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Dr. C.
Dr. C., Board Certified
Category: OB GYN
Satisfied Customers: 3064
Experience:  30 yrs experience, awarding winning educator
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Doctor, my wife is pregnant in two babies she is in the

Customer Question

Hi doctor, my wife is pregnant in two babies she is in the 30th week. One has weight of 2,205 gms and the other's weight is 1,123 gm. The main problem is the smaller fetus has negative EDF. Weight progress of the small one os slow (30 gm gained during the past week) Is there any threat that the smaller fetus will not be delivered or will die after birth? Please advice if you need me to send you scanned copy for the doctor report.
Submitted: 11 months ago.
Category: OB GYN
Expert:  Dr. C. replied 11 months ago.
Hi, It's Dr. C. Board certified Ob-gyne with 30+ years of experience. I can help you today. I'm very sorry to hear about this situation. A negative EDF is a VERY bad sign. In this circumstance, the doctors would usually be advising delivery. Because the babies are preterm, they may try to delay slightly while they give steroids to help mature the lungs but it's also possible they may decide that there isn't enough time to do that. I really hope that both babies do well despite this situation. There is obviously a risk to both babies but if the babies are delivered soon, it's quite possible that with excellent neonatal care, they may both survive and do well. The perinatologist (high risk pregnancy specialist) who is managing her pregnancy should be able to give you statistics on survival and risk of "morbidity" for each of the babies. Some of that depends on details of the situation of how the blood vessels are feeding from the placenta and to the babies along with other factors. Here is a link to a studies on some the statistics involved: http://www.ncbi.nlm.nih.gov/pubmed/8766482 The doctors may decide to monitor the fetal heart rate and other parameters of fetal health on ultrasound. If abnormalities develop, the situation is quite urgent and delivery should be very soon, even if the babies premature. I hope this information has been helpful and really wish you and your wife the best of luck. Please reply if I can clarify anything.
Customer: replied 11 months ago.
Actually the two babies are normal in terms of everything except the blood supply. One has higher blood supply than the other, however the blood going to the brain is normal for both but the main problem is in the weight progress for the small fetus plus the negative EDF. She has started to take Fortecortin 8 mg in order to expedite Lungs formation. The doctor advises that we could deliver both babies withing 2 weeks. Please advice the way forward and if you need me to send you scanned copies for the report please tell me. Thanks in advance
Expert:  Dr. C. replied 11 months ago.
This sounds exactly correct regarding management. I'm glad the babies are perfectly normal otherwise. The doctor is giving steroids to expedite the lung maturity. And will be monitoring the fetal heart pattern and other ultrasound parameters of health versus distress. If any signs of distress develop, they will want to deliver sooner rather than wait the full 2 weeks. If the babies are delivered before signs of distress develop, the babies have a good chance of doing well. Even a small fetus of 1000+ grams can do well with excellent neonatal care and some luck. Sometimes the smaller baby actually does better than the larger one. We think this is because the stress leads to faster maturity of some of the organ systems. The report can be scanned and attached as a file using the paperclip icon on your screen. Any other questions?
Customer: replied 11 months ago.
Kindly find attached the report, please advice. Could you tell me what are the signs of distress? In order to take our precautions.
Expert:  Dr. C. replied 11 months ago.
Thank you for the report. The most important good factor is you'll notice that the smaller babies head is actually normal size and the ratio of the head to abdominal circumference is high. This is called "head-sparing growth restriction". This is a way of the smaller baby responding to the stress and protecting itself. You'll want to ask the doctor which baby is at higher risk. It's possible that the larger baby will have more trouble after birth than the smaller. But since the larger baby also has normal fluid, that is a good sign. Usually if the bigger baby is in trouble, the fluid will be excessive around that baby. Overall, with the fetal movement and the fluid being normal, things are ok right at the time of the report. Signs of distress that the doctors will be looking for include worrisome pattern of the heart rate on monitoring. On ultrasound they will be looking for the fetal movement, fetal breathing activity, normal fluid levels, signs of "meconium" in the fluid and calcifications and aging of the placenta. Meconium is fetal poop. It will show up as bits floating in the fluid that are visible and are a sign of fetal distress. An aging placenta that is overstressed gets calcifications, white visible specs and instead of being one large "pancake", begins to break down into consolidated "cotyledons". I hope this added information is somewhat reassuring. There will be a lot of testing with heart monitoring and ultrasounds. As long as the babies don't show signs of distress, it would be helpful for the steroids to have a chance to improve the maturity of the lungs. But the doctors will be ready to move quickly if signs of distress develop. Overall at 30 weeks gestational age at those weights, babies should do reasonably well statistically speaking. I hope in your individual case all goes well for you, your wife and your babies. Anything else?
Expert:  Dr. C. replied 11 months ago.
If no more questions, please leave a rating for my service. I aim for excellent and appreciate your feedback. Thanks and good luck.
Expert:  Dr. C. replied 10 months ago.
It's Dr. C. Checking in to see how things are going for you, your wife and your babies. I hope things are stable and the babies doing well. Let me know if you have any additional questions.

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