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Pregnancy situation based on ULTRASOUND reports.

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Hi Doctor,
My wife has conceived on 1st Dec 2013 by second cycle of Clomed. After first visit the doctor suggested that she should take duphaston as she has PCOC.
In her first trimester she had a little bleeding and was rushed to the emergency where the Gyne informed us that there is nothing to worry as it is normal to experience this when the plecenta is getting formed. After which she was given extra dosage of progesterone of Primolut D injection plus cyclogest along with her ongoing duphaston. And after completion of second trimester doctor has stopped her duphaston and cyclogest and she is only taking weekly injection of Primolut D currently.
She is in her 35th week of pregnancy and we have done three major ultrasound scan: NT & Trisomy, Morphology and Growth Scan. All three scan reports with images has been attached. We also have the full scan video, if you wish to refer those please let me know.
Please advise how her overall pregnancy is proceeding and if there is any area of concern we need to pay extra attention? As per latest Growth scan the technician advised that baby head is downward and have no obstruction toward the birth canal. We wish to have a normal delivery and our sole purpose for this second opinion is to find out if there are any issues pertaining to same.

Category: OBGYN

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Category: Infertility Specialist
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Hello. Thanks for writing to with your health query.
I understand your concern. I have a few questions before proceeding further. - What is your wife's age. - What is her height and weight ? - What is the baby weight in the latest scan ? - Are her blood sugars, thyroid profile and blood pressure normal ? - Is this her first pregnancy ?
Please let me know these details. I am unable to access your uploaded reports in the .zip format. Kindly upload them in pdf format.
Please include the latest scan reports ( images are not necessary, just report is fine ) so that I can guide you further.
Looking forward to hearing from you.
Take care.

Patient replied :

Hi Doctor, Please find all three reports in Jpeg attached here and all scan images on below link. Looks like zip upload didnt worked out. Scan 1 Images - NT and Trisomy Scan 2 - Morphology Scan Scan 3 - Growth Scan Your question answer's - What is your wife's age.----- 32 years old patient- What is her height and weight ? ------- Height is 5"6, weight at conceriving 93kg and now at 99kgs - What is the baby weight in the latest scan ? ---------- He is weighing around 1.75 kgs - Are her blood sugars, thyroid profile and blood pressure normal ? ---------- All normal - Is this her first pregnancy ? --------- First succesful pregnancy (as she had miscarriage in 2011 at 11 weeks).

P.S: Looks like I cant upload normal files here even, so I have added report images in Google Photos link above.

Thank you for the reports, I have gone through them.
She is obese, and there are various risk factors such as previous miscarriage, pregnancy after ovulation induction, PCOS etc.
Also, one more request.
I need to have the report page of the latest growth scan.
Not the images, just the inference / conclusion page.
Normal or vaginal delivery depends on a lot of factors.
The head is below so that is a good thing.
At the time of delivery, around 38 weeks, your obstetrician will perform an internal exam - per vaginum check up.
That will assess the size of the mother's pelvis in relation to the baby's head and body weight.
If the assessment is favourable, trial of normal labour is given to most women.
Where are you based, in which location ?
Please write back with the details requested.

Patient replied :

Hi Doctor,
We understand all the concern mentioned by being obese, previous history, PCOS etc. And we fully understand that no one can guarantee anything in such scenario's and it's entirely in God's hand and baby's wish.
What we seek an opinion is on the basis of 3 major ultrasound provided to you especially the last growth scan (attaching again in PDF). We basically want to know the overall health of the baby and how healthy this pregnancy is proceeding.....?
Should we have some concern per the attached report or if there any complication with baby's health at the moment? We are just over concerned parents who want to seek a second opinion in hope to have a health and sucessful pregnancy with a happy and healthy baby.
We are based in Dubai and we still prefer Indian Doctor's more than anyone else. Hope to hear your detailed review over latest scan.
Please view latest scan in pdf in below link, as I cant attach PDF here.

I can understand your query.
Now the report is much more clear and legible in the PDF format.
According to this growth scan, the baby is severely lagging behind in growth.
Also, the blood flow to the baby is compromised.
In this scenario, C section seems more likely in the interest of the baby.
Feel free to discuss further,

Patient replied :

Thanks Doctor,
For clear insight on the report, and as a lay man I can only understand from the dotted position in each section and see that AC (dont know whats that) is only outside the borderline and rest seems under the range.
Can you please explain what exactly is lagging behind, as technician just commented that it seems small baby and nothing as you mentioned that it lags severly in growth. Can you be please be more specific what is lagging as in some indiviual area or overall growth?
Is this normal to be small such small size...?
What we can do improvise his growth...? (change in eating habit)
How we can improvise the blood flow to baby...? (getting some medicine or injections)
Any idea what has caused this situation and if there is anything specific we need to pay extra attention in future for our next pregnancy...?
Another experience, I think worth sharing is our baby seems quite active to us all the times and respond to our voice call immeditely within 5 seconds. And his kicks and movements is so strong that it can move our hand up and down nicely. And in some cases we see the whole stomach deforming different shapes and sharp angels.
For such small baby or baby with slow blood flow, seems contradicting.
How accurate these ultrasounds are and how much percent chances are there for human error vs software error in such scan....?

The AC is the abdominal circumference , measures the stomach part of the body and it is lower than normal.
The weight of the baby too is at 2.7 centile, which is way below average.
The head size is also smaller.
I would say it is an overall lag in baby growth.
This can be due to various reasons - intrinsic problem in the baby, maternal hypertension, problems in the placental blood flow.
It is not normal to have such growth disparity.
To improvise the growth, the causative reasons need to be checked.
If her sugars, blood pressure are normal, then the placenta is the problem.
She should always assume the left lateral position while lying down.
Drink atleast 5 litres of water daily.
Eat high protein diet - egg, chicken, fish, paneer, tofu, beans, nuts.
Take Alamine infusion and Alamin - SN capsules.
Take Protinex powder 2 tablespoons with milk daily.
The baby movements will be fine, till the baby is severely compromised.
Ultrasounds are quite accurate. If this problem has shown up, there is a very less margin for human or software error.
Also, typically ultrasound reports are ended with a page showing the conclusion or inference.
The report sent by you only has images and figures, and there is different type of software in different centres.
It is best to request the conclusion/ inference report so that there is clarity regarding the figures, legends and symbols used.
Take care

Dr. Aarti Vazirani
Category: Infertility Specialist
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
Dr. Aarti Vazirani and 4 other Medical Specialists are ready to help you

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