scan report as well. This scan was taken when I was 20 weeks 6 days. I ovulated on aug 13th 2013. My last period was on july 23rd. Let me know if the anamoly scan report is normal. ? Additional information about our height. . I am 5 ft and my hubby is 5.4 ft. I have trouble sleeping due to back pain and hence for past 3 weeks I have been lying on my back for 15 to 20 mins. Will this be a cause for less nutrition supply. ? What can be done to increase the nutrition supply and what diet do I need to follow. ? I'm ddrinking arginine XXXXXXX to increase AFI.
Answered by Dr. Aarti Abraham 14 hours later
Brief Answer: AS BELOW Detailed Answer: The anomaly scan is normal, so you can rest assured. The growth deficit seems to be of late onset. Yes, the baby could be constitutionally small , as both of you are short statured. However, the AC also is small and Doppler changes are also there, so there is definitely some component of IUGR. Yes you can lie on your back, however try to spend more time lying in the left lateral position, that will increase blood flow to the baby. Take a diet rich in protein ( fish, chicken, paneer, tofu, sprouts ) and atleast 4 - 5 litres per day of fluid. You can take Pep Amino capsules daily and Protinex protein powder two tablespoonfuls daily with milk twice a day. Also, regular scans and weekly Dopplers - if parameters worsen, then intravenous fluid and amino acid ( Alamine SN) infusion might be needed.
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