IUGR - How far did you make it?

Hi ladies - I am nearly 34 weeks pregnant with B-G twins. My babies were always relatively close in size until our 29 week scan, when we discovered that Baby A (our little girl) had started to fall of the growth charts. Her head and limb measurements were average, but her abdominal circumference was very small, putting her in only the 9th percentile overall. In addition, the tech detected a slight amount of resistance in the blood flow through baby A's cord.

My peri diagnosed IUGR, pulled me out of work, and placed me on partial bed rest with the hopes of increasing blood and nutrient flow to baby A's placenta. In addition, twice a week since then I have been going in for nonstress tests and for ultrasounds with doppler scans to check the babies' fluid and the blood flow through their umbilical cords and to their hearts and heads. Thankfully, the babies' fluid and doppler scans have continued to look great - the resistance in baby A's cord has not progressed to the point where it is a concern. The nonstress tests have not revealed any cause for concern, either.

We have also had 2 growth scans since the 29 week scan, and thankfully both have shown that the babies are continuing to grow. Baby A is still small overall - she remains in the 9th percentile - but she is still gaining and her growth rate has not slowed as they feared it might. They surmise that the bedrest may have helped to get her back on the right track. At our last scan (32 weeks), Baby A was estimated at 3 pounds 6 oz and Baby B at 3 pounds 15 oz. I have another scan this Friday.

Sorry for the long-winded lead in, but I guess I am wondering how long can I reasonably expect this pregnancy to continue with a growth-restricted baby. Is it safe to assume that at some point either the growth or the blood flow will become enough of a problem that it will necessitate an early delivery? My peri's guess is that we'll probably need to deliver by 36.5 weeks, so I have a C section tentatively scheduled for then. Since the babies have been doing so well on their bi-weekly tests, though, I'm hoping that I might be able to make it longer. On the other hand, I of course wouldn't want to keep them in if it increased the risk for them in any way.

For those mommies who have had one or more twins disagnosed with IUGR, I am curious to know: at what point in the pregnancy you were diagnosed with IUGR, what percentile your baby was in, when you delivered, what necessitated delivery (i.e., baby stopped growing, blood flow issues, or some unrelated factor), and how quickly after diagnosis that condition progressed.

Thanks in advance for any insight, input, and advice you might have! I am a little nervous about all this and of course, worried about my babies.

 

I have no advice but wanted to send you a :hug: Hang in there and you are doing a great job taking care of those babies!

 

IUGR was diagnosed at 32 weeks. The girls had not grown any since 30 weeks. I carried them until 34w3days. At that point they were estimating that Carli had lost weight. Blood flow was good, NST were good. But the Dr. felt they would do better on the outside.They were less than 5%. We delivered them at 3lbs 9.5 oz and 3lbs 14.5 oz. Carli was on a CPAP for 30 mins, and other than that they spent 17 days being grower and feeder.s

Good luck and hang in there.

 

IUGR was diagnosed at 25 weeks for twin b/Jake and we made it 36 weeks. Delivery was due to his lack of growth. I was immediately on bedrest (i had high bp as well). KEEP TO YOUR BEDREST AS MUCH AS YOU CAN. We did a bunch of tests and we couldn't identify any cause other than my body's inability to feed two. I got steriod shots at 28 weeks (?) and started NSTs at 29 weeks, I think. We were quite surprised at how small he and his sister were (peri measurements were off), but they were both healthy. Jake did have some breathing/eating issues (in retrospect i have my own theories), but he is just fine. He is being monitored since small birthweight puts him at risk for a bunch of stuff (which I only found out later) - but so far, so good.

He did (does?) have asthma and landed in the hospital at 6 months old and we had to take him from daycare. He is off the treatments and seems to be fine this summer.

Again, we are very lucky and I'm not trying to scare you because it hasn't been scary, but just be prepared. We were prepared for him to be in the Nicu, so it wasn't hard for me. His sister came home with me on day 3.

 

Ours was found at the 20 week US, he was in the less than 10th percentile, while his brother was in the 50th. At that point they monitored closely and tried to determine the cause. The monitoring became more frequent as our baby B continued to decline with growth scans, dopplers, and NSTs. I was not put on home bedrest, but at 32 weeks admitted to the hospital after a NST was showing signs of further distress. We made it one more week and delivered at 33 weeks. We delivered because Gavin continued to show distress and reduced blood flow through the cord. We might have made it another couple of days or week, but the doctors did not want the delivery to turn into an emergency. You can see in my signature that Gavin was born weighing 2 lbs 7 oz and his brother, Warren was 4 lbs. We did receive steroid shots and neither boys were ever on any breathing assistance. Feel free to PM me if you have any more questions, I know how scary all of this can be.

 

Thank you so much ladies. A few follow-up questions based on what some of you have said - Did you find the weight estimates they were giving you at the growth scans were way off, and if so, in which direction? Did your OB recommend bed rest (full or partial) or increased caloric intake?

Everyone keeps telling me I look so small for twins - I'm so nervous that my babies are even smaller than they're telling me and that they won't be big enough even if I make it to 36 or 37 weeks.

 

QUOTE(Lawyerlady @ Oct 22 2008, 09:20 PM) [snapback]1038196[/snapback]
Thank you so much ladies. A few follow-up questions based on what some of you have said - Did you find the weight estimates they were giving you at the growth scans were way off, and if so, in which direction? Did your OB recommend bed rest (full or partial) or increased caloric intake?


Yes, my u/s weight estimates were way off. I believe she measured at the 35 week appointment, Jake was expected to be over 4lbs and Becca over 5lb, she was at least a pound off in her estimates.

My bedrest was at home, it was modified. I could do what i need to do (eat, shower, go to the bathroom), but I had to spend most of the day laying on my left side to keep my bp down. I was able to work for 7 weeks from home, at that point I was ready to be written out of work - because I was going to appointments 2-3 per week and I needed an "end date." Toward the end, I took more liberties, snuck out to old navy for a few items and after each dr. appointment I would run a small errand. Since i wasn't in ptl, she just wanted to make sure all the nutrition went to the kids. I probably gained 28 lbs total for my pregnancy. As far as food, my husband took over. We focused on protein and i supplemented with Boost High Protein shakes. It was an easy way to take in calories. My peri was never that specific, she just said eat.

 

Sierra was IUGR due to TTTS and a 2-vessel umbilical cord. We started watching her at 19 weeks. The size difference between the girls was constantly widening but Sierra kept growing and her blood flow looked good so we kept them in. She was also extremely active.

In the end, we made it to 35 weeks before she stopped growing and we decided to induce. She was measuring 3 lb 14 oz by u/s at that point. I had the girls at 35.3 weeks and Sierra was 3 lb 15 oz. She was perfectly healthy though. The stress she had gone through in the uterus had helped her to mature more quickly than her sister and she actually came home before Ainsley.

 

Here's my story...

At 21 wks, both twins were measuring 95th percentile or higher.

At 25 wks, DS was measuring 10th percentile and lower (head was the least restricted, other measurements were below 2nd percentile) and his fluid was very low. I was sent for steroid shots right away, and we didn't know if we'd have to deliver in days, or eke out a few more weeks.

Although they told me to go on bedrest, I did some research and found that no studies show any connection between bedrest and better outcomes for IUGR. I asked a peri about this, and she said I was right - obviously, take it easy, but not worth killing myself lying in bed. I also asked her if I should be eating extra or anything, and she said no. And in the end, it turned out that the cause of IUGR in our case was that DS's placenta was abnormally small, and 30% of the blood vessels were clotted off. So I could have been eating 5000 calories a day, and it wouldn't have mattered, since the placenta just couldn't deliver it to him.

We made it to 34 wks 2 days. I had 2 BPPs/NSTs a week, 1 cord doppler and fluid check a week, and growth checks every 2 wks. All scans looked good, and he managed to keep growing, barely. The doctors told me that as time went on, the criteria for delivery would get lower and lower. Before 28 wks, it would have to look REALLY bad; after 32, moderately bad; after 34, if anything looked even the slightest bit fishy, that was it. And that's what happened - on the babies' birthday, cord doppler looked good, fluid looked good, but the NST was really off. They sent me straight to the hospital.

(Interestingly, although everyone had convinced me to try to wait until 36 wks to deliver as long as tests looked ok, my instincts were just screaming to deliver at 34 wks - and turned out to be right!)

Birth weights are in my sig. In my case, the u/s weight estimates were spot on. DD spent 2 wks in the NICU - she came out breathing on her own, but soon after needed to be intubated, and needed a little extra oxygen for a while after that. She was also too sleepy to eat enough for a while. DS spent 4 wks in the NICU & Special Care - he just needed to grow and get big enough to maintain body temp etc.

Anyway - it is GREAT that you've made it to 34 weeks! The longer they bake the better, but at this point anything more is just gravy. I hope everything goes well for you - and feel free to PM me if you want to talk/vent!

 

QUOTE(Lawyerlady @ Oct 22 2008, 09:20 PM) [snapback]1038196[/snapback]
Thank you so much ladies. A few follow-up questions based on what some of you have said - Did you find the weight estimates they were giving you at the growth scans were way off, and if so, in which direction? Did your OB recommend bed rest (full or partial) or increased caloric intake?

Everyone keeps telling me I look so small for twins - I'm so nervous that my babies are even smaller than they're telling me and that they won't be big enough even if I make it to 36 or 37 weeks.


We were not put on home bedrest - our OB stated that would not help, although looking back I am not sure I agree. I believe our growth scans were very close, although we had not had one for 2 weeks prior to delivery. I was put on a high protien diet at 20 weeks. I did not gain much weight, despite eating all the time, but I also started out heavy. It sounds like your kiddos are already in a pretty good place, even if you had to deliver soon. Have you had steroid shots?

 

Ryan was diagnosed with IUGR at 19 weeks...same day I learned it was twins. They were born at 33 weeks 1day. I went into labor when Ryan's water broke. The U/S estimated the boys to be over a pound more than they actually were. They were 3lbs 3oz and 3lbs 11oz. Now Ryan is 2lbs bigger than his brother and has been since we left the NICU (there one month). Lots of hugs and hope everything goes well for you!

 

QUOTE(fuchsiagroan @ Oct 23 2008, 02:56 AM) [snapback]1038328[/snapback]
Although they told me to go on bedrest, I did some research and found that no studies show any connection between bedrest and better outcomes for IUGR. I asked a peri about this, and she said I was right - obviously, take it easy, but not worth killing myself lying in bed. I also asked her if I should be eating extra or anything, and she said no. And in the end, it turned out that the cause of IUGR in our case was that DS's placenta was abnormally small, and 30% of the blood vessels were clotted off. So I could have been eating 5000 calories a day, and it wouldn't have mattered, since the placenta just couldn't deliver it to him.


I want to advise that each situation is different. I personally disagree with this as I believe my bedrest helped considerably, however High Blood pressure contributed to Jakes IUGR. So the bedrest was also necessary to keep my bp down. And, unlike Ivy, we never determined the cause of my IUGR. I can see where in Ivy's case it may not have helped, but I would recommend erring on the side of caution when it comes to bedrest.

Another friend of mine had growth issue from the beginning, was told to go on bedrest, had another child so I don't think she was able to follow it that closely, ended up in the hospital and delivered at 29 weeks, one of her babies was less than 2lbs. I don't know all the details of her story and there may be other issues, but I would rather "kill myself" in bed for a few weeks than deliver at 29.

 

QUOTE
I want to advise that each situation is different. I personally disagree with this as I believe my bedrest helped considerably, however High Blood pressure contributed to Jakes IUGR. So the bedrest was also necessary to keep my bp down. And, unlike Ivy, we never determined the cause of my IUGR. I can see where in Ivy's case it may not have helped, but I would recommend erring on the side of caution when it comes to bedrest.

Another friend of mine had growth issue from the beginning, was told to go on bedrest, had another child so I don't think she was able to follow it that closely, ended up in the hospital and delivered at 29 weeks, one of her babies was less than 2lbs. I don't know all the details of her story and there may be other issues, but I would rather "kill myself" in bed for a few weeks than deliver at 29.


I hope my post didn't sound negligent or frivolous. The 9 weeks I spent waiting to see if Andrew would survive were among the most harrowing I've ever experienced. When the issue of bedrest came up, I did my homework, read all the peer-reviewed studies I could get my hands on, and discussed them with my perinatologist. With her approval, I continued limited and very gentle exercise (swimming and walking) and a semi-normal life, while being careful to make up for any activity with periods of rest. I think the toxic effect of the stress I'd have been under without these outlets would have outweighed any (unproven) benefit to Andrew of going on bedrest.

I should also make clear that I am not giving advice one way or the other. I'm not a doctor, nor do I play one on TV. I completely agree with you that all cases are different, especially if there's a condition such as high blood pressure that bedrest is shown to help. I was just sharing my personal experience with the OP.

 

Thank you so much ladies for all the replies. Your success stories make me feel better.

My growth scan yesterday revealed that both babies are still growing. Hooray! They estimate twin A, the little one, at 4 lbs even. That's only the 7th percentile, but she did gain 10 oz in 2 weeks which isn't bad. Her brother is estimated at 4 lbs 15 oz (30-something percentile). He gained almost a pound in that same 2 week stretch.

My OB was very pleased with the growth and with the dopplers, and said if the twins continue to grow at this rate he would like to try to keep them in an additional week past my scheduled C section, or until 37.5 weeks. He said he would be reluctant to let me go past that point because the risks probably would outweigh the benefits by that point. I have another growth scan in 2 weeks, so the results of that will determine whether we deliver at 36.5 weeks or continue on to 37.5. (Of course, I could always go sooner if anything looks off with any of the NSTs or dopplers.)

On the one hand I would be thrilled to keep them in until 37.5 weeks; on the other hand I am a little worried about the risk of something happening to baby A if we leave her in too long. Is that silly? I know they are monitoring me multiple times per week with dopplers, NSTs, and BPPs, but I still worry. What do you girls think??

 

Yay for a good growth scan! :yahoo: It's terrific that you've made it so far, and can keep chugging along for a bit.

QUOTE
I am a little worried about the risk of something happening to baby A if we leave her in too long. Is that silly? I know they are monitoring me multiple times per week with dopplers, NSTs, and BPPs, but I still worry. What do you girls think??


I remember asking the doctors the same question, especially once we hit 32 weeks. They always told me that if things go bad, it's gradual, not sudden, and with multiple scans per week they'd definitely catch it in time.

I was still very worried, though. No matter how much they told me that they'd catch problems in time, in my heart I was just too scared to believe it.

All I can say is trust your instincts. All the doctors told me that after 34 weeks, if you deliver early, you'll face some NICU time, but rates of survival and intact survival (=no long-term health problems) are pretty much the same as delivering at or close to term. As we approached 34 wks, I had an intense feeling that we HAD to deliver at 34, but the doctors persuaded me to wait until 36 (as long as no problems came up) --- only for problems to arise right at 34 wks. Obviously, the longer you can keep them in, the better - but if your gut is telling you that something's wrong, listen!

Hang in there, mama. And keep on growing, babies!

 

Were any of you IUGR ladies allowed to try a vaginal birth?

For me, both babies are vertex and my IUGR baby is baby A, if it makes a difference.

 

QUOTE(Lawyerlady @ Oct 26 2008, 08:24 AM) [snapback]1042523[/snapback]
Were any of you IUGR ladies allowed to try a vaginal birth?

For me, both babies are vertex and my IUGR baby is baby A, if it makes a difference.


My peri was pro c-section from the beginning and once I heard it was twins, honestly I had no opinion. Almost from the beginning my A twin was on her back, not head down. And we knew I probably wouldn't go into labor naturally - so I didn't want to face an induction.

So for me, i was pretty much expecting a c-section and with my high blood pressure and the 11 weeks of bedrest, i didn't want to risk the unpredictability of a vaginal birth. I know folks have strong feelings on this issue, but for me I really didn't and my c-section wasn't too bad. Neither was my recovery.

Glad the growth scans looked good.

 

Here is my story in a nutshell!!

I was having no problems - sailing right on through and at 30 weeks I went to my regularly scheduled peri appointment for a growth scan. they determined that Addison (baby A) not only had not grown since our last appointment but had low fluid and they could not get her to "wake up" and had to use this stupid buzzer. OH I remember that day! it was awful!! up until that point she was the exact same size, had a great fluid level and was very active! My peri pulled me out of work, put me on bedrest and told me to eat and drink all I could .From that time on we were monitored twice a week. I did the bedrest and eating - they told me that she would still be smaller and her fluid level did not improve (it did not get worse thank goodness!). When they were born, at 38weeks 4 days! Addison was actually a tiny bit heavier than Ava!! Addison was 6.9 and Ava 6.8 pounds!!!

I know this is s scary time for you - just hang in there and do everything your dr tells you I wish you and you sweet babies the very best!

and I did end up having a c-section - we had it scheduled but a week before, they did an u/s and WOW both were head down!! so they told me that I could try a vaginal if I wanted too - well 4 days before, they flipped back into their preferred positions babyA breech and B transverse. My peri wanted them out because of the low fluid level so we went ahead with the c-section!

:hug:
Heather

 

QUOTE(fuchsiagroan @ Oct 25 2008, 05:55 PM) [snapback]1042015[/snapback]
I remember asking the doctors the same question, especially once we hit 32 weeks. They always told me that if things go bad, it's gradual, not sudden, and with multiple scans per week they'd definitely catch it in time.



Same here - I was always told it wouldnt be anything sudden.

As for vaginal birth - the doctors didnt think our little guy could handle a vaginal birth - too much stress.

CONGRATS - things are going great - you are doing a great job! :Clap:

 

Hi Everyone

I've been reading all your posts on IUGR and they have given me great insight into the matter. I am 27 weeks and 4 days pregnant with natural identical boy twins. Baby B was diagnosed with IUGR on week 24. At first they were trying to figure out if it was TTTS but i cleared that, the fluids were good in both babies.
Basically i was a very active person, i work in a family owned business, spent a lot of time shopping for the boys and was always out and about. When we were first told that Baby B was not growing as well as it should be, i asked my doctor whether i should be on bedrest? She said NO, you are so active, your weight gain is great so you should not limit yourself. I didn't bedrest for a week and when we went back for a sonogram (at this point going twice a week) the specialist said the blood flow was still pretty bad and that i should stay off my feet. I was a little thrown off since my doc said not to bed rest. So i deceided that i would bed rest anyways.
Long story short, the BEDREST helped tremendously! in about a week after that sonogram, the blood flow had gone for absent to a high number of 5.3 and than the following check up it went to 4.6 and last week it was at 3.8!

I know there might no scientific study that links bedrest to IUGR but i wanted to get it out there that plenty of rest and good nutrition can really help as i am proof. I am hoping to go on till at least 34 weeks-35 weeks. I don't know if i want to take a chance after 35 weeks. Also i think it may be a c-section.

Hope everyone is doing well and that this post help.

Thanks =)

 

I am so glad to have found this thread. We aren't having issues yet but are definitely keeping an eye out for it since Baby A has a single umbilical artery (SUA). The girls had both been measuring right at the same give or take 1-2 oz until my ultrasound last week when Baby A measured 6 oz smaller than her sister. I was put on bedrest at that point due to my cervix being way too short. Hopefully Baby A holds her own and this doesn't become an issue for us. However it is great to hear such positive stories from you girls! Thanks for sharing!