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How are 'small for date' babies managed?

Q: My wife is in the 32nd week of pregnancy. Her fundal height is around 24-26 wks according to the obstetrician. Her weight is 72 kg, total gain since pregnancy till now is from 73 kg to 75 kg only. We did USG which shows 33+1d wks size fetus with 974g +or- 316g fetus, we are really worried about our baby. Could you please give us valuable suggestion regarding possible diagnosis and management?

A:The weight gain is less than expected and the fundal height is less than the period of gestation suggesting intrauterine growth restriction - IUGR (i.e. a small for dates baby). The fetal maturity on USG corresponds to the dates. However, other parameters on USG have not been mentioned, which could confirm IUGR. The weight is also slightly less, but if the 316gm is considered, it could be significantly less. I hope your wife's blood pressure (BP) is normal. Also, the progress record in the antenatal period will show when the growth stopped or lagged. These details can help in pointing towards the possible cause of IUGR, which could be treated appropriately. In many cases, no definite cause is found despite performing all investigations. In that case, the only answer is intensive fetal monitoring and termination of the pregnancy when the monitoring indicates fetal distress or compromise. The mode of delivery i.e. by cesarean section or induction for vaginal delivery will depend upon numerous factors that are evaluated by the obstetrician when the decision is made to terminate the pregnancy. It is important that your wife keeps a track of the baby's movements - there should be atleast 10 good movements from morning till evening (we take 7AM to 7PM). Another method is to count the movements for 1 hour after breakfast, lunch and dinner and multiply by 4 to get the kick count over 12 hours. Every baby has its own count and the mothers differ in their ability to feel fetal movements. If at any time the baby's movements are not as strong, are less than 10, or decrease by 50% of the previous days counts, or are totally absent, she should report to the obstetrician immediately, and some action will definitely be taken. I am sure your obstetrician will order a biophysical score and a Doppler velocimetry of the fetal umbilical artery and MCA, and decide what needs to be done. I am sure she would have done all the necessary tests by now and administered betamethasone injection to hasten fetal lung maturity. Your wife needs to be delivered in a hospital having good neonatal ICU facilities, and a good neonatologist.

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