A 25-year-old patient attended at eight weeks pregnancy for her first antenatal visit of her first pregnancy.
Initially, the pregnancy progressed normally and without any concerns. There started to be a slight fall-off in baby’s growth, first detected by ultrasound scan at 24 weeks of her pregnancy. There was less than one week’s discrepancy between pregnancy gestation and overall ultrasound scan size at each antenatal visit until she was 36 weeks when there was two weeks difference. The baby was measuring 34 weeks 0 days size when the patient was 36 weeks 1-day gestation. At 37 weeks 0 days, the baby measured 34 weeks 2 days size. With consideration of limitations of accuracy of pregnancy ultrasound scans, I suspected there was no growth of the baby over that week.
I advised the couple the likely problem was placental insufficiency. That meant the placenta was not functioning normally and there was reduced nutrition getting through to the baby. That put the baby in a compromised situation and at increased risk of foetal distress and even death in the womb. There was no obvious background reason for the problem. There was no relevant past medical history, the baby appeared to be normal, there was no hypertension or preeclampsia, no diabetes and no other reason apparent.
While the baby’s well being as assessed by CTG (foetal heart rate) monitoring, ultrasound scan assessment of wellbeing and mother awareness of baby movements were normal I advised with the lack of growth and the gestation (37 weeks) it was safer for baby to be delivered.
Labour was induced by an ARM (artificial rupture of membranes) and a Syntocinon infusion. Labour lasted 5 1/2 hours. She had a normal delivery of a baby girl who was born in good condition and weighed 2350gm. The patient had an intact perineum, though there was a small vaginal tear. She did not have an epidural block for pain relief in labour. There was no concern about the baby’s well-being in labour.
Postnatally all has gone well. Mother and daughter have been discharged home. There were no issues except for some challenges with breastfeeding related to baby’s size and which should resolve.
In a recent article titled ‘Public or private – What is the difference?’ I mention ‘a ‘low risk’ pregnancy is not a ‘no risk’ pregnancy’. This case illustrates that point. Complications such as intrauterine foetal growth retardation can occur without any background or risk factors. Optimal quality pregnancy care and patient compliance are important to enhance the chances of a good pregnancy outcome.