Brief Answer: Detailed answer below. Detailed Answer: Hi XXXXXXX and welcome, I completely understand your problem and your worry for the baby. Please do not worry so much. Most of the danger period is over s she is already 34+ weeks. I will need the details of the following before I provide a decision: 1. when was the last menstrual period and how were the periods [ menstrual cycles regular or irregular] before the pregnancy, any first 3 months USG [ ultrasound report] report if available, even a later report will do. A complete ultrasound report that was performed this time as you have used common man terminologies that may have a different meaning in medicine. So if possible kindly provide the complete report [ scanned if possible or typed will also do] in the medical language that the doctor may have provided to you. Also any history if she had bleeding or how the baby is moving inside and anything else even if it seems irrelevant to you, please provide for me to form a better judgement. As of now, with the above information, stripling is not a medical term. Do you mean to say that there was a separation of the placenta? If yes then it is a condition that needs careful monitoring. A grade 2-3 placenta at 34 weeks if fine. It is not a cause of concern if the baby is OK and the amount of amniotic fluid is fine. If there is placental separation then careful monitoring is needed. But I will comment on this only after I see the report. Now about the factors that need to be aware of before deciding for preterm delivery: The most important criteria is that the indication, if the baby is having problems inside the uterus, cannot get nutrition or blood supply, not growing, not moving, waters are broken and patient leaks the amniotic fluid before 37 weeks all are indication for delivery. There are many other conditions that may warrant a preterm delivery depending upon case to case. How long will it take for USG to show grade 3 placental maturity: absolutely cannot be commented, normally it takes about 37 weeks for grade 3, but may come earlier also even in normal pregnancies. Absolute minimum to wait: there is no absolute minimum if the indication for delivery is an urgent one like placental separation, bleeding, etc. Most babies start to have maturity of lungs [ biggest problem after birth s if lungs are not mature they are not able to breath] by 34 weeks and more than 90% will achieve this by 37 weeks. Some may not even achieve it by 37 and need 40 weeks. So the risks are lower after 34 weeks and then decrease successively after each day added. So the cut off for us if there is an urgent and pressing need is anytime, if possible to wait, first cut off at 34 weeks and then monitoring carefully and deliver at the earliest indication any time after 34 weeks. She has already crossed the danger mark so there should not be much worry. Tracking the baby growth: follow up ultrasound every 14 days or even every 7 days [ repeating every 7 days may not show a change always so it is recommended to do every 14 days]. Keep a watch on the babies movements, if 3 or more movements are there in one hours it is fine. If movements decrease go to a doctor. Please do not worry and provide me the complete USG report and history as until then all these are vague speculations. [ Kindly also note that you are allowed to ask follow up queries, so use this facility. I am informing this to you once again as I lost some of my patients that did not respond thinking that they had to pay for every question. ] Hope this was helpful. Feel free to ask any further queries and I will be happy to help. Thanks for using HCM. Have a good day. Dr Nilajkumar Bagde Consultant Obstetrics and Gynecology

---

Brief Answer: betnacol will help. Detailed Answer: That will be fine XXXXXXX From the current query it seems that she has received drugs to help achieve fetal maturity. Also she has received fluids [ either must be simple salines or amino drips]. This indicates that there were issues related to babies growth or the amount of amniotic fluid that surround the uterus. So for a pregnancy with less growth or less fluid, the above treatment is correct. Also the steroids [ betnacol] help the lungs to mature earlier so if the baby is delivered early chances of it having respiratory distress are low. I am waiting for the full reports as well as her date of the last period and any other complication apart from thyroid. If you have a report of 32 weeks and now a new one, please upload both as it will help me to compare. Also if there are growth problems in the baby, ask your doctor if they are doing a special scan called doppler that checks blood flow to the baby. If doppler is normal, we can wait for a few more days. As of now, she must drink plenty of water [ at least 3-4 liters or more in a day], lie down in left side to help improve blood supply to the baby, take deep breaths, eat a healthy diet with proteins [ eat egg whites if non vegetarian or sprouted beans daily], protein powder with milk and rest will all help in the growth of the baby. Hope this was helpful. Take care, Dr Nilajkumar

---