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Pregnancy Bliss | Reproductive Health Hub

Contact Answers In the News Hot Topics

Symphysis Fundal Height (SFH)

Question: I went for a check up at 32 weeks and my symphysis-fundal height measurments was 23 is this a problem? S.E. (UK)

Answer: That, if correct, is a significant discrepancy. The symphysis fundal height in the second half of pregnancy in singleton pregnancies is supposed to roughly correspond to the number of weeks.

A discrepancy of 2 cm either way is acceptable as long as there is a normal growth trend. With the figures you have given, the size of your bump is apparently smaller by 9cm compared to expectation. If these measurements are correct, you need to be reviewed by an obstetrician without delay.

‘Slow’ fetal heart rate at 6 weeks gestation

Question: I had a m/c on 8th June and found myself immediately pregnant again.  I have a long history of infertility and m/c due to polycystic ovaries (PCOS).  I have one baby aged 15 months.  I am currently taking high strength vitamin D, aspirin and Metformin.  I had a scan last week at 6.2 weeks and we have one baby with a heart beat. However the consultant mentioned that the heart rate is low at 112 bpm.  I have read so much conflicting info about what is slow at this early stage.  I personally have a very slow heart rate so not sure if that affects the baby's rate.  Please can you tell me your honest opinion.  I have a follow up scan on Thursday (in 2 days time). R.D. (UK)

Answer: So that we don’t get side-tracked, I will just comment on something you have mentioned in passing: Your intake of “high strength Vitamin D”. Whilst Vitamin D supplementation in pregnancy is generally highly beneficial, excessive intake can be downright dangerous. Now, I don’t know what your ‘high strength’ is, but I would advise that you stick within the recommended daily intake of no more than 1000iu (25µg).

Regarding your main question, it is true that reference ranges for fetal heart rate at various stages of pregnancy do vary but, in fact, differences tend to be insignificant. At just under 6½ weeks gestation, there is consensus that a fetal heart rate below 90 beats per minute (bpm) is dangerously low and prospects for the baby bleak. For gestations of 6½ to 7 weeks, that cut-off point shifts to 110 bpm. Now, because in practise, it could be difficult to operate within those very tight margins since scans have a margin of error of a couple of days or so and the majority of women/couples do not know the exact day of conception, many obstetricians tend to use the higher figure for pregnancies under 7 weeks to be on the safe side.

Looking at your particular case, the heart rate of 112 bpm is, in my view, marginal. This is because in fetal medicine, at this gestation of 6 - 7 weeks, if a heart rate is 110 - 120, it would be regarded as borderline (rather than overtly slow). If on prolonged observation this is what your obstetrician saw, then I think it is correct to be cautious. The increase in the possibility of miscarriage with a borderline fetal heart rate is still a subject of debate, with some studies showing a modest increase (less than 10%) and some showing no increase at all. This is as opposed to a loss of up to 60% when the rate is overtly slow. The measure that your obstetrician has taken is the correct one, keeping a close eye on developments.

Regarding your own heart rate, no; that has no influence at all on the heart rate of the fetus in your womb.

I have, in fact, answered a similar question in the past and you can find that answer here: My best wishes.

Timing of delivery for the older mother

Question: Hi, I’m now 36 weeks and today I saw the consultant to ask for possible induction because I don’t want to go over. She asked me to go back at 39 weeks but she couldn’t commit herself to the induction. Is it safe to go over? I’m 42. Y.S. (UK)

Answer: There is really no evidence that mothers of your age need to be treated differently when it comes to timing of delivery. The evidence is simply not there to suggest that their babies are at increased peril and that they need to be delivered early. Having said that, many obstetricians use their discretion and if spontaneous labour has not occurred as Term approaches, a membrane sweep may be done followed by a formal induction at 40 weeks. This is mainly to alleviate the anxiety that these mothers tend to have. However, even at 40 weeks, if there is no evidence of fetal compromise and if examination shows that induction is unlikely to succeed, it is arguably better to wait a little for the situation to be favourable. Regular monitoring of the baby can be arranged to ensure continued well-being.

Charcot Marie Tooth disease and pregnancy

Question: I am 8 weeks pregnant with my first baby. I have got the nerve disease CMT. How will this affect my pregnancy? Thanks. D. (USA)

Answer: I am assuming you are referring to Charcot Marie Tooth (CMT) disease. This is, indeed, a disease primarily of the nerves which leads to loss of sensation and loss of muscle tissue. It tends to affect lower limbs disproportionately but  upper limbs can get involved too. It is hereditary but there are various types of this condition and mode of inheritance varies. If you want to know what the prospects for your baby are, especially on the question of your baby’s chances of inheriting the condition, you will need to get specialist review by a clinical geneticist.

Regarding what to expect in pregnancy, this tends to be no different from anybody else’s. However, there is evidence that prospective mothers with CMT disease are at increased risk of having a caesarean section or instrumental (forceps) delivery. There is also increase risk of postpartum haemorrhage (PPH).

By the way, this triple-barrel name comes from the first physicians to describe this condition in the 19th century. Two of them (Jean-Marie Charcot and Pierre Marie) were French and Dr Howard Tooth was English. Charcot Marie Tooth disease is also known by its descriptive name Hereditary Motor and Sensory Neuropathy (HMSN)

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