Fetal Growth Delays: Risks and Options for Expecting Mothers

Fetal growth restriction

Hello Doctor, I am currently 31 weeks pregnant.
I have had two previous pregnancies; my first child is healthy and four years old, while my second pregnancy ended at 12 weeks due to a loss of fetal heartbeat.
I am at high risk for preeclampsia and have been taking aspirin.
During a high-level ultrasound at 20 weeks, it was found that the fetus was two weeks behind and there was very little amniotic fluid.
Pulmonary venous reflux was detected, and I was referred to Linkou Chang Gung Memorial Hospital for a repeat high-level ultrasound, which showed no issues.
During my follow-up appointments, due to the low amniotic fluid and small fetal size, the doctor informed me that the fetus might not survive past 27 or 28 weeks and advised against amniocentesis due to high risks.
I then went to another clinic where it was found that the fetus's limbs were three weeks behind, raising suspicion of dwarfism.
Following the doctor's recommendation, I underwent amniocentesis and dwarfism testing, and the results were normal.
Three weeks later, at 29 weeks, during a hospital check-up, the fetal head and abdominal circumference were gradually catching up to the gestational age, but the limbs had only grown by one centimeter, still lagging by three weeks.
Two weeks later, on July 28, during another check-up, the fetus had not grown and remained the same size as two weeks prior.
The doctor mentioned that the cause of this could be unknown, possibly due to a viral infection or osteogenesis imperfecta (brittle bone disease).
They suggested we consider terminating the pregnancy, as the fetus may not be healthy and could be different from a healthy fetus, with the possibility of fetal heartbeat cessation in the coming weeks.
I asked the doctor if I could induce labor to deliver the fetus early and care for it, but the doctor indicated that delivering a problematic child would not be meaningful.
Could the doctor provide me with some advice or share experiences of other mothers in similar situations? I currently feel hopeless and do not know how to make a decision.
Thank you.

Yuan, 30~39 year old female. Ask Date: 2022/07/30

Dr. Huang Yuande reply Obstetrics and Gynecology

There are several reasons that could be causing your issue.
It may be due to fetal growth restriction caused by preeclampsia, or there could be genetic abnormalities in the fetus itself, or it could be a consequence of certain viral infections during pregnancy.
If preeclampsia is the cause, it is indeed advisable to consider an early delivery, as it is relatively safer.
However, if there are congenital anomalies, my perspective is to advise against rushing into induction.
One value to consider is how much effort you are willing to invest in caring for a child with deformities, as premature infants can often be managed, but significant congenital defects present a different situation altogether.

Reply Date: 2022/07/30

More Info

Fetal growth delays can be a concerning issue for expecting mothers, especially when there are additional complications such as oligohydramnios (low amniotic fluid) and potential genetic disorders. Your situation, with a history of two pregnancies, one healthy and one resulting in a miscarriage, adds to the emotional complexity of your current pregnancy at 31 weeks.
Firstly, it’s important to understand that fetal growth restriction (FGR) can occur for various reasons, including placental insufficiency, maternal health issues (like preeclampsia), infections, or genetic factors. In your case, the presence of pulmonary venous return issues and oligohydramnios raises significant concerns. The fact that your fetus has shown signs of growth delay, particularly in limb length, could suggest a possible skeletal dysplasia, such as achondroplasia, but the normal results from the amniocentesis and genetic testing are reassuring.

Given your high-risk status for preeclampsia and your ongoing aspirin therapy, it’s crucial to maintain close communication with your healthcare providers. They can monitor your condition and the fetus's growth through regular ultrasounds and assessments. The fact that your fetus's head and abdominal circumference are catching up while the limb length remains behind is a positive sign, but it also indicates that careful monitoring is necessary.

Regarding your inquiry about inducing labor, it’s essential to weigh the risks and benefits. If the fetus is determined to be non-viable or has significant health issues, the recommendation to consider stopping the pregnancy may be in your best interest. Inducing labor in cases where the fetus is not expected to survive or has severe health complications may not provide the desired outcome and could lead to unnecessary emotional and physical stress.

In clinical practice, there are cases similar to yours where mothers face difficult decisions regarding the continuation of a pregnancy with known complications. Each case is unique, and the decision often hinges on the potential quality of life for the child, the mother's health, and the emotional toll of carrying a pregnancy that may not result in a healthy outcome.

Here are some options and considerations you might discuss with your healthcare provider:
1. Continued Monitoring: Regular ultrasounds to monitor fetal growth and well-being can provide more information about the fetus's condition. If growth continues to stagnate, it may inform your decision-making process.

2. Consultation with Specialists: Engaging with a maternal-fetal medicine specialist can provide additional insights into your situation. They can offer a more comprehensive assessment of the risks involved and potential outcomes.

3. Psychological Support: Given the emotional weight of your situation, consider seeking support from a counselor or support group for parents facing similar challenges. This can help you process your feelings and make informed decisions.

4. Discussing Induction: If you and your healthcare team determine that the risks of continuing the pregnancy outweigh the benefits, discuss the process of induction and what that would entail. Understanding the procedure and what to expect can help alleviate some anxiety.

5. Consider Future Pregnancies: If you decide to stop this pregnancy, consider discussing with your doctor about future pregnancies, especially given your history of complications. They may recommend preconception counseling to optimize your health before trying again.

Ultimately, the decision is deeply personal and should be made based on a thorough understanding of the medical facts, your values, and your emotional readiness. It’s crucial to have open and honest discussions with your healthcare team to navigate this challenging time.

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