Low papp-a - bubs smaller than average - anyone else experience this?

Ok - well we've known since 12 weeks that my papp-a levels were low and were told this could result in a smaller than average baby or the baby stop growing. At my 20 week scan I was told that things 'look normal' (whatever that means) but was referred to have a scan at 28 weeks to check continuing growth. At my ob app today I found out that bubs is measuring at the 24th percentile (forgot to find out if that was height or weight, but I think it was weight) and 5th for stomach circumference. My ob didn't seem concerned. They seemed to imply the stomach thing didn't matter cause the head was 'normal' size and said 24th percentile overall wasn't bad. Anyway, I'm having another scan at 32 weeks to check everything again.

My question is - has anyone else had similar growth at this time and still gone on to carry to full term, or should I be preparing myself for an early bub now?

I can't offer advice re: having a similar experience.
Just know that they can often get very caught up on percentiles and if you looked at a chart, it may only be the difference of mm's or a cm, differentiating you or your baby between different percentile groups. Both my sons were born huge and dropped down the percentile chart, from high 90% to the 10-25th%. The mchn usually freaked out about this, but they were fine. A lovely paed once said that some babies have a catch down, if they are born big and full of fluid etc. So, I'm just saying, that 24% doesn't sound bad - some babies have to be smaller, b/c that's what they're basing their percentiles/averages on. A friend had her firstborn on the 3rd % and her paed said 'well, somebody has to be on that percentile and he was feeding and sleeping well etc. I'd say if your obs isn't concerned, then it should be fine. Hope the rest of your pregnancy is healthy and that you and bubs get to full term in no time!

What you're saying is very true. Thanks for your wise words. My ob didn't seem concerned and I wasn't worried at the time, but I guess I'm just dwelling on it a bit now. But that's just me i guess - I'm good at worrying!

Chody we all love worrying! Fingers crossed you get a full term bubba and that she us perfect!

Weight guesses are really inaccurate during pg, if that's what it was. My first bub was born weighing less than what was guessed at in a scan two weeks earlier. And like someone said, this early, just a small difference in measurement makes a big difference on the chart. The skill of the technician plays a big part too.

Hope it all goes well.

No advice, just wanted to let you know that I'm thinking of you and your precious bubba (but I agree with the others that 24% is pretty good!)

Thanks everyone! Hopefully bubs stays at the same percentile for the next scan. It makes sense with what your all saying that the difference between percentiles at this point is probably tiny.

My last two were both little bubs, yet my last ne we did u/s every month and then every couple of weeks. I was told very early on the my bub wasn't growing well and that she may have to be born at 28 wks, then 30, then we see how the next scan would go, and they also wanted me to do a amnio at 34wks there about, which I declined. Happy to say, I made it to 38 wks when we had our c/s. She was 2375 gms and even now is still little at soon t be two. She is doing well though.
My little girl was under the 10 th percentile and was even I think at times lower than that quite a bit, I would be able to tell you exactly as my scans are packed away, but you can look up under the high risk prgncy thread for my user name and it should show.
I wish you all the best, take care and I hope you have an improvement with the next scan so you don't worry too much.

Aww hon :hug: she is going to be beautiful and perfectly sized when she arrives on the scene ......EEEEK! (Can't tell i'm excited much!! :happydance:)

I try not to get too focused on what scan size says. They told me DS was going to be huge. He was 3.8kg's so not this huge baby they were anticipating, so I know for a fact that they can be wrong either way.

Chody, I don't think I had low Papp-a but my placenta is calcifying early, and bubs growth has been restricted. I've been having weekly scans since 32 weeks, just to check on bub, and fortnightly growth scans. I had the steroid shots at 32 weeks as well just in case early delivery was needed. Last Monday we had a growth scan and bub had virtually stopped growing, very minimal growth and has dropped off the percentile chart for abdominal circumference. We are around 15-20th percentile for head circ and biparietal diameter which doc said is fine, but not when abdomen has stopped growing. Baby's estimated weight was 5lb 3oz, after only gaining 250g in the fortnight from last scan. Weights by ultrasound can be way off though. It just sounds like we were going to have a petite baby anyway if all else had gone well.

After those results, dr decided that baby will be born by caesarean tomorrow (baby is frank breech, IUGR, low amniotic fluid and increased umbilical dopplers and technically pre term by one day!), which is 36+6. We have been having CTGs 2-3 times a week as well and baby has still been very active and happy, so I think that has helped the argument for keeping baby in as long as possible.

Ask lots of questions at your appointments, set your mind at ease! The only thing I have found online about this is that every situation truly is unique, my best advice is ask for reassurance if you need it, even if you feel like a nuisance or like you're over reacting, it's no worry to them to give you extra monitoring-better safe than sorry! And my dr told me that one of the most important things was my perception of the baby's movements, if anything changed or there was a decrease I had to report it straight away and go in to L&D. He said their tests are only so good, and if baby gets distressed it will stop moving.

That's just my experience, which will likely be different in the long run to yours, but like others have said, you're still on the charts, which is great news! All the best with it, I'll be interested to see how your next growth scan goes (another thing dr told me-a single growth scan doesn't tell them a whole lot, they need more than one to compare data to make sure baby is still growing).

My levels were low due to PCOS and my girl measured in the 25th percentile through my pregnancy. The last scan I had around 32 weeks (I think) and she had gone up to the 55th percentile but I'm not sure that measurement was right cause she was in the 25th percentile when she was born. I was told that they expected her to be on the smaller side but she was growing at the right rate so even though she was smallish the whole time, they weren't worried. I just had to have an extra couple of scans to make sure she was growing at the right rate.

I ended up being induced at 41+1. I'm pretty sure if I'd not been induced she wouldn't have come out at all, she seemed pretty cosy in there!

Well I had another scan today. It'll be interesting to hear the report when I see my ob next week. From what I could tell from the quick look at the charts I got, stomach circumference is now less than the 5th percentile. The sonographer said that head circumference was still close to normal. The growth charts seemed to indicate that bubs is still growing, but has dropped down them more, so isn't growing at an average rate. It'll be interesting to hear actual percentiles at my appointment. Hopefully my ob is happy with growth and we can get at least a few more weeks of growing before coming out.

EDIT - (and I know this is totally jumping ahead but just wanted to ask) Does anyone know whether I'm likely to be advised to have a CS if my ob decides bubs needs to come out? Or is an induction more likely? I'm not sure what they advise for bubs that are not growing properly.

Chody I would say yes about the CS for a number of reasons, mainly a smaller bub has less reserves to cope with labour and would get into distress more easily,is often not head first yet and also to induce a labour earlier than term is often very difficult as your body isn't ready and would most of the time end up a failed induction/ CS.
Often a slow growing baby has a placental issue, so the stress of labour on a not-quite-100% placenta would be too much.

Anyway, good luck and I hope this isn't an issue, but its good to be informed of the possible outcomes, so you don't get shocked if the Dr suggests CS!

You might at least get a few more weeks with regular scans.

Saffy - Your thoughts are along the lines of what I was thinking. I know bubs is head down, but I was wondering about bubs ability to cope with labour. I hope it doesn't come to that, but ultimately I will do whatever my ob recommends as they are the doc and I trust their judgement. I might try and do a bit of reading about CS just to prepare myself 'just in case'. At least that way I am informed.

I agree with Saffy, my bub was born by CS 3 weeks ago as her growth was dropping off (plateaued around 35 weeks). She was also breech though. Abdominal circumference was the main thing that had stopped growing with my bub too, head circ and femur length were pretty much fine. My ob is the only one here that will attempt breech deliveries vaginally, and he told me that he wouldn't take the risk and that I must have a CS because bub is more likely to get distressed.

All the best with it, every extra day is a bonus. I saw it that bub would be better nourished and much safer on the outside, and she was perfect at birth. Hope your ob lets you have some choices about your birth too :)

Thanks for sharing your experiences too frog. I too am of the thoughts that if it is deemed safer to get bubs out I'll do it ASAP. As it is we are at 32 weeks. My app isn't until 33 weeks (unless for some reason I get called in sooner), so I figure that's pretty good if worst comes to worst. Obviously the longer in the better, but ultimately I want a healthy bubs, no matter when or how they are born. Like you, the head and femur length seemed to be close to gestational age, the stomach seemed to be 2-3weeks behind each time she tried to measure it.

Can you speak to the midwives about getting the steroid injections to mature baby's lungs? I had those at 32 or 33 weeks, because they anticipated that we would need to deliver early. The midwives at the hospital in the normal antenatal clinic decided on that, and spoke to the dr on duty that day to get the ok... It has to be given in 2 doses ideally, so might be worth checking out, just one more thing you can do to help make an early delivery a little easier on baby!

Thanks for the advice. I'll definitely talk to my ob about it next week if she doesn't call me prior. She has been really good this pregnancy calling me if anything was concerning with my tests. I figure she should get the report either tomorrow or Monday. At the very least I won't be surprised if I get sent for another scan in a couple of weeks time....