Almost 40 weeks, can go to 41

I'm still pregnant. Imagine that!

Still being seen at Beth Israel Deaconess Medical Center in Boston,
USA, by the high risk (maternal fetal medicine) group. They are very
thorough, and not at all anxiety-prone. I spent hours over the weekend
researching the question of how to distinguish between a fetus that is
healthy but small for gestational age (SGA) and one that is suffering
from growth restriction/retardation (IUGR, due to a systemic medical
problem in the mother, placenta, or baby). The clinic usually is very
busy, so I have not wanted to take their time asking technical
background questions. Instead, I do my own research, mostly on PubMed.
And from that I can see the clinic staff have been checking all
angles, and they have confirmed again and again that all is well. Of
course it is possible that something is wrong, but that's always
possible. I will take my chances there.

I accept that my baby is SGA. And has a medical problem. But, problem
aside, baby appears to be healthy. All signs are excellent. The
current plan is to continue waiting one more week; if I don't pop
before week 41, schedule an induction. I doubt I will make it another
week, because warm-up contractions have been a regular grumpy-making
highlight of the past 4 evenings. I consented to 2 internal exams,
last week and today, and they show what I already know: I am
progressing, slowly. Today my cervix was 60% effaced; still not
"favorable" for induction, but getting there.

RANT mode on

The obstetrics community really needs a more intelligent method of
diagnosing IUGR. The current method of diagnosis by proxy is almost
absurd: any baby under 10th percentile weight for gestational age is
assumed to suffer IUGR. This is often false. Misdiagnosis of IUGR
causes unnecessary management of healthy small babies (extended bed
rest, hospitalization of the mother, attempts to induce prematurely,
unnecessary and risky C-sections, premature *AND* low birth weight
babies) and totally misses the babies that (eg) should have been 90th
percentile but are only 50th percentile due to severe IUGR.

RANT mode off

Monkey Boy, now 2.5, has been making tremendous progress in potty
training. He is such a big boy!

Congrats on hitting 40 weeks! Here is to 41!
--

Jamie
Earth Angels:
Taylor Marlys, 1/3/03
Addison Grace, 9/30/04

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The obstetrics community really needs a more intelligent method of
diagnosing IUGR. The current method of diagnosis by proxy is almost
absurd: any baby under 10th percentile weight for gestational age is
assumed to suffer IUGR. This is often false. Misdiagnosis of IUGR
causes unnecessary management of healthy small babies (extended bed
rest, hospitalization of the mother, attempts to induce prematurely,
unnecessary and risky C-sections, premature *AND* low birth weight
babies) and totally misses the babies that (eg) should have been 90th
percentile but are only 50th percentile due to severe IUGR.

I'd have to agree there, my first was almost certainly IUGR, but he was
5lb13oz when born, which was 25th centile for his gestation, but he'd been
heading for 75th, but gained almost no weight in the last 5 weeks of
pregnancy. There was some suspicion that something was happening before he
was born, but everyone said he's not really tiny, so no worries, but I'd
done my reading like you and was sure that what I had was an IUGR baby who
wasn't under 10th centile for gestational age, so it was a fairly worrying
time, thankfully he came at 37+4, an induction due to PROM, which I probably
wouldn't have consented to without the IUGR concerns.

Glad everything is well with you and labour vibes for the next few days.

Anne

Pologirl wrote:
I'm still pregnant. Imagine that!

Congrats on making it to 40 weeks! Sending labor vibes for an
appearance of your little one this week!

Sharalyn
mom to Alexander James (9/21/01)

Pologirl wrote:

Still being seen at Beth Israel Deaconess Medical Center in Boston,
USA, by the high risk (maternal fetal medicine) group. They are very
thorough, and not at all anxiety-prone.

The researchers there are way up to speed.

The obstetrics community really needs a more intelligent method of
diagnosing IUGR.

The most recent NIH conference actually had some discussion of markers
that could be used (at 11 weeks) to catch the vast majority of IUGR --
some 80%, IIRC. Not that this is any help, to you. :-)

--
C, mama to three year old nursling

Pologirl wrote:
I'm still pregnant. Imagine that!

40 weeks is awesome! Congratulations.

Sounds like you are in great hands (yours and your medical team's). Are
you away from home while you wait?

Well done on the potty training! I am pretty excited about that phase.

Elle
DD 02/23/2005
#2 EDD 04/23/2007

"Pologirl" wrote in message
oups.com...

I'm still pregnant. Imagine that!

I've been looking for an update from you! 40 weeks- fabulous! Maybe
you'll have this lil' babe on Grant's 1st birthday-Friday the 29th.

Still being seen at Beth Israel Deaconess Medical Center in Boston,
USA, by the high risk (maternal fetal medicine) group. They are very
thorough, and not at all anxiety-prone.

Sounds like you're in excellent hands.



I accept that my baby is SGA. And has a medical problem. But, problem
aside, baby appears to be healthy. All signs are excellent. The
current plan is to continue waiting one more week; if I don't pop
before week 41, schedule an induction. I doubt I will make it another
week, because warm-up contractions have been a regular grumpy-making
highlight of the past 4 evenings. I consented to 2 internal exams,
last week and today, and they show what I already know: I am
progressing, slowly. Today my cervix was 60% effaced; still not
"favorable" for induction, but getting there.

Things sound good. Hope the baby arrives before needing an induction, but
if not, it sounds like things are going well.

RANT mode on

The obstetrics community really needs a more intelligent method of
diagnosing IUGR. The current method of diagnosis by proxy is almost
absurd: any baby under 10th percentile weight for gestational age is
assumed to suffer IUGR. This is often false. Misdiagnosis of IUGR
causes unnecessary management of healthy small babies (extended bed
rest, hospitalization of the mother, attempts to induce prematurely,
unnecessary and risky C-sections, premature *AND* low birth weight
babies) and totally misses the babies that (eg) should have been 90th
percentile but are only 50th percentile due to severe IUGR.

RANT mode off

Sounds like a worthy rant!

Monkey Boy, now 2.5, has been making tremendous progress in potty
training. He is such a big boy!

That is excellent!! My 3.5 yo trained a month ago, and it was easy-breezy
and so welcome. LOL Go, Monkey Boy!

Joy

I've been looking for an update from you! 40 weeks- fabulous! Maybe
you'll have this lil' babe on Grant's 1st birthday-Friday the 29th.

we had this discussion last year! my birthday is 5th October and wasn't that
the date Grant came home from hospital?

arrggh, it's moving week now, so I'm not going to get news, I'll probably be
offline from lunch time tomorrow til Tuesday at the earliest, when I'll have
to go to a Starbucks or something to get access!

Anne

"Anne Rogers" wrote and I snipped:
arrggh, it's moving week now, so I'm not going to get news, I'll probably
be offline from lunch time tomorrow til Tuesday at the earliest, when I'll
have to go to a Starbucks or something to get access!

Good luck on your move! I'll be thinking of you. (talk about thread
drift.....)

:-)
-Patty, mom of 1+2

Pologirl wrote:
Still being seen at Beth Israel Deaconess Medical Center in Boston,
USA, by the high risk (maternal fetal medicine) group. They are very
thorough, and not at all anxiety-prone.

wrote:
The researchers there are way up to speed.

Indeed, but it is a huge hospital, and most OBs there do not see
high-risk patients.

Basically, I decided to make a first-pass choice between BIDMC and
Brigham and Women's Hospital (BWH), simply because both are within
blocks of Children's Hospital (only in truly extraordinary situations
are babies delivered at Children's Hospital). BIDMC passed muster;
BWH did not. I decided against BWH in part because although BWH has a
large midwivery group, the high-risk OB I interviewed there knew (or
claimed to know) absolutely nothing about the group. Ditto for the
nurses and receptionists I spoke to there. I gather that the midwifes
primarily do prenatal care at satellite clinics. In effect, they serve
a business function, vertical integration: a pipeline sending women to
BWH rather than another of the many other good hospitals in Boston.
The OB also suggested I write a birth plan, but only in the course of
telling me that anything not part of the hospital's L&D routine (such
as no IV without need) I would have to take up myself with whatever
nurse was on duty at the time of my labor. Ie, I should expect no
support from the OB staff.

And here (http://www.nlm.nih.gov/medlineplus/e...cle/001500.htm)
is a supposedly authoritative medical encyclopedia entry about IUGR,
that is woefully inadequate. The author is an MD on staff at BWH.


The most recent NIH conference actually had some discussion of markers
that could be used (at 11 weeks) to catch the vast majority of IUGR --
some 80%, IIRC. Not that this is any help, to you. :-)

The devil is in the details. How did they define IUGR?

Tell me more. What conference? Which institute within NIH (there are
so many!)?

Here is a clinical trial that attempts to identify IUGR from early
amniotic fluid samples:
http://www.clinicaltrials.gov/ct/show/NCT00143039

And here is a website that gives the conceptual history of IUGR:

http://eb.niehs.nih.gov/bwt/subchist.htm

It doesn't go quite far enough, though, unless you dig for it. The
latest thinking makes an important distinction not only between low
birth weight (LBW) and small for gestational age (SGA), but between SGA
and IUGR (intrauterine growth restricted / retarded). AFAIK, this was
first shown in 1993 by an analysis of babies born at high altitude (in
Colorado); on average Colorado babies are smaller, but the *shape* of
their weght-vs-mortality curve is exactly the same as for the entire
US.

For an intelligent discussion of IUGR as a problem distinct from SGA,
see this:

Am J Epidemiol. 2006 Aug 15;164(4):303-11. Epub 2006 Jul 17.
Comment in:
Am J Epidemiol. 2006 Aug 15;164(4):312-4; discussion 315-6.
Birth weight and mortality: causality or confounding?
Basso O,
Wilcox AJ,
Weinberg CR.
Epidemiology Branch, National Institute of Environmental Health
Sciences, National Institutes of Health, US Department of Health and
Human Services, Research Triangle Park, NC 27709, USA.

The association between birth weight and mortality is among the
strongest seen in epidemiology. While preterm delivery causes both
small babies and high mortality, it does not explain this association.
Fetal growth restriction has also been proposed, although its features
are unclear because it lacks a definition independent of weight. If, as
some postulate, birth weight is not itself on the causal path to
mortality, its relation with mortality would have to be explained by
confounding factors that decrease birth weight and increase mortality.
In this paper, the authors explore the characteristics such confounders
would require in order to achieve the observed association between
birth weight and mortality. Through a simple simulation, they found
that the observed steep gradient of risk for small babies at term can
be produced by a rare condition or conditions (with a total prevalence
of 0.5%) having profound effects on both fetal growth (-1.7 standard
deviations) and mortality (relative risk = 160). Candidate conditions
might include malformations, fetal or placental aneuploidy, infections,
or imprinting disorders. If such rare factors underlie the association
of birth weight with mortality, it would have broad implications for
the study of fetal growth restriction and birth weight, and for the
prevention of infant mortality.
PMID: 16847040