My wife is 23. Is delivery at 37 weeks necessary for FGR?

Question

Hi doctor,

My wife, aged 23 years, has autoantibodies SSA strong positive 3+, SSB borderline positive, and RO 52 strong positive 3+. She lost her first pregnancy before a year because complete congenital heart block (CHB) was found in the fetus by TIFFA at 19 weeks with a condition of fetal hydrops bradycardia.

She conceived again and is now going into the 36th week. Her medications include:

Aspirin 75 mg once daily.
Wysolone 5 mg once daily.
HCQs 200 mg once daily.
Folvite 5 mg.
Sandocal 500 mg twice daily.
Livogen.
Protein powder.
To suppress antibodies, the rheumatologist put her on steroids and anti-inflammatory drugs since the 12th week.

There is no problem till now except for fetal growth restriction. Because of that, our doctor advised us to go for delivery at 37 weeks. The fetus's weight grew just 7.055 ounces in the last two weeks, but my wife increased to 130 pounds from 109.2 pounds. However, she initially lost 6.6 pounds in her first trimester.

She did not have any complications right now. Please answer a few of my questions:

Is delivery at 37 weeks necessary?
What are the risks to the fetus if she delivers at 37 weeks?
Will the baby's growth remain normal after birth?
If we extend the term up to 38 weeks, do we need to face any risk?

For your reference, I have enclosed the latest fetal scan report and doctor's prescription.

Please understand all my concerns and give us valuable advice.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through your question and understood your concerns.

I have reviewed the reports (attachment removed to protect patient identity) and the prescription. If the ultrasound shows fetal growth restriction, delivery should be conducted at 37 weeks. The fetal doppler in the ultrasound report is slightly deranged, so it is better to conduct delivery at 37 weeks.

There will be no or minimal risks to the baby if the baby is born at 37 weeks, as the baby will be mature at that gestational age. Yes, babies who are growth restricted in utero will catch up on their growth very quickly in the neonatal period. There are no issues with growth if the proper nutrition is maintained.

Delivery can be delayed till 38 weeks only if the fetal doppler is normal. Fetal movements and the non-stress test of the fetus are entirely normal. In your wife's case, the fetal doppler is just starting to get deranged, hence delivery is advised at 37 weeks.

I hope this helps you.

Please reach out if you have any further queries.

Thank you, and take care.