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Elliot Ruff
Elliot Ruff,
Category: OB GYN
Satisfied Customers: 1241
Experience:  GP at Whitstable Medical Practice
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I’m 28 weeks pregnant, I was told there’s a placenta

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Hi. I’m 28 weeks pregnant, I was told there’s a placenta insufficiency and the baby’s stomach is small 24 weeks gestation. But the femoral structure is 28 weeks. I was given a steroid injection yesterday and I’m told I could have c-section this Friday. I have done though blood test and the only thing is bilirubin Total 4.46 low and direct bilirubin 4.20 high. My question is as I’ve been told there is IUGR...what are the risks if I opt to push the pregnancy to at least 32 weeks and do I have to have c-section to deliver the baby. Please I need some advise on this

Good afternoon, I am Dr Ruff, thank you for your question, I appreciate this is a stressful time for you and your family. Placenta insufficiency implies that it is not likely to give your baby what it needs to grow. If there is then evidence of growth restriction the concern is much greater. The bilirubin can be secondary to the pregnancy also, often more of an obstructive caused due to having the baby pushing on certain areas of your abdomen.

If the growth restriction was not present then yes I think it would be reasonable to monitor it regularly and delay. But I am assuming someone has decided the risk is now great enough to justify delivering the baby earlier. The steroids are given to assist the babies lungs for when they are born.

I am very sorry this is not the answer you want, but it sounds like you are in good hands.

Customer: replied 2 months ago.
File attached (7LPGMZT)
Customer: replied 2 months ago.
Thank you for your reply. That’s the report I was given, could you please have a look.
Customer: replied 2 months ago.
The evidence of IUGR is only prominent on the fetus stomach

No worries, so the report only really mentions the amniotic fluid being of reduced quality/volume, and the abdominal size, but this is only a few weeks off the normal.

Are they scanning you again, or planning to go straight for a C-section

Customer: replied 2 months ago.
They are planning to scan me on this Friday but have told me to prepare for c-section if the scan shows no changes or improvement

Okay, what they are saying then is if there is growth, they will probably say not for c-section and monitor frequently. Fingers crossed this is the case and they can push you a little further

Customer: replied 2 months ago.
Ok, I’m hoping for that. But D.R. do I really need a c-section? Can I not deliver by induction? And at what stage will it be better to deliver

I think it is more that a C-section means the baby is delivered that day in a controlled fashion. An induction will have a high conversion rate to an emergency c-section which you would want to avoid it you can

Customer: replied 2 months ago.
If I get to push the pregnancy from Fridays scan, what are the risks, especially the bilirubin levels. At what stage will you say it’s better to have the baby, please.

So they will advise you to have a regular blood test, as long as it isn't worse then the risks are low. The risks are better the longer you can delay, assuming the growth is increasing, but if it wasn't the risks of harm would be higher, hence why you should deliver sooner.

Customer: replied 2 months ago.
Please, explain again the above, do you mean it’s better I deliver now, or if the scans show growth increase to ask to hold on.

Sorry - it all depends on your scan, if there is minimal growth, then yes, safer to deliver now. Also if your liver function worsens (bilirubin increases further), this may also suggest you need to deliver sooner.

Until your scan it is all a bit of a guess regarding risks sorry

I hope that I have been of some help to you, I certainly wish you and your baby well. Good luck for friday

Customer: replied 2 months ago.
If the scan shows a slight growth can I ask to hold on...I mean will it be ok in terms of the stomach growth to be Slightly below the rest of the body. And, the bilirubin isn’t alarming right?
Customer: replied 2 months ago.
Thank you

Yes of course, but just my advice from experience as family in this situation and as a professional, make sure you say what you are feeling. This is so that your concerns can be addressed. It is easy as a doctor to think you are making the best decision for you and your baby, but this needs to be agreed with you, and even if you have concerns, they would be able to discuss why they want to do what they are suggesting.

Best of luck. I hope all will go well.

I am more than happy to address further concerns, and please feel free to come back and message, this thread should be available for a further week after rating.

Please could you also kindly rate my response to your question, many thanks

Elliot Ruff and other OB GYN Specialists are ready to help you
Customer: replied 1 month ago.
Good morning D.R. had the scan just now and I’m told the placenta isn’t working at all. I need to go to hospital immediately, does this mean the baby is dead...what if they want me to have an operation c-section. Is this a useful exercise now. How long is it before the baby is affected....when placenta stops working. Please be as open as you could...

Good morning, not at all, but it means delivering the baby will be by far the safest option now.

Customer: replied 1 month ago.
Thank you. I’ll keep you updated. Anything I should be asking the Dr

They want you to go for a C-section as soon as possible

Customer: replied 1 month ago.

Good luck. You can ask them about the scan but if they say the placenta is failing, there isn't much to discuss as without have a c-section your baby will be at greater risk, also there is not enough time to use an induction.

Customer: replied 1 month ago.
Is magnesium sulphate needed