Your Pregnancy

Month 7: You’re so small!

Pregnant moms-to-be all around you have largerthan-life growing bumps, but yours seems to be growing at a snail’s pace. Here’s what to watch out for, and if you should be worrying at all.

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It’s month seven, and friends, family and well-meaning strangers keep commenting on how “small” your belly is. Don’t panic: there are plenty of reasons why your baby bump may appear petite. Your build, the position baby’s lying in, the amount of amniotic fluid, and your genetics (some people are just small!) can all make your bump look like it’s on the small side. “Most women who are told they’re ‘small’ will have a normally grown, appropriat­e sized baby on board,” reassures Dr Bronwyn Moore, obstetrici­an and gynaecolog­ist. In fewer cases, however, it could be because baby’s not growing at a healthy rate. “The most common reason for this is that the placenta can’t pass on enough nutrition to baby,” Dr Moore says. Doctors call this intrauteri­ne growth restrictio­n (IUGR), and there can be quite a few causes for it. The condition preeclamps­ia, which causes the flow of blood through the placenta to be reduced, is a fairly common cause. IUGR could also be due to early placenta calcificat­ion (when the placenta ages faster than it should). “Some other causes include smoking, high blood pressure, auto-immune disease or another pre-existing medical condition,” Dr Moore adds. “It can be due to many things, and often no cause is found.”

RED FLAGS TO WATCH FOR

Aside from a small belly, the only other growth “red flag” you may notice is a sudden decrease in baby’s daily movements (see box for more on how to measure movement).

“The small baby who’s not getting enough nutrition from the placenta to grow often reduces his movement to conserve energy,” explains Dr Moore. It’s up to your midwife or gynaecolog­ist to pick up any clinical red flags during your regular check-ups. The most common clinical signs that there may be a growth problem is if baby’s head is smaller than expected, and the height of your fundus (the top part of the uterus) is smaller than the benchmarks for your stage of pregnancy. If either of these is noticed during a check-up and/or there’s a decrease in baby’s movements, the next step is to have an ultrasound scan.

Often you’ll need to have two or more ultrasound scans over a short period (usually weekly) to measure exact growth. “Some babies are geneticall­y small but show a normal growth from one scan to the next,” Dr Moore explains.

PROBLEM SPOTTED – NOW WHAT?

But if your baby is found to not be growing at a healthy rate, what to do next depends on a few factors: how many weeks pregnant you are, what your placental function is like, and how severe the IUGR is. There’s no “one size fits all” solution. Your midwife/gynae will decide what action to take based on these factors. In general, if yours is a mild case, your midwife/gynae will most likely want to see you more frequently to monitor your baby. This monitoring may include more ultrasound scans, Doppler ultrasound scans to measure blood flow from the placenta to baby, and non-stress tests to monitor movement and heartbeat (see box for more details).

“Your doctor will usually be happy to sit tight until 37 to 38 weeks if there’s some weekly growth, the amniotic fluid is maintained, and the Doppler scans are reasonable,” Dr Moore says.

You can help by relaxing, easing up on strenuous exercise, cutting back (or stopping) work and increasing bed rest. “While this won’t reverse the problem, it may help to improve things for a few more weeks to allow baby to grow a bit more and mature,” she suggests.

AN EARLY ARRIVAL

In more severe cases you may have to deliver baby early, either by induction or by caesarean.

“No growth on two consecutiv­e scans will lean towards early delivery, as will decreasing amniotic fluid volumes and increasing resistance to blood flow,” Dr Moore says.

She adds that a scheduled caesarean is usually needed “if the placental function is poor and there’s no reserve for baby to cope with the demands of labour”. And if your Doppler scan shows a reverse flow of blood, expect to be taken in for an immediate (same-day) caesarean section.

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