Hi XXXXXXX
Thanks for writing to us.
Normal fetal measurements at 24 weeks are -
BPD ( biparietal diameter ) - measures the width of the head of baby - 60 cm +/- 6 cm.
HC ( Head circumference ) - measures around the head of baby - 220 + / - 20 cm.
AC ( abdominal circumference ) - measures around abdomen of baby - 201 + / - 20 cm.
FL ( femur length ) - length of thigh of baby - 45 + / -4 cm.
As you can see, most of your baby's parameters fall in the normal range, apart from the Abdominal circumference.
The normal baby weight at 24 weeks should be 670 gms, and the 10th percentile is 556 gms.
This means that of all babies born, less than 10 % babies are less than 556 gms. at 24 weeks.
Hence, your baby weight is definitely quite less.
This is called IUGR ( intra uterine growth restriction ).
The main reason for such is obviously constitutional, that is, small babies are born to small parents.
However, such growth is overall small, in your case it is asymmetrical IUGR, where preferentially vital organs like brain ( head ) grow normally, but the abdomen does not grow.
The reasons for this could include -
1. Nutritional deficiency - specifically less of protein intake by the mother.
2. Genetic or chromosomal abnormalities in the baby due to which the baby is underweight - less likely in your case, as the screening so far is normal.
3. Decreased amniotic fluid around the baby.
4. Chronic maternal diseases like hypertension, renal diseases, jaundice, prolonged illness, fever, starvation etc.
4. Placental abnormalities due to which blood supply to baby is compromised - again the COlor Doppler is normal, so this is less likely.

Hence, most probably cause for IUGR in your case could be decreased calorie intake.
However, Color Doppler should be repeated every 4 weeks till 28 weeks, and then 2 weekly to rule out risk to the baby, due to decreased blood supply.
The management now would be -
1. Increased calorie intake, particularly proteins . Non vegetarian protein is the best, but since you are vegetarian, eat a lot ot nuts, dry fruits, paneer, tofu, dal , egg if possible.
2. Increase fluid intake ( you have not commented on the amniotic fluid in the ultrasound report ) atleast 4 - 5 litres per day.
3. Take Aminomix as instructed.
4. Have small frequent meals, do not go hungry for more than 3 hours.
5. Lie down in the left lateral position when you sleep, and keep watch on baby movements.
6. Have a detailed anomaly scan to rule out abnormalities in the baby.
7. Monitoring of baby growth with periodic ultrasound and Doppler as recommended.
8. Careful measurement of blood pressure, weight, blood sugars, hemoglobin etc. to look for any maternal diseases.

Take care.
Please feel free to discuss further.

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Hi again
Congratulations on your IMSI pregnancy !
Yes, amniotic fluid is commonly called liquor, and if it is normal, it is a positive sign.
Continue with the diet control for the prediabetes.
BLood pressure monitoring also should be continued.
It is common to get slightly decreased hemoglobin readings as pregnancy advances, as water level in the body increases relatively.
Continue iron supplements, if possible, include non vegetarian sources of iron and protein in your diet.
Generally, there is no infection without symptoms.
You can have the WBC count repeated after a few weeks, but if the symptoms are gone, there is no cause for worry.
Weight loss on your part does not necessarily mean that the baby is gaining weight too.
In fact babies of overweight mothers are also sometimes growth restricted.
Make sure your diet is healthy and XXXXXXX in protein , that does not mean you have to overeat.
Too much weight gain will also result in hypertension and worsening of diabetes.
Continue with regular colour doppler.
Increase fluid intake to atleast 4 litres - 5 litres per day ( can include water, buttermilk, nimbu pani, coconut water, soups etc.)
Avoid eating or drinking outside stuff.
Take care.

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Hi

You are taking enough protein.
Increase your intake of heme containing foods.
Take lots of beetroot, methi, palak ( spinach ), chana, walnuts etc.
The soup can contain beetroot, tomatoes, spinach also.
Try taking multigrain rotis also.
Increase intake of vitamin C by taking oranges, strawberry, kiwifruits, amla etc.

Regards,

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Brief Answer:
DETAILED BELOW

Detailed Answer:
Hello again XXXXXXX
The 10th percentile weight at 27 weeks is 876 grams, so the IUGR is still persistent.
The AC is also slightly lagging behind as earlier.
The improvement is not as expected, however go for further Aminomix infusions as advised. Sometimes, it takes more time for the improvement to occur.
The weight gain is indeed more, Aminomix would not cause such drastic weight gain.
You should reduce the intake of rice, potatoes, sugar, full fat milk etc.
Stick to whole wheat or multi grain rotis ( without ghee ), increase green vegetables, fruits, dal, paneer as advised.
Also, reduce the amount of cooking oil in your food.
Do not take excess salt in the diet.
You can use Low sodium salt ( eg. Dabur XXXXXXX salt )
Excessive weight gain can lead to development of high blood pressure and diabetes during pregnancy, and pose risk with delivery also.
Try to curtail the weight gain.
Cervical length is dynamic, and the readings differ between observers, and as long as it is normal, do not worry. Also, you should be worried if it further gets reduced, or shows signs of funelling or opening up.
The baby's head is normally down, it normally occupies the pelvic, so do not worry.
As you do not have history of abortions or preterm deliveries, do not worry unless you have consistently decreasing cervical length, signs of funelling, and symptoms such as cramps , lower abdominal pain and backache, excessive discharge, sensation of pressure in the pelvis etc.
All the best.

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