SGA = Small Gestational Age

Many babies with SGA have a condition called intrauterine growth restriction (IUGR). IUGR occurs when the fetus does not receive the necessary nutrients and oxygen needed for proper growth and development of organs and tissues. Early-onset IUGR is often due to chromosomal abnormalities, maternal disease, or severe problems with the placenta.

Severe placenta problems. I had a concealed placental abruption.

Okay so I figured it all out. Not as bad as I thought.

What are "AC", "BPD", "FL" and "HC" in ultrasound measurements?

Abdominal Circumference (AC) measures the mother's belly in cross section. Especially later in pregnancy, it is used as an indicator of fetal weight and growth. Sometimes, serial measurements are taken to ensure an accurate reading.

BPD stands for Biparietal Diameter and is an ultrasound measurement taken of the baby's head (from side to side). Along with the Femur Length (FL) and Abdominal Circumference (AC), it is used to estimate the fetal weight.

Femur Length (FL) often is measured along with AC and BLD measurements. The femur is the longest bone in the body and measurement of this bone is taken to estimate fetal growth.

AC, BPD and FL are combined in a formula to estimate fetal weight. While most ultrasound machines contain calculators, here is the formula used to figure the fetal weight: 1.4 X BPD X FL X AC (all in centimeters) - 200 = Fetal weight. (This is an estimate and becomes less accurate as baby gets farther from about 5.5 lbs.)

HC indicates Head Circumference. Babies of the same weight can have different head sizes.


IT STILL SUCKS THAT NO ONE TOLD ME ABOUT THE ANTERIOR PLACENTA OR LOW AMNIOTIC FLUID OR SGA! I took care of myself during pregnancy, but if I had known that something wasn't 100% right I would have stuffed my face with veggies and only healthy healthy healthy foods. I cheated and ate hardcore cheese pizza a few times, along with a ton of bacon and french toast. Sometimes I wonder if sticking to extremely healthy food would have ensured that my baby received every single vitamin and nutrient possible.

It is very strange they did not share the information with you, especially because it seems some of it WAS okay so they could have told you yet reassured you. I had an anterior placenta so I totally feel you on the not-being-able-to-feel-much-movement front--the U/S tech who found this told me I would probably feel the baby later and less than people with other placements. It helped me not worry that the baby never seemed to move that much, but it certainly sucked when he died and I had no indication from movement. It makes me wonder if it was that or the umbilical cord problems, or both, that made him be or seem less active...he measured big so it wasn't a matter of getting him the goods.

Here's my non-medical opinion on your other stuff:

SGA probably shouldn't have mattered until the last U/S because babies measure differently, especially by the end of the second trimester....if they were concerned they definitely should have told you and offered some ideas of what to do. Perhaps it is common to measure a couple weeks off in the last trimester so they didn't bring it up at the second U/S? I still think measuring 6 weeks behind should get them to tell you though (at the 3rd U/S).

They probably did not tell you about the low fluid because it says "low normal," which to me means in the normal range but just on the low side. However, I would think they would tell you this because they can ask you to drink more water, watch your weight gain/loss, and rest a bit more. Again, perhaps it just was not that abnormal so they weren't worried (yet)? I still think they should have warned you...but I can see if it is in the "normal" range why they wouldn't.

I wonder if the big discrepancy among the measurements should have told them something? I guess the "normal growth pattern" meant they thought the rate of growth was doing what it should.

I bet they had question marks because they wanted to get a second opinion, double check, or look more into it at a later time. You are right it doesn't seem professional or confident, but I know when I am taking notes I do question marks for where I want to go back. I'm no doctor though!

You have to know that you couldn't have changed ANYTHING you did to prevent what happened. Think of all the idiots who smoke, drink, and eat like crap their whole lives and get all the healthy, living babies they want. Of course you want to eat well and do everything you can...but you cannot feel guilty because you couldn't have changed anything your placenta did. It wasn't from diet and it wasn't preventable. Do not feel guilty!!

Lastly, I would like to say that I switched doctors after my stillbirth. I thought about it, and then an insurance change made me really shop around. The new doctor took one look at my information and spat out about 10 things the other doctors did not convincingly tell me. He is certain my baby died from one thing, while the other doctors wavered between two things and didn't really want to commit. My lawyer husband of course thinks it is because the delivery doctors didn't want a lawsuit...but I dunno. I just think if you can't get straight answers from your current doctor (you should ask him/her straight up to explain the questions you had above) then you should switch and find someone who will explain the stuff to you and be prepared to treat you differently in the future.

Becca, don't beat yourself up about eating pizza or anything else. You did everything you could for your daughter. The doctors' absoultely should have told you about the problems they were seeing. I wish I had more insight for you. Good luck with your research

First of all my dear if this was your first pregnancy it is not uncommon to not look like you are as far along as you are. I am so sorry about all this. I too had Placental Abruption but it was known as a Silent Placental Abruption because I had no warning signs of any kind. They found a large blood clot on the Placental wall indicating that it had torn away from my uterus and clotted. Most likely several times before Caleb finally stopped breathing. The day I went in to the doctor when he stopped moving they did and ultrasound to check for his heart beat. I do remember them telling me my fluid was low and asked if I had had any leaking. I sad no because I hadn't. To this day I do not know why my fluid was low but the cause of death was determined as Placental Abruption. All the tests they did came back normal except the one that showed Caleb's blood had begun to mix with mine. Evidence of the Abruption.
Do I blame myself. All the time. Did I lift to much, was I too hard on myself. I have gestational diebetes when I pregnant which I guess can effect all this. I had just started my GD diet and blood testing when I lost Caleb so I often wonder if that played apart. I guess the point is if you continously dwell on "was it my fault" you will eventually drive yourself mad. It was not your fault. It was just something that happened. I agree that if the doctors thought there was a problem they should have told you. If it would help you to to switch Doctors for your next baby by all means do so. I have contemplated this myself. But what happened to me was not my doctors fault. Everything appeared normal his heartbeat was nice and strong 6 days before his death. I was measuring a little bigger then normal too. You just never know my dear. I know it doesn't make it better. Praying for you Becca.

My baby was IUGR, so I've seen all these terms before on my US reports. AC is actually the circumference of the baby's abdomen, it is used along with HC (head circumference) and FL (femur (thigh bone)length) to estimate the baby's weight. The measurement of your tummy is FH (fundal height) and is measured from the top of the fundus(pregnancy belly) to the bone at the most front part of your pelvis (the pubic bone). The FH is measured at each appt with a tape measure and should equal in centimetres the number of weeks gestation. The last I measured was 31, at 39weeks.
The US is meant to give a more accurate view of how the baby is developing. But from the research it isn't too accurate. It can be the baby weighs for example 5 lbs +/-1lb, so if you're lucky the baby weighs 6 lbs, but if you're unlucky (like me) the baby actually weighs 4lbs. The AV is a measurement of the amniotic fluid. You can't increase it by drinking more, I know I asked!!! It's actually an indication of how well the baby's kidneys are working, because the AV is mainly made up of urine produced by the baby. Kidney failure is often the first sign something is wrong.
You can't compare US reports, unless the technician doing your US was the same person using the same machine. If they are different machines and technicians, it is less accurate. They can't use the actual measurements, they more look at the trend over a series of recordings and if the growth rate slows considerably or the fluid levels dip considerably they consider induction. UNfortunately for you, it is likely that because baby was growing on schedule, and you were only 31 weeks, they probably decided to monitor, because they don't like to induce so early coz of breathing complications, as the lungs don't mature until 36+ weeks, so survival rates for v prem are v low. It's no comfort obviously, my DH said he wished our angel could have been induced earlier coz even if she was ill there would have been a chance coz they could have been more active in her treatment.
What were the actual measurements of your LO at birth, was the US estimation good or no? How about the placenta? Was it the correct size? Approx 400-500g (sorry don't know what it should weigh in lbs/oz) My placenta weighed only 200g and my angel weighed 4lb 10oz, but in the end they said it hadn't contributed to her death. I think she was weakened by the poor nutrition though.
Oh and really don't worry about eating pizza etc, you could have been eating the best food ever, and if the placenta wasn't working properly, it still wouldn't have reached baby. They often don't worry about SGA with new moms so much, esp if they were petite beforehand, coz the abdo muscles hold everything in, so it is only an indication for further investigation.
I have a friend who only measured 26 weeks at 37 weeks, so she was monitored and as soon as 37 weeks arrived she was induced, her baby was well over 6lbs, she just had full on hardcore abdo muscles. But even with her they still waited til 37 weeks before induction, and I think it was only when I lost my angel at 40 weeks that she realised SGA is something to worry about, she was totally calm and unconcerned about having her induction, to her it was a convenient outcome coz they could plan better for baby, but when I lost my angel she knew how serious it was for her.
I have made sure that for my rainbow the monitoring will be different. I am to have the same machine, and the same person do each US, a consultant radiologist. She will work with my OB to decide on what to do and when. I will be montoired every 4 weeks in the last trimester, and more often if the reports show any indication of problems. There is a difficult balance between inducing too early and having baby spend weeks in special care baby unit, with health complications later in life such as eyesight/hearing issues/ developmental issues/breathing difficulties... and leaving baby too long in a environment which doesn't support optimal growth..
Talking like this sounds ever so clinical, but I prefer it actually, I want my Drs to be clinical and make good judgements, the OB I had with my angel laughed at my questions and told me to do as I was told (in not so many words) he even hugged me on the way out of my last appointment and said don't worry mom, your baby is low risk... I never did find out until the induction day what my baby was at low risk of.... anaemia? jaundice? being on the small side? Actually it was low risk of death, and had he said that maybe I would have worried more. FInd someone to be your Dr or to look over your records that isn't lovely and charming, but that is hard, cold and clinical... they will tell you how it is straight up, and then you can make proper decisions and know the truth about what happened with you. find some answers soon, message me anytime if you need to talk, hugs
Hope you

Ty had undiagnosed IUGR, it wasn't discovered until he was born. My measurements were fine and I was gaining weight but because we don't have protocol in Ontario to do third trimester ultrasounds (which I intend to change) they didn't catch it. However, in your case, I would surely assume your doctor would be concerned with a small baby. My cousins babe was small and they had her in almost everyday measuring to keep an eye on the baby and deliver early if needed. I do find it very odd your doctor didn't clue in. All I can say is make sure you have a different doctor next time.

I hate saying next time becasue we shouldn't even be talking about that yet, we should be enjoying our angels. But, next time you now know what all of this means so you can question your doctor. I read everything I could on the things wrong with Ty so with my rainbow (I stuck with the same Dr, she's really great) but so I can tell her my worries and fears and she can help reassure me through tests. It's like we have to take matters into our own hands. Hugs

You are ALL so wonderful. Jess (tiberius' momma).. I'm moving down to you're area for my next pregnancy and stealing your Doctor. You have had such great luck with her, I am very jealous. Also, if you have a plan you need help putting into action for 3rd trimester ultrasounds in Ontario, then I can definitely help if need be.

Thank you to everyone for responding. I am putting together a very long list of the dos and donts for the next Doctor. I really love my current Doctor's personality and how easy it is to get in to see her when I'm pregnant, so I think when we start trying again I will confront her and ask her if she's up for the challenge to be my Doctor for her next pregnancy. I will give her my booklet of what I want/need/expect, and I will go from there I suppose.