Hello doctor, I am 27 weeks pregnant now and by scan two weeks back and the doctor says the baby is IUGR due to placental insufficiency. She said to terminate the pregnancy but I feel baby movement and heart rate. Also, I am pre-eclamptic and diabetic but sugar is controlled. Tell me what can I do. Any treatment or way to have a healthy baby and near to due date? IUD 18 weeks, fifth-week pregnancy due to no fetal heart rate, so DNE was done. Currently, I am taking Duphaston 10 mg BD, Asgard 75 mg OD, Glucophage 500 mg TDS, and Aldomet 250 mg QID two tablets.
Hi. It would be better if you can send me your ultrasound report. You have the previous history of stillbirth around 19 weeks. At present, as your medicines that you have described here, you have been on diabetes and blood pressure control drugs and placental supportive drugs as well. Blood pressure is towards higher limit and urine protein is also high that is showing your kidneys are affected and secreted protein in the urine. Due to high protein and blood pressure that is confirming preeclampsia, placenta insufficiently working and nutrition that needs to reach baby is not reaching to the baby that why growth retardation is confirmed in the scan and this is completely pathological. Your high blood pressure and urine protein are also really alarming as there are chances of eclamptic fits any time. That can be life-threatening to you. The only solution for preeclampsia is delivery, actually, if this is affecting mother and baby both too much. But, how and when that depends on the whole scenario of the patient, her vitals, signs, blood and urine reports, her scan report and baby's condition. Placental insufficiently also having grading that is helpful to make a decision. If the reversed flow in dopplers scanning is poor prognosis for intrauterine growth restricted fetus of preeclamptic, diabetic mother (who have a history of the previous stillbirth). As I do not have your complete history and recent scan but you need strict monitoring in high dependency unit. Baby is also very premature and growth-restricted as well, lung not developed and need months to develop. If delivers prematurely alive due to your unstable condition, it will need neonatal premature intensive care unit support for months and risk of neonatal infections, neonatal death even is very high. Lung supportive injection (Dexamethasone) can be given but still, the tissue that can respond to that injection nicely is still in a very early stage of development. Under your high blood pressure, sugar levels and low placental perfusion with abnormal dopplers and growth restriction not only you have chances of eclamptic fits that will worsen your condition but also greater risk of intrauterine fetal death. Strict diabetic diet, with almost nil salt, blood thinning medications (tablet Aspirin and injection Heparin), strict sugar and blood pressure control with normal blood, urine investigations, normal vital signs, and scan, stress free life with light exercise or walk from start of pregnancy were the basic rules to treat patient like you (with high BP, sugar, and previous stillbirth). Have a discussion and all arrangements with a multidisciplinary team including neonatologist, anesthesiologist, obstetrician, you can reach to final discussion with your family as well. For more information consult an obstetrician and gynaecologist online -->