Small fetus: 7 years post-RNY and 30 weeks pregnant
I'm now 30 weeks along, expecting 12/4/13. I had gastric bypass (RNY) in June of 2006, and have never had any problems, lost all my weight, and I've been really good about my diet. However....
When I went for an ultrasound at 28 weeks, the perinatologist said the fetus is small, in the 16th percentile. Now, this is just the starting baseline, so nobody's worried yet. But they said if they don't see a good growth rate by 32 weeks, they're going to assume placenta problems, start monitoring me more closely, and might eventually recommend inducing early because of presumed placenta failure. Skipping all of my feelings about THAT for the time being ---
I talked to my bariatric team and nutritionist, who found 2 different studies on PubMed that said that compliant bariatric patients are 2.3 times more likely to have small gestational-weight fetuses. It's not because of placenta failure; it's more likely because of our restricted diets (low sugar, low carb, etc).
My other measurements have all been great: fundus, my weight gain, fetal heart rate, kick activity.
Anyone else run into this? What we're planning to do now is go back for my 32-week scan after eating like a pig as much as I can.
If the growth doesn't look good, we'll get a second opinion. I don't trust the original perinatologists much because they're affiliated with a very "high intervention" hospital. My primary OB caregivers are a midwife-run birth center.
We definitely will get a 2nd opinion, for sure, if the first perinatologists say the growth isn't good next week. I think they're full of sh*t, personally... the wee one is kicking more than ever, and my belly really has taken on a "Holy crap, I'm really, really pregnant" appearance this week....
I put very little weight (no pun intended) in the accuracy of these scans. Unless they can prove placenta problems, I'd never induce just because they think maybe the baby is small. Not to mention, 16th percentile is not tiny, it is bigger than 15 percent of babies.. I hate the way doctors love to compare. I had a 6 lb baby at 41 weeks, before I even had WLS, she was perfect, just petite. At my scan, they told me she was going to be "at least 9lbs if I go full term"... boy were they wrong. Definitely go with your gut and don't let this worry you. Also, eating more will not translate to an automatically bigger baby, probably just more baby weight for you to lose. Good luck!
I've never heard from one person who actually had an accurate, or remotely accurate, measurement at the perinatologist. Crazy.
And the "eating more" advice was given by my bariatric team; it wasn't just a whim of mine.
I'm thinking it's a similar idea to the RNY... I absorb less nutrients, so *maybe* if my placenta is likewise absorbing less, then I don't mind eating more to compensate. It's been a challenge, though. I really struggle trying to get more than 1500 calories a day, even with protein powder.
I'm 30 weeks (due Dec 5th) and has VSG in August 2012. I have gained 15 lbs since i found out I was pregnant. I pretty much threw my diet out the window within a month of finding out I was pregnant. I eat what I want when I want. I just cant eat much at a time. (I'm really going to miss these carbs after baby comes!!!) My OB sent me to a perinatologist early on just because of the VSG. He released me after a couple months saying everything was good. Last week my ultrasound showed my baby to be small. His head circumference is measuring in the 7th percential while his body as a whole is in the 30th. My OB is waiting 4 weeks to do another growth scan and having me come in once a week for a stress test and measuring my fluid. Everything else is perfect just the size of his head is worrisome. If there isn't growth at the next ultrasound I will be going back to the perinatologist. They explained how they may want to take him early if he doesn't grow enough but like you I don't agree with that. I know this baby is small I'm 7 months and have to wear tight shirts just so people will notice I'm pregnant!! I hope to go the full 39-40 weeks but in the end I will probably do what the OB and Perinatologist recommend.
Indiana
Looks like we're due at the same time. I'm not going to let them induce me early unless there's clear evidence the placenta is failing. That means I'll definitely get a second opinion if next week's scan isn't up to par.
I've had my RNY and eating habits since 2006, so I won't miss the carbs and calories! I'm finding it difficult to force down more than 1500 calories a day, and eating when I'm not hungry, and so on. Right now, I'm forcing myself to drink a protein shake although I'd rather be sleeping.
I don't think a darn thing is wrong with the wee one, honestly. The kicking and activity have been really good, and my belly seems to have grown a lot in the last few days. Still, though, like you, I'm considered small when people find out I'm 30 weeks. I'm a bit tired of the "You're so small," comments, actually. (What I think in response:"OK! I'm not huge! I was a normal weight when I got pregnant, ok? It's my first pregnancy to make it beyond the first trimester! I'm not GOING to be huge!" It's exasperating sometimes.)
Anyway, I'm trying to eat a lot more sugar and carbs, and I'm honestly looking forward to not eating this way after the birth. I don't like how the sugar makes me feel.
I hope all is well with both our babies...My doctor said the earliest he would consider inducing is 37 weeks I'm curious what your Dr told you? I think the longer they get to "cook" the better off they will be.
I know what you mean about the comments. If I hear one more time "are they sure your pregnant?" I might choke someone. I try to remind myself to appreciate not being big. I know a woman who isn't as far as me but is huge and miserable. She gets teary when she sees me because she is having so much discomfort. I am grateful to not have that problem but like you I feel like my belly is growing now, that uncomfortable huge feeling may be coming soon!!
I find myself eating all the time. more like grazing. I try to really watch during meals because its so easy to overeat then feel like I need a nap or just feel crappy. I worry about getting back on track after delivery but I plan on hitting it hard from day 1. I was 10 lbs from goal when I discovered I was pregnant. I am determined to hit that magic number!
Please update how your scan goes next week.. I will be thinking of you!
My care is run by midwives at a birth center, so I don't have a primary OB. The perinatologists are not talking induction yet. And I will shut them down if they do. I require proof before considering induction.
I'm hormonal and furious about the government shutdown (I'm losing my maternity leave or paycheck), so I dare them to **** me off next week at the perinatalogist's office.....
anyway, the peri doesn't have the authority to make decisions for me, so I'll tell them to kindly f*ck off if they try to get me to switch to their care or follow their instructions. I'm going to get a second opinion if I need it. But I'm also annoyed that *they* didn't do any bariatric research first -- they just assumed it was placenta failure. F*ck that!
yeah, I'm mad today.....
None of my Doctors know anything about bariatric either. I'm the 1st bariatric patient my OB has had. I trust my OB's opinion completely, he is doing more than I ever expected and although I get annoyed with all the "extra" tests, I know he is just doing his best to make sure he don't miss anything. My perinatologist hasn't acted like he knows too much about it and doesn't appear to care to learn either. He is treating me more for being "old" than having had VSG. (I'm 39, I have a 20 year old and 16 year old daughter, this baby was a COMPLETE SURPRISE) I'm just thankful I haven't had any "real" complications. I do believe your own instinct is best, I learned with my 2nd pregnancy that you have to follow your own heart. you know more about that baby than anyone. Momma knows best....
Hope all this government mess ends soon. I live close to a navy base and most of my community are government workers. It's going to hit us pretty hard if it lasts too long.
