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What Does These BPD And HC Scan Reports Indicate?

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Posted on Mon, 7 Apr 2014
Question: My wife is 35 weeks pregnant, aged 40. The 35 week scan reported BPD : 81 mm, HC 283 mm. BPD was around 5%, HC was below 5% range. The doctor advised 2 injections of Dexamethasone. Question: Was this suggested as there is a pre-term delivery risk due to placental insufficiency ? Antenatal steroids do not have a positive effect if delivery does not happen within 7 days- and there are negative reported effects like reduced head circumference. Is this a good decision to take this injection , or should we explore other causes for the sudden low growth numbers ? The last 29 weeks 3 days scan was quite normal: BPD 78 mm (75 %) , HC 273 mm . In general BPD, HC have always been 75%-80% in past scans. note:there was a change in machine and doctor this time.
doctor
Answered by Dr. Aarti Abraham (1 hour later)
Brief Answer: STEROIDS SHOULD BE TAKEN. Detailed Answer: Hello XXXXXXX Thanks for writing to us with your health concern. Would you mind uploading the ultrasound scans mentioned ? As such, if the BPD and HC are less than the fifth percentile, then there is definite IUGR ( intra uterine growth restriction.) If this is due to placental insufficiency, then the baby would generally have reduced abdominal circumference ( AC ) compared to the BPD and HC, which will be well maintained. When BPD and HC are specifically stunted in relation to the rest of the baby, the causes are generally infections or chromosomal anomalies, and then this would show from early on in pregnancy, and not this late at 35 weeks. Hence, I would like to look at the scans personally before offering a more specific opinion. ALso, if truly the BPD and HC are showing the lag, yes Steroid injections are better given. This is true that the maximum benefit is when delivery is within 7 days of administration of steroids, however, with such severe IUGR, if the picture deteriorates further, then delivery would have to be conducted anytime, so steroid administration is justified. There are risks known with steroid injections, but the benefits outweigh the risks. It is standard procedure to administer these steroids in case of severe IUGR. Was a colour Doppler done, it should be done too. ALso, ask your wife to keep strict tabs on fetal movements, ask her to lie down in the left lateral position three times a day, one hour each, after breakfast, lunch and dinner, and count the fetal movements. Total of these 3 hours movements should be 10 or more. Also, strictly monitor the blood sugars and blood pressure. All the best Please feel free to discuss further.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Aarti Abraham (17 hours later)
Dr. XXXXXXX I've attached the reports. We repeated the scan with the old doctor and the ratings were above the IUGR range ( 17% BPD). AC, FL measures have not been impacted as much as the BPD and HC have between the 29 weeks and 35th week scan. (I have not attached the latest repeated scan of week 35) Also, we took the first injection 12g dexamethasone to be repeated 24 hours later. This is not matching the recommended approarch of giving it every 12 hours, : We recommend betamethasone as the steroid of choice, when available, to be given in a course of two doses of 12 mg administered intramuscularly 24 h apart. An alternative regimen would be four doses of 6 mg dexamethasone intramuscularly every 12 h.
doctor
Answered by Dr. Aarti Abraham (2 hours later)
Brief Answer: EXPLAINED BELOW Detailed Answer: Hello again I have gone through the scans. There is definite evidence of IUGR, the good part is that Colour Doppler is alright. Yes, steroid should be given 12 hours apart, wonder why your doctor has given a different dosage. Also, betamethasone is recommended over dexamethasone by most studies, but then they are not conclusive. Evidence as of now points to betamethasone being the drug of choice but more research is needed. Sometimes, availability of betamethasone is a problem, so many practitioners choose Dexa instead. Please have weekly reviews of the scan and Dopplers.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Aarti Abraham

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Practicing since :1998

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What Does These BPD And HC Scan Reports Indicate?

Brief Answer: STEROIDS SHOULD BE TAKEN. Detailed Answer: Hello XXXXXXX Thanks for writing to us with your health concern. Would you mind uploading the ultrasound scans mentioned ? As such, if the BPD and HC are less than the fifth percentile, then there is definite IUGR ( intra uterine growth restriction.) If this is due to placental insufficiency, then the baby would generally have reduced abdominal circumference ( AC ) compared to the BPD and HC, which will be well maintained. When BPD and HC are specifically stunted in relation to the rest of the baby, the causes are generally infections or chromosomal anomalies, and then this would show from early on in pregnancy, and not this late at 35 weeks. Hence, I would like to look at the scans personally before offering a more specific opinion. ALso, if truly the BPD and HC are showing the lag, yes Steroid injections are better given. This is true that the maximum benefit is when delivery is within 7 days of administration of steroids, however, with such severe IUGR, if the picture deteriorates further, then delivery would have to be conducted anytime, so steroid administration is justified. There are risks known with steroid injections, but the benefits outweigh the risks. It is standard procedure to administer these steroids in case of severe IUGR. Was a colour Doppler done, it should be done too. ALso, ask your wife to keep strict tabs on fetal movements, ask her to lie down in the left lateral position three times a day, one hour each, after breakfast, lunch and dinner, and count the fetal movements. Total of these 3 hours movements should be 10 or more. Also, strictly monitor the blood sugars and blood pressure. All the best Please feel free to discuss further.