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Suggest treatment for fetal growth restriction along with calcium deficiency

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Posted on Fri, 22 May 2015
Question: Our granddaughter is pregnant and the fetus is smaller than normal and may have calcium deficiency. She is in China, so US treatment is not possible. What is a good, generic piece of advice, such as drinking milk and broccoli?
We (grandparents) realize you don't have the lab results and have not seen the patient, so we are primarily looking for general advice for this condition. For example, would calcium supplements be good, or is this something serious? Likewise, is this something quite common and not to be worried about. We just don't know if we should have a concern that is great or small. Milk is not as widely available as in the U.S., it is often packaged in small tetra-packs (irradiated and super sterile for non-refrigerated keeping.) we can mail her calcium supplements, Vitamin D3, or B12. So sending vitamins and herbal things is wishing our ability.

1) Is this condition common? Is it cause for some, little, or a lot of concern and worry? Basically, how serious should we take this?

2) What small things can we advise or do to help? Ie, mail her supplements.

3) her doctor in China has not recommended any course of action. And, he has not been overly communicative, which is why we don't know if we should worry or not.

Thanks for giving some perspective on this.
doctor
Answered by Dr. Sameer Kumar (11 minutes later)
Brief Answer:
IUGR

Detailed Answer:
hello,
Thanks for the query to HCM,
Firstly if your grand daughter is in the second trimester or early third trimester then one can actually establish a diagnosis of IUGR or intrauterine growth retardation. Period of gestation is important to know when she can be placed on L-ARGININE TABS THRICE A DAY or satchets once a day till delivery. Other causes of IUGR like gestational hypertension would also have to be excluded before that .

2. calcium deficiency can be treated by taking 1000mg OF CALCIUM DAILY with 500mg tabs each twice a day along with 100mg elemental iron tabs. Though foods like milk, cheese, curd and other form of dairy products do provide calcium but not in adequacy; hence calcium tabs are mandatory.

If you have further details about her pregnancy such her latest scan reports, please furnish further details. This will allow me to comment on your other questions.

Regards
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Sameer Kumar (26 minutes later)
Fetus is 5 months with 4 months remaining. We will have grand daughter ask if condition is IUGR/intrauterine growth restriction. We will send her 500 mg Calcium supplements to take 2x daily and 100 mg elemental iron tabs. Both of these are readily available to us in the U.S. and we can mail to her.

Can you please advise (with the limited information we have been able to provide) how serious and how common this condition is? Should we be moderately concerned, or very concerned, or terrified, or just aware? In general, is this a common or rare and serious condition? I don't have absolute numbers or measurements or test results to share, and I am sorry, we will get what we can. So I realize your answer is a bit generic and that you are shooting in the dark. But knowing, in general, would help us to worry to th correct extent.

Thank you very much for your help and advice!
Reports, unfortunately in Chinese but with photos, are attached.
doctor
Answered by Dr. Sameer Kumar (24 minutes later)
Brief Answer:
Triple scan is normal

Detailed Answer:
Hello,
5 MONTHS Is 21 weeks of period of gestation and hence it is too early for IUGR to be established and commented upon. It is usually after 28 weeks that such diagnoses can be made depending on the fetal femur length( FL) and abdominal circumference ( AC) values and FL/AC RATIO.
The report which you have sent is a triple marker report done in either 11th till 14th week of gestation. The report is absolutely normal and confirms that baby doesn't have any genetic aneuploidies especially for trisomy 21( downs syndrome). trisomy 18 and 13 ( patau's and cry du chat syndrome). So foetus is free from anomalies.

There is always a 10 per cent discrepancy between ultrasonological age and the gestational age , so that is fairly normal unless fl/ac is deranged.
So, presently a level 2 scan is due by 20 weeks which she must got it done by now and she should be continued on iron and calcium tablets till term.

At 20 weeks, at present it is too early to comment upon decreased growth baby. Follow up scans shall be helpful, you may send me the same so that i would be able to guide you further.
Have just seen the umbilical artery report as well which you just uploaded and it shows good systolic and diastolic flow, hence not major concern to be worried about, this is a normal blood flow in foetus.

In other words she should be followed up. At the moment I will keep her encouraged and free from worries.

Regards
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Sameer Kumar (1 hour later)
Thank you! My wife says Thank you very very much! I really appreciate your looking and giving us some insights. it is comforting to know things look basically normal. Our grand daughter worries a lot and tends to jump on anything that may be a problem. It sounds like it is too early.

You have been a great service to us. These long distance families are sometimes hard to know what is happening, with many countries and languages it's almost impossible to understand.

You have given us a great service. Thanks.
doctor
Answered by Dr. Sameer Kumar (21 minutes later)
Brief Answer:
THANKS

Detailed Answer:
Thank you very much for opting this service. If you have no further query then you may close the query.
Anytime in future if you feel you need assistance, you can write to me directly through the below link:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68814

Regards
Above answer was peer-reviewed by : Dr. Prasad
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Suggest treatment for fetal growth restriction along with calcium deficiency

Brief Answer: IUGR Detailed Answer: hello, Thanks for the query to HCM, Firstly if your grand daughter is in the second trimester or early third trimester then one can actually establish a diagnosis of IUGR or intrauterine growth retardation. Period of gestation is important to know when she can be placed on L-ARGININE TABS THRICE A DAY or satchets once a day till delivery. Other causes of IUGR like gestational hypertension would also have to be excluded before that . 2. calcium deficiency can be treated by taking 1000mg OF CALCIUM DAILY with 500mg tabs each twice a day along with 100mg elemental iron tabs. Though foods like milk, cheese, curd and other form of dairy products do provide calcium but not in adequacy; hence calcium tabs are mandatory. If you have further details about her pregnancy such her latest scan reports, please furnish further details. This will allow me to comment on your other questions. Regards