Dr. Sanap Sneha Umrao
Obstetrics and Gynecology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My wife is currently 38 weeks pregnant. She has gestational diabetes and suffers from high blood pressure. The doctors have requested that they commence induction next week so that she can deliver next week itself. The doctor also informed my wife that the baby's stomach, in terms of development, is three weeks "behind schedule," although when giving birth the baby will be normal and there will not be any abnormalities. I am asking because it is not entirely clear to us what this means. The doctor said they measure the baby size by the circumference of the tummy. All other tests, including Doppler, are fine. Can you help us?
Kindly help.
Hello,
Welcome toicliniq.com.
I read your query and can understand your concern.
When there is diabetes and hypertension, it is better to induce labor at 37–38 weeks of gestation, as this week's baby is well developed and the lungs are mature by this time. As per your description, your doctor said the baby is smaller than the gestational age by abdominal circumference. The actual age of the baby is determined by her last menstrual date if her periods are regular and she is sure about her dates; if they are not, then the actual age is calculated by her 1st-trimester scan, and in subsequent scans, the baby's growth is seen by the head circumference and abdominal circumference; if they are smaller than they should be at this week, then it is considered a smaller baby. In hypertension, it is common to have a small baby, as babies get less blood supply as compared to non-hypertensive people. By how many weeks is the baby lacking?
I hope I have answered your question.
Let me know if I can assist you further.
Regards.
Patient's Query
Hello doctor,
She told us "three weeks".
Kindly help.
Hello,
Welcome back toicliniq.com.
I read your query and can understand your concern.
Up to 2 weeks of lag is okay. But it is fine as the Doppler study is normal. However, I would advise against delaying delivery for too long. If the baby's weight is more than 5.1 pounds, then there wont be any issues even after the delivery of the baby. She should look for the baby's movement. Whenever she feels that there is no movement or less movement of the baby, she should immediately consult with her gynecologist. She should keep herself hydrated and drink at least 3 liters of water per day. Have a proper diet.
I hope I have answered your question.
Let me know if I can assist you further.
Regards.
Patient's Query
Hello doctor,
Thank you for your query. I feel much better already. I am attaching the latest data I have. Perhaps you can confirm my concerns. I just want to make sure both she and the baby will be okay.
Kindly help.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
You are most welcome. I have gone through the data.
According to that, the weight of the baby is 5.51 pounds, so it is fine. But I want to ask you if she already had diabetes or if she got it during the pregnancy and since she is taking the tablet Metformine. Because in pregnancy Metformin (candellila wax, cellulose acetate, hypromellose, magnesium stearate, polyethylene glycols) is not recommended, it causes IURG (intrauterine growth restriction of the baby).
I hope I have answered your question.
Let me know if I can assist you further.
Regards.
Patient's Query
Hello doctor,
She developed diabetes during pregnancy and was recommended to take Metformin because her glucose levels were oscillating a lot. I am aware it causes IURG, yes, but we were told it was necessary. So to answer your question, she was not diabetic prior to the pregnancy. Will the child develop any functional problems growing up? Or will the baby need to be kept in an incubator?
Kindly help.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
In pregnancy, to maintain the glucose levels within normal limits, injection insulin is prescribed, but now that it is okay and she is about to deliver the baby, and according to the baby's current weight, the baby will not need to be kept in an incubator unless there is not any difficulty during the delivery. And there will not be any problems in the development of the baby; do not worry.
I hope I have answered your question.
Let me know if I can assist you further.
Regards.
Patient's Query
Hello doctor,
I really appreciate it She was monitoring her glucose levels using Dexcom. She has only been taking Metformin (500 mg) for the past 4 weeks. She is currently taking 200 milligrams of labetalol due to her high blood pressure. Thanks for assuaging any fears. I will keep you posted.
Kindly help.
Hello,
Welcome back toicliniq.com.
I read your query and can understand your concern.
Yes sure, it will be my pleasure to help and guide you.
I hope I have answered your question.
Let me know if I can assist you further.
Regards.
Patient's Query
Hello doctor,
May I kindly ask you, based on the data provided (including the abdominal circumference graph), whether this is classified as a "normal" pregnancy?
Kindly help.
Hello,
Welcome toicliniq.com.
I read your query and can understand your concern.
According to the data, I will not say it is a normal pregnancy, but it can be said to be well-managed and well-maintained. high-risk pregnancy. Do not get worried about the word high risk, as high risk is labeled when there is hypertension, diabetes, and other conditions along with the pregnancy. Yes, definitely, the parameters are lagging behind as expected, but it is not very serious to worry about. When the baby's weight is less than 2.5 and especially less than 5.51 pounds, then there are things to worry about. I totally understand your concern and worry about the mother and baby. But trust me, at this stage, everything is under control, and the baby and mother are absolutely fine, according to the data. I would suggest not getting stressed and going for the induction of labor as prescribed by your gynecologist.
I hope I have answered your question.
Let me know if I can assist you further.
Regards.
Patient's Query
Hello doctor,
That is fine from my end and perfectly answers my query. I really appreciate the guidance.
Kindly help.
Hello,
Welcome toicliniq.com.
I read your query and can understand your concern.
Thank you so much for the compliment, and it is my job to help you.
I hope I have answered your question.
Let me know if I can assist you further.
Regards.
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