Brief Answer:
Caesarian section is a safe choice...

Detailed Answer:
Hello XXXXX and welcome,

I am Dr Madhuri a Consultant Obstetrician and Gynecologist and will be helping you with your queries.
Your wife’s LMP was 19/11/13 so her EDD as per LMP is 26/8/14.

Your USG at 27 weeks that is on 30/5 was showing the correct EDD that is around 26/8. However the current scan shows that the maturity is 34 weeks and the EDD is 11/9.

Every ultrasound has an error or +/- 1-2 weeks depending upon at which part of the pregnancy the scan is performed. However having said this, the baby must be at least beyond 36 weeks at 9 months [ it will help a lot to know the date of the last scan so that I may provide you about how much the baby is expected to be mature]. So it seems that the baby is having a low birth weight. This is called fetal growth restriction in our language. This means that the baby is having an issue and is not able to grow well inside the uterus. So it is showing leaser maturity as it is smaller than expected.

The ultrasound calculates the EDD as per the baby’s maturity. So if the baby is 34 weeks then the machine will give you a date of delivery that is needed for a 34 weeks baby. Meaning that it will calculate and add 6 weeks from the date of 34 weeks and give it as the date of delivery [as the duration of pregnancy is 40 weeks]. The machine does not know that the baby has to be 36 or more and is only 34 and so this is IUGR. This is decided by the doctors considering all the parameters. This is the reason that we never believe in dates that are given by ultrasound after 24 weeks as they are more likely to be wrong as we do not know if the baby is well or is growth restricted if only one ultrasound report is available.

So both the doctor and the ultrasound are correct in their own way. The machine is miscalculating as it calculates based on findings of that date and it is not meant to analyze them depending upon previous findings or previous reports. The doctor is correct as she knows all the other considerations and so has to balance all probabilities.

Now my opinion:
The baby is growth restricted and so these babies find it difficult to sustain inside the uterus as the pregnancy reaches term. It is advocated to deliver these babies earlier than the expected date as they are more likely to have complications the longer the duration of pregnancy. 99% babies are completely mature by 37 weeks and can survive very well outside. So it is wise to deliver these babies any time after 37 weeks [even earlier if needed as per the severity of the condition] as soon as possible.
Your wife has a cesarean, so induction or artificial beginning of labor pains will carry a risk of the uterus getting ruptured. Also very limited means can be used to induce pains in cesarean cases and they are more likely to fail. Also a growth restricted baby is more likely to develop problems in heart beat and also pass stools and then breath them inside its lungs and so get choked during labor.
Considering all this a cesarean is a relatively safer choice.

This is the best explanation for the issue that I can provide as of now. I do understand your situation a but consider everything and re discuss with your doctor if needed before taking a final decision

Hope this satisfies your query.
Thanks for using HCM.     
Feel free to ask any more questions that you may have.
Dr Madhuri Bagde
Consultant Obstetrician and Gynecologist

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Brief Answer:
detailed answer below

Detailed Answer:
Hello XXXXXX and welcome,

I completely understand your concern as a father.
Unfortunately the questions do not have a direct explanation and we as doctors weigh probabilities and then make a decision based on multiple factors. It is impossible for me to provide you with a rationale for all of these queries as it means explaining to you the complete medical science. I will try my best to answer your queries to the best of my ability.

As of now, as you have seen in the report, the expected maturity of the baby is 37 weeks on the date of the scan and the maturity in scan is 34 weeks 5 days. So the baby does show a lag. However if we look at the fetal weight it is already about 2.5 kg which is the cut off limit for low birth weight. Means that babies that weigh less than 2.5 kg at birth are called low birth weight in XXXXXXX Your baby is already 2.5 and still not delivered so there is every chance that the birth weight may be closer to or more than 2.5 kg.

However IUGR is a relative term. What is normal for one baby may be abnormal for the other. So a weight of 2.5 is normal in XXXXXXX but low birth weight in west. Also ultrasound is not an accurate machine. It itself has an error. You can see that the weight has an error of almost 400gm, that is more than 15% error. So now you will understand that even for us it is not possible to be very accurate. Another issue is the amount of amniotic fluid or liquor. It is mentioned that the fluid is adequate in the report. The complications in growth restricted babies are higher if the fluid is low. So an adequate fluid means the chances of complication are low [ but they are not zero in any pregnancy, please remember that].

So the baby has an average weight and maturity lags behind a little. So it does have growth restriction but is not severely affected.

Having said all this, I rely more on my findings on abdominal examination as they are the best indicator for me about the pregnancy outcome. Even if the scan says adequate liqour but if I cannot feel it with my hands, It indicates that there may be problems inside.

So it is a judgement call.

About the best time, if the doctor feels that clinically liquor is less and baby is past 37-38 weeks cesarean can be undertaken any time after that as the baby is already mature and environment inside the uterus is hostile for it to survive. Even if it has less birth weight or finds it difficult to maintain its temperature, still the outside world is better for its survival. So for any baby with low weight and liquor, we prefer delivery as soon as possible after 37 completed weeks.
Her expected date of delivery is 26/8/14. So she completed 37 weeks on the 5th of this month. Hence the section can be undertaken at any time now on.

About the baby not going into complications. It is impossible to predict this. We do not know what will happen in future and also I am not sure what was the reason for acidosis after 2 months. The only thing that can be said now is that chances of respiratory complications are LOWER [ NOT ZERO] after 37 weeks and with a birth weight of 2.5 kg.

I completely understand and share your concern as a father Nazim, but unfortunately medical science has its own limitations and we must work within those. l We still do not know everything and predicting future is still not possible in every case.

So all my good wishes are with you both. Hope I am able to answer all the queries.

Feel free for any further queries.

Take care.

Dr Madhuri

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