It’s Almost Time!

Discovered the greatest Whole Foods hack- if you go in the morning when they have their breakfast items at the hot bar, you can get a bunch of bacon for cheap.  It’s perfect- you save the effort of frying it up, and since it’s light it doesn’t cost much if you can resist the other items at the hot bar.  I think I got like 9 pieces of bacon for $1.35.  If only everything else there didn’t cost so much.

I’m 39 weeks and 3 days today.  Several days ago, after having no Braxton-Hicks practice contractions whatsoever, I woke up at 2 am with them.  Though my whole uterus did get hard, I found it interesting that the pain was lower down, and felt like bad menstrual cramps.  They were coming 10-15 minutes apart, and I wasn’t able to go back to sleep for several hours.  They continued less frequently throughout the day.  After that, I haven’t really had them very often.

I have continued to have that occasional discomfort in my cervix- it must be his head pushing down into my cervix, because when my doc checked my cervix yesterday, I was already 3 cm dilated.  Between the contractions a few days ago and whatever the little guy’s been doing with his head, things are definitely progressing.

At each prenatal visit, we measure a fundal height, which is a measurement from the pubic bone to where we feel the top of the uterus (fundus of the uterus).  After 20 weeks, the measurement in cm is supposed to match how many weeks the fetus is, give or take a couple cm.  I’ve always measured on the smaller side by a couple cm, but today it was about 35 cm even though I’m 39 weeks, and it was 36 cm last week.  Although my doc figured he had just dropped lower in my pelvis, it is a significant discrepancy, so to be safe she had the high risk OB doc do an ultrasound.

He’s measuring 2880 grams, which is 6 lb 5 oz.  It’s in the 10th percentile for his gestational age, which technically is considered borderline growth restriction.  The high risk OB doc recommended that I be induced around my due date if I haven’t yet gone into labor on my own.  The good news is that Little Willie’s head is super low, which he was able to see on the ultrasound.  So that combined with my 3 cm dilated cervix hopefully means I won’t have to be induced.  And even if I were, my cervix would be favorable for induction compared to a long and closed cervix.

Intrauterine growth restriction (IUGR) is when the fetus in measuring in less than the 10th percentile.  With that said, many fetuses in that category are constitutionally small, which is a fancy term for growing appropriately small for its genetics.  If the mother is a smaller woman, it would be less concerning for the fetus to be growing <10th percentile compared to if she were 6 ft tall.  Though there are slightly higher risks of stillbirth for fetuses measuring less than 10th percentile, the risks of stillbirth as well as other issues after birth, are more significant for fetuses measuring in less than the 3rd or 5th percentiles, depending on the study.

Reasons that fetuses may develop growth restriction include maternal chronic conditions like diabetes, high blood pressure, and autoimmune diseases.  Also maternal substance use, teratogen exposure, and infection can contribute, as can fetal conditions/anomalies.

For fetuses that are growth restricted, there are two types: symmetric and asymmetric.  The latter is more common, and is also called head-sparing.  Four measurements are used to obtain the weight of the fetus- the diameter of the head, the head circumference, the abdominal circumference, and the femur length (thigh bone).  In asymmetric or head-sparing IUGR, the abdominal measurement is decreased relative to the head measurements.  It’s thought that the fetus is redistributing blood flow preferentially to the more vital organs.

On the converse, one of my attending physicians in my residency training who is a diabetes in pregnancy expert always said that if the abdominal circumference is relatively large in comparison to the head measurements, there’s a higher chance of a shoulder dystocia.  A shoulder dystocia is when the head comes out, but the shoulder gets stuck behind the pubic bone, preventing delivery.  This can be an obstetric emergency, since the cord at this point is compressed.  If the baby is not delivered quickly with the maneuvers that we use for this situation, then it can end up with permanent damage or death.  So these little football player fetuses, particularly if their moms have diabetes, can be at risk.

Turns out Little Willie’s abdominal circumference was lagging behind his other measurements.  With that said, 10th percentile is still borderline, and otherwise there is nothing to suggest any concern about his well-being.  Given my size, I wouldn’t exactly want to attempt to push out a 9 pounder.  So I’m not that worried, and hopefully I’ll just go into labor by my due date so I won’t even have to worry about the whole induction.

In my experience, the fetuses we worry about tend to be the ones who have mothers with chronic medical conditions, and perhaps have had growth concerns from earlier on.  The vast majority of my patients who have fetuses in the mild IUGR range have babies who are totally fine.