What do the following sonography report at 37 weeks indicate?

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Posted on Mon, 8 Jun 2015 in Pregnancy
Question: hi my wife is37w3d pregnant. we had color Doppler today and afi is 4cm.we did another sonography for second opinion and afi is 6cm on same day. what is the conclusion. as per first report we are advised urgent csection.

thanks XXXXXXX
doctor
Answered by Dr. Nishikant Shrotri 32 minutes later
Brief Answer:
Evaluation of baby is more important before deciding about delivery.

Detailed Answer:
Amniotic Fluid Index less that 5 cms is not a good sign. It indicates that there is foetal growth restriction. However, the second USG has shown AFI 6 cms.
As it is there is no added advantage of continuing pregnancy after 37 weeks since at this stage the baby has become fully mature.
Does your wife have high blood pressure, pregnancy induced hypertension, diabetes or any such complication? In such event, immediate termination by caesarean section is advisable.
Now some other parameters like the activities of baby and the maturity of the baby as suggested by weight of the baby play supporting role in taking decision of inducing the labour. Also we must know how much the baby is getting suffocated inside the uterus.
However, even in Manning's score, AFI is given most importance.
To go safe, I would also advise to undergo immediate delivery.
Now when AFI is low, the chances of foetus being under the stress are quite high. So it may not stand the stress of vaginal delivery; hence caesarean section is advised.
It is advised to have caesarean section done in a well equipped hospital having expert doctors. Presence of a neonatologist at the time of caesarean section is necessary. It is advisable to have a neonatal intensive care unit in the maternity home to take care of the new born child, where your caesarean section is performed as the chances of baby being critical are high.
If you can inform me the detailed reports and maternal parameters that you have with you, particularly regarding the baby's maturity and health, I can review the case in details to review my advice again.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Nishikant Shrotri 16 minutes later
thanks for answee. pfa the reports...
doctor
Answered by Dr. Nishikant Shrotri 3 hours later
Brief Answer:
Keep a watch on baby's movements

Detailed Answer:
Dear XXXXXXX Pingale,
I have received your reports of ultrasonography scans. However, I would have like to have some more information:
Age of your wife, number of previous children or first pregnancy, blood pressure and all the reports of blood and urine examination. However, with available information and some presumptions I am giving you flowing advice. If certain facts are different from my presumption, please correct mad inform me.
Considering your age, I presume your wife to be of just under 30 years of age. Since you have not mentioned any previous history and you are so anxious and concerned, I believe this to be her first pregnancy. Also, since you have not mentioned anything about other investigations and her blood pressure, I consider them to be within normal range.
Both reports of ultrasonography indeed are showing varied findings - right from the different measurements to the age of gestation and foetal weight. However, I must complement you for going for the second opinion.
Considering the date of her last menstrual period 2/9/2014, her expected due date of delivery comes to 9/6/2015 and not 15/6/2015. Thus today she is almost 37 weeks pregnant.
From both reports one thing is definite - there is some degree of oligohydramnios; i.e. less amount of amniotic fluid around the foetus. This suggests the risk to the foetus. Now the question is - how much risk?
You can keep a watch on the foetal movements. Has she started feeling that the foetal movements are lesser that previous? If so, it is not a good sign and she should not weight for long before delivery.
Even now, keep a count of foetal movements. Please maintain a written record of this. Immediately after meals - breakfast, lunch and dinner - count how many times she feels foetal movements in the next one hour. They should be minimum three times after each meal. If they are less, it is suggesting foetal affection and should go for immediate delivery. Also, in these three readings or throughout the day, if the foetal movement count goes on diminishing, please do not pull on with the pregnancy further. It is indicating that foetus is not safe inside the uterus than outside the uterus. Then, delivery ASAP is indicated.
The weight of the foetus is quite varied in two reports - in first one it is barely above 2500 grams (which is not bad) while the other says more than 2800 gms (which is good). For more than 2800 gms, the foetus is well matured and can be delivered anytime.
I would take the decision on foetal movements. Also, watch on amniotic fluid index as per your obstetricians advice. If he/she feels that foetus will not be able to stand the stress of uterine contractions, caesarean section would be a safe option. Please leave this decision on when and how to deliver to your obstetrician. If she has given birth to children previously, her chances of vaginal delivery are higher than if this is first pregnancy. If her blood pressure is high, vaginal delivery may be risky for the baby.
Meanwhile to help the growth of the baby, please ask her to consume 300 extra calories from only carbohydrates. They should be over and above her normal meals. I may suggest you certain recipes for ready decision. Since you are Marathi speaking in XXXXXXX my first suggestion would be rice-flakes with jaggery in milk, jaggery with peanuts, puffed rice with jaggery - मुठभर पोहे आणि गुळ दुधात घालून दुध-गूळ पोहे रोज एकदा खाणे. दाण्याची चिक्की, चुरमुऱ्याचा लाडू यासारख्या पदार्थांतून हे मिळते. Jaggery (गूळ) plays an important role in providing carbohydrate along with iron.
I hope I have answered your queries based on whatever little information you have provided me.
If you feel getting some queries on this with me, please ask further questions I would appreciate you providing me with all the information and the reports I have requested you.
Wish your wife a safe and fruitful delivery and a bonny baby for both of you.

Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Nishikant Shrotri 59 minutes later
thanks Dr Nishikant. this indeed is a great and detailed answer. most of your assumptions are correct apart from age. her age is 31 yrs and 2 months. bp is normal and within range. her last urine report was normal. she has bit swelling feet though. and this is our first baby hence all anxiety.
I appreciate your time for detailed answer you have provided. thanks again. currently as per second opinion we are thinking to get her admitted and try for natural delivery with manual induction of labour. if no success we will go for c section
doctor
Answered by Dr. Nishikant Shrotri 3 hours later
Brief Answer:
Caesarean seems safer option

Detailed Answer:
A primi (first pregnancy) above 30 years of age, swelling on feet and oligohydramnios! I will not opt for a full trial for vaginal delivery. Caesarean seems to be a safer option.
However, no proteins in the urine and blood pressure within normal range (I don't know how much - I believe in you) would tempt the doctor to give a vaginal labour trial.
I still persist that you keep foetal movement count.
Please let me know the out come. I am keen to know the progress.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Nishikant Shrotri 15 minutes later
thanks for reply. we got admitted now and trying to induce labor. we will wait till tomorrow and then will go for c section... will keep you posted for sure.
doctor
Answered by Dr. Nishikant Shrotri 6 minutes later
Brief Answer:
All the best

Detailed Answer:
Dear XXXXXXX and his charming wife,
I wish you all the best for this delivery.
Please greet the baby with heartful of love - whether son or daughter. Makes no difference.
Oh mother-to-be, please start feeding your baby on the breast within first half an hour of the birth 9even after caesarean section) and continue to give exclusive breast feeding for six months.
Please give all immunisation shots religiously.
And lastly follow goof birth control method with doctors advice.
All the best again.
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Nishikant Shrotri 14 hours later
thanks Dr for nice advice and wishes. updates is she so still in inducing labor stage. til afternoon if no labor we will start csection..
will keep u posted.
doctor
Answered by Dr. Nishikant Shrotri 3 hours later
Brief Answer:
Thanks for update

Detailed Answer:
Dear XXXXXXX
Thanks for update about progress of labour.
I shall be looking forward for a good outcome of the labour.

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Nishikant Shrotri 2 hours later
indeed it is. we are blessed with baby boy... 2.4 kg. doing good... thanks a lot for your guidance...
doctor
Answered by Dr. Nishikant Shrotri 20 minutes later
Brief Answer:
Congratulations

Detailed Answer:
Heartiest Congratulations.
Looking at the weight of the baby, the first USG report seems to be reliable.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Nishikant Shrotri 10 minutes later
yes... :).. thanks a lot.
doctor
Answered by Dr. Nishikant Shrotri 53 minutes later
Brief Answer:
Don't forget

Detailed Answer:
I presume it was vaginal delivery.
Before you close these questions, please do not forget:
1. Early and exclusive breast feeding
2. Effective contraception for at least 3 years
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Dr. Nishikant Shrotri

OBGYN

Practicing since :1968

Answered : 2916 Questions

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