Fetal Welfare

Intrauterine growth restriction
 
Poor fetal growth is typically diagnosed or suspected during routine ultrasound scans. It may result from poor placental function, which itself may be due to failure of the placenta to attach properly to the lining of the uterus, so that it does not sustain itself sufficiently from the mother's circulation. The cause of this problem is often unknown; it may be related to the mother's nutrition, or to smoking, or to a blood clotting disorder. Intrauterine growth restriction may co-exist with hypertension (high blood pressure) and pre-eclampsia.
 
Where there is intrauterine growth restriction, Yinka will recommend frequently checking the baby's growth using ultrasound scanning, and additional antenatal visits. Careful assessment of foetal growth and blood flow will help him to monitor your baby's well being and make a decision about the time and safest option for birth. Predisposing factors such as smoking need to be reduced or cut out completely.
  
IVF pregnancies 
Women with IVF pregnancies are at high risk of pregnancy complications, particularly those in their first pregnancy and age >35 years. 

Multiple pregnancies: 
They carry significant risk of preterm labour, preterm delivery, bleeding during delivery, operative delivery, pre-eclampsia and diabetes.
 
If you do become pregnant with identical twins (monochorionic twins), you will require close monitoring during pregnancy to watch for signs of complications that are unique to these twins such as twin-to-twin transfusion syndrome or discordant growth restriction.
 
If you do become pregnant with three or more fetuses, you may wish to see the fetal medicine specialist early in pregnancy to discuss the option of reducing the number of embryos. This may be necessary sometimes to reduce the complications associated with higher order pregnancies and to provide the best chance for one or two babies to grow inside the womb.

Recurrent pregnancy loss

Preterm labour
Measuring the neck of the womb during pregnancy may help to predict the risk of preterm birth. If you are considered to be at risk, you may benefit from progesterone supplements, bed rest or cervical cerclage.

Vasa previa  - A detailed ultrasound check for abnormal placental vessels

Birth defects: Babies conceived by IVF are at slightly higher risk of birth defects. The risk of defects in naturally conceived pregnancies is 2-3% and of that in IVF conceptions is 2.5-4%.

Hence a detailed scan in early pregnancy between 11-13 weeks gestation and repeat at 20 weeks gestation would help to exclude fetal abnormalities.

Low birth weight or small babies  
Will require serial growth and Doppler assessment to ensure appropriate growth and to intervene where necessary.

Large for dates babies
Women with thawed embryos tend to have larger babies compared to fresh embryos and would benefit from input from an obstetrician specialised in high risk pregnancies and fetal medicine.
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