Thoughts and Advice on Size @ 33 weeks

[mllewellyn]

At 27 weeks, I had an ultrasound and Gabriel measured 49th percentile and everything looked good. The OB office does growth ultrasounds to measure weight and other measurements every three weeks. At 30 weeks, Gabriel measured 39th percentile and I had lower fluid (11 to 9). That's when I questioned the whole thing with my friend who is a tech. Yesterday, I had another scan. Gabriel is measuring in the 19th percentile. He weighs 3 lbs 13 oz (up from 3lbs, 1oz three weeks ago). My OB actually showed me the report that is generated by the US computer. His abdomen is measuring right but his head is in <5 percentile. I guess this means I have IUGR? My fluid levels dropped from 11 to 5 since Friday. But, the last time they told me this, it went back up at the next US 3-4 days later. My BPs have been normal to high normal (130s/80s) but I have had a few days of high BPs (over 140/90 but not many beyond this parameter). I am maxed on aldomet (3000 mg/day). I am not sure that the meds are working since he is not growing fast enough. He is moving and he moves a lot, which is good. He was trying to breathe at the US yesterday. On the BPP, he did well on each category except fluid. I have been diagnosed with PIH only. I am not spilling protein. In my last 24 collection, it was "inconclusive". When my OB got those results, she called them and they told her I had almost no protein in the collection. My PIH blood work (liver and platelets) are normal. My OB told me yesterday that we would wait until it was obvious that growth was completely restricted before inducing and her hands are kind of tied since I don't have pre-e. She said I would be induced if BPs were 160/110 or higher, my fluid levels dropped some more, there was a decrease in fetal movement OR if I developed pre-e. I am 33w2d today.
If Gabriel is measuring smaller than normal (in weight, he is a week behind) how might this affect him if he is born soon? I understand that he will likely have trouble breathing and learning to suck/breathe together. Does anyone have experience with a similar situation? I am really open to all situations at this point because I really have no idea what to expect except the NICU and I don't even know much about this. I worry that if his head is so small he might encounter a brain bleed or something similar. Everyone keeps saying "Oh you've made it to 33 weeks, you are doing great, everything will be fine you are far enough along." WHy don't I feel relief with these comments?
Thanks for anything you have to share. I am a little scared and sad that this is happening.
Mistie

[kbielec]

I wish I had some words of advice for you but I feel like I am reading my own post when I read yours...I am so sorry you are going through this.
I will say this, your son is a nice weight and you are 33 weeks, I feel like this gives you odds on your side if he has to come early. Another positive is you aren't sick, no pe or hellp so that's good. I will be thinking of you and praying for you! Hang in there...

[crocusgirl]

My daughter was born at 32 weeks, with IUGR. I had severe PE and HELLP, and I was hospitalized for 8 days before she was born my emergency c-section due to HELLP. She was small for her gestational age - only 2.5 lbs when she should have been 4 lb or more. She quit growing well at about week 28 or 29. She did really well once she was born. She never had any issues with breathing or eating. She was in hospital for 5 weeks, and only lost weight overnight once. She was feed by gavage tube for about 3.5 weeks (I was pumping) until she was ready to suck - bottle went easier than breast. Came home at 37 weeks, at just about 5 lb. Now she's 2, and you'd never know she was a preemie. From the time I was admitted, the NICU staff was very positive about her outcomes. At 33 weeks and a pretty good weight, I think you don't need to panic. Hope that helps!

[mllewellyn]

It does help a lot. I have spent a great deal of time worrying about Gabriel. Thanks to both of you for your posts. I hope that all goes well for both of you!
M

[angieb]

I don't think you are officially IUGR yet. I might be mistaken but I think it's 10%ile or near that...

I have heard that IUGR babies often do better than bigger babies because they adapt to the restricted blood flow or something like that.

Have they thought about decreasing your meds? Are you seeing an MFM? Have you had any blood flow studies done lately?

[mllewellyn]

I have an ultrasound with doppler of blood flow twice a week. I don't know if there is anything else they can do for blood flow? Are there other tests? I can ask them and they will do them. I know that they have dealt with situations like mine, but they are treating me as if I were on hospitalized bedrest and coming to docs. They are excellent and I see my OB and the MFM each week since I have two appointments/week.
They increased my BP meds on Monday. My BPs were getting over the 140/90 mark. Now, they are pretty good 125-130s/78-80s. I don't have protein in my urine at all. I dip daily and I know that is not always the most reliable measurement (24 hour collection better), and my blood work (liver, platelets) are normal. What I am having trouble understanding is the rate of growth on certain body parts: head measures <5th percentil and then the abdomen is normal. I really don't understand ow somethings are growing and others are not. I am worried that the differences in growth will affect him if he is born early. From my reading, I have learned that I am in a good place for his survival, he weighs in at almost 4 lbs and I have made it to almost 34 weeks (I am 33w 4d). I have actually seen him trying to breathe on the US so I know he is getting himself ready. I just worry and probably too much.
THANKS for your questions, and if there are any answers you have or know, I would love to read them.
I must say that this board is really a great one. You have all made me feel a little better when I read your posts and replies. There are a bunch of really sincere and genuine people here which is so helpful.
M

[angieb]

I would probably still try to get steroid shots, if you haven't already, just in case, as an extra precaution.

The blood flow studies I mentioned are the same that you sai tey are doing, glad they are watching you closely. Yes, you are in pretty good shape as far as gestational age. Hopefully you can get a few more weeks in!

[crocusgirl]

I agree with the poster just above me - get the steroid shots. Better safe than sorry.

[mllewellyn]

I asked for the shots and was told that unless I went into L&D, I wouldnot get them now that I have made it to 34 weeks. When I argued, they said my insurance will also not pay for them because it is customary to let the baby alone after 34 weeks. I told them, I will pay for them. Still not much luck.
I did talk to my mother about all of this because she is a nurse, but also because she has access to docs who can give me advice. They said simialr things. One of the asked my mom how much did I weigh when I was born and when she told them, they said, "Oh, she was really small too? It's genetics." We passed our BPP on Monday (8/8) so as long as Gabriel stays in there and he is doing well, I guess i'll leave the issue for now. THANKS for the responses.
M

[nov_mum]

My first pregnancy they gave me steroid injections at 34 weeks, my second they didn't bother and I got to 38 weeks yipee! Third time around,, BP was up at 22 weeks and was on twice weekly monitoring, they told me that any time close to 34 weeks there is little to be gained according to current thinking. Every time is a different Dr with a different idea! This time around I am hoping for 38 weeks but realistically, if I get passed 35 I am home and hosed!