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When should a c-section be done as per the following ultrasound report?

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Practicing since : 2007
Answered : 5136 Questions
Question
Hi,

My wife is 27 years 8 months old. We are 35 weeks 5 days pregnant.

Below are the points to note:
1. Low lying placenta
(Placenta covering/touching internal OS)
2. Possible IUGR
(At the 35th week scan, got a Gestational Age of ~33 weeks)
3. Gestational diabetes
(On Insulin. Current doses - Actrapid: 20 units before breakfast. Actrapid: 45 units before lunch. Mixtard 50: 38 units before dinner. Sugar levels are mostly under control)

1) Question
a) Is this 2 weeks lag in the age a serious concern?
b) Are these scan reports 100% accurate esp in the third trimester?
Note: LMP/Ovulation dates that we know are 100% right. So there is no scope for miscalculating the conception date etc.
c) What should be our next steps to ensure everything's alirght? We are a bit worried.

2) Question
When should we go for a c-section now?

Have done non-stress tests which came out ok.

Have attached the detailed ultrasound scan reports.

There are about 30-35 baby movements per day and my wife as advised by the doc, is on bed rest. Her diet is healthy and is as prescribed by the dietician.

Request you to please answer in detail.
Early awaiting your expert opinion.

Thanks.
Posted Sun, 24 Aug 2014 in Pregnancy
 
 
Answered by Dr. Manisha Jain 1 hour later
Brief Answer:
cesarean delivery 37-39 weeka

Detailed Answer:
Hello Mr XXXXXXX thanks for trusting health care magic.
After going through the reports and detailed history provided by you I would like to tell you following points-
- Scan reports are not 100% accurate and have person to person observation bias which is more in third trimester.
- the lag in growth is not very high because though the measurements of gestational age on HC, BPD and FL are in lower range baby weight is still almost normal because it should be around 2.5 at 37 weeks
- cesarean section can be done anytime around 37-39 weeks and timing will be guided by daily fetal movement counts and non stress tests.
- if everything stays within range cesarean delivery will be done around 39 weeks because by that time baby's lung maturity will be good which is very important as it is usually delayed in diabetic patients.
- bed rest and good diet is very important and so is the regular follow up with your obstetrician.
- she can take amino acid supplements and a high protein diet which will help in fetal growth a lot.

I hope I have answered your questions but in case you have any other query I will be happy to help.
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