Which fruit is better - small or large?

How a baby gains grams in the womb: graph

In the first weeks of pregnancy, it is difficult to measure the weight of the baby in the womb: the fetus is still too small and weighs less than 1 gram. The growth graph is approximately as follows:

• 8th week – 5 g, with a length of 1.6 cm;
• 10th week – 9 g, 3.1 cm;
• 16th week – 118 g, 11.6 cm;
• 20th week – 345 g, 25.6 cm;
• 25th week – 844 g, 34.6 cm;
• 28th week – 1319 g, 37.6 cm,
• 31st week – 1779 g, 41.1 cm;
• 34th week – 2248 g, 45 cm;
• 40th week – 3373 g, 51.2 cm.

At the beginning of pregnancy, the fetus gains weight by 10–60 grams per week. In the later stages, he gains grams much more intensely - up to 300-400 per week.

Changes by trimester

The weight of the baby in the mother’s belly depends on the quantity of nutrients and oxygen supplied to it, as well as on the quality of the placenta through which it feeds and breathes. From one cell, by the end of the term, a baby grows, weighing several kilograms. Its habitat also grows in the mother’s belly – the uterus. It increases 5 times - from 50 grams it grows into 1200.

1st trimester

By week 7, the embryo is tiny and almost invisible on the monitor during an ultrasound. During this period, important organs and systems are formed: heart, brain, circulatory, nervous and bone.

By the 8th week, the embryo acquires the outlines of a person: a head that is very large compared to the body, the makings of limbs, and the outlines of a nose and mouth are noticeable on the face. By week 12, muscles grow and the fetus begins to move. At the end of the trimester, the weight of the fetus reaches 40 grams.

12 weeks of pregnancy – baby 40 grams

2nd trimester

The baby grows up, his appearance changes, and the proportionality of his physique becomes noticeable. During this period the following happens:

• the placenta formed and began to perform its functions;
• the size of the head decreases, but there is still a disproportion;
• the kidneys and other internal organs begin to work;
• the formation of the cerebral cortex ends;
• fetal movement occurs, noticeable to the woman.

At the beginning of the trimester, the fetus develops towards an increase in weight by 80 g per week. At the end, the changes are insignificant - the total set is 200-300 g. By the end of the second trimester, the fetus weighs about a kilogram.

A baby born at 24 weeks is the size of a human palm.

3rd trimester

The baby is fully formed, it’s time to gain fat tissue and muscle mass. He is still gaining 200 g per week, his weight increases by 3-4 times by the end of the term. The fetus chooses a position for birth - presentation. His skin becomes coated with vernix.

Important ! At birth, the baby weighs from 2.5 to 4.5 kg. There may be minor changes up or down. But often this is due to peculiarities in pregnancy and possible deviations.

How is a baby's weight measured in the womb?

You can find out how much your baby weighs using an ultrasound examination.

After the 35-36th week of pregnancy, it will be possible to determine the approximate weight of the unborn baby without a device. This is usually done by a gynecologist at a scheduled appointment. The abdominal circumference of the expectant mother and the height of the uterine fundus are measured. Measuring VSDM may give an error of 1-2 cm depending on the position of the child in the womb. The formula used for calculation is:

(VSDM + coolant) x 100 / 4 = weight of the child in the womb

Neither the ultrasound specialist nor the doctor who took measurements of the abdomen can tell the weight of the unborn child to the nearest gram. 100% accuracy is not needed here. It is important to determine whether there is dynamics. In the later stages, it is important to find out whether the baby is expected to be too large. In this case, you may have to have a caesarean section.

What affects the weight of the fetus?

Why is it that during full-term births, some babies are born as heroes weighing under 5 kg, while others are born as crumbs, barely reaching the standard 3 kg?

It is believed that boys are born heavier on average than girls. Boys at birth weigh on average 3.2-3.5 kg, girls - 3 - 3.25 kg. But it's not just about the field. Many factors influence the entire unborn child: how severe the toxicosis was in the expectant mother, whether there was swelling, whether there were any chronic diseases.

Some reasons for low weight in children in the womb:

• hereditary factor: father and (or) mother are short, thin and at one time were also born with low weight;
• insufficient nutrition of the expectant mother;
• lack of oxygen reaching the fetus;
• smoking of the expectant mother;
• alcohol consumption by a woman during pregnancy.

The cause of too much fetal weight can be either a hereditary factor or health problems:

• maternal diabetes. Women suffering from this disease have a higher chance of having a large baby. Such pregnant women are under special supervision by doctors;
• hemolytic disease of the unborn child. The disease occurs as a result of Rh conflict between mother and fetus: the woman has a negative Rh factor, her husband has a positive Rh factor, and the child inherited Rh factor from the father. With this disease, excess weight appears due to the accumulation of fluid in the body cavities (edema).
• Poor nutrition during pregnancy: an abundance of carbohydrates contained in white bread and confectionery, irregular meals. The expectant mother gains weight on her own, and the same thing happens with the baby, who may become obese already in the womb.

Also, a large fetus is typical for the 2nd and subsequent pregnancies. Statistics say: younger children are born weighing 30% more than their older sisters and brothers. This is understandable: the expectant mother worries less and does not make mistakes related to nutrition and lifestyle, which, due to inexperience, she may have made during her first pregnancy. The fetus gains weight better. And if the older child was closer to the larger ones in weight, the younger one has a chance of jumping over the normal limit.

Which fruit is better - small or large?

I often have to answer the questions of desperate women who, after undergoing an ultrasound, suddenly find out that their child is stunted in growth (or intrauterine development), and, as always, they urgently need to go to the hospital for treatment. When you start to clarify how the measurements were taken and on what basis the diagnosis was made, in most cases the diagnosis is “made up out of thin air.” When it came to a large child, the woman was often forced to “go on a diet” and even starve.

Before we share with you information about fetal growth restriction syndrome or intrauterine growth restriction, let's discuss a number of issues related to the definition of this fetal condition. Is it correct to talk about height or development, or weight?

What is meant by intrauterine growth retardation?

Oddly enough, the growth charts are actually charts of fetal weight. Why, then, are growth deviations determined by the weight of the fetus? Disputes on this issue between clinicians are still going on. In some sources you will find mention of developmental delay. However, we are talking, rather, about growth retardation, since it is determined by measuring the parameters of the fetus - the size of its body parts. Usually, there are no deviations in development, that is, in the shape and structure of organs and organ systems - a normal small fetus, except in cases where growth retardation is caused by a number of fetal diseases. From a medical point of view, the size of the fetus in itself says little, so the weight of the fetus is calculated, albeit conditionally, but by comparing the weight of the child after a certain period of time, you can more accurately determine whether he is stunted or not.

It is also important to understand that we can judge the growth of something or someone only in a certain period of time, and also taking into account a number of facts. For example, you meet a friend with her child on the street. If you don’t know how old the child is, then you can approximately determine the child’s age by his height, constitution, and only then by other parameters. What if the child is just small? What if the child has been “fed” and is big?

It is impossible to feed the fetus, so in obese women, on the contrary, the fetuses are often small in size (with the exception of women with gestational diabetes). But poor nutrition of the mother can affect the growth of the fetus - it will not have enough nutrients.

Thus, we decided: in order to judge development and growth, it is necessary to observe the growth of the fetus in dynamics, that is, at certain intervals . Why are these intervals important and how long should they last? One day, a woman sent me ultrasound data at 12 weeks and at 32 weeks, and asked me to comment on whether I saw any delay in the growth of her child. First, ultrasound data from the first trimester cannot be compared with ultrasound data from the third trimester. The conclusion from such a comparison will always be the same: pregnancy is progressing, so why be nervous and worry?

For comparison, periods of 2-4 weeks are required, and the size of the fetus is monitored in such cases no earlier than the 20th week. If no serious abnormalities are found, then the woman is asked to come back for a repeat ultrasound scan in 4 weeks. If any abnormalities are detected in the child’s organs, in addition to growth retardation, the woman is offered to undergo an ultrasound scan in 1-2 weeks.

By medical definition, intrauterine growth retardation refers to the condition of the fetus when its weight is 10 percentile (centile) or more below the average for a particular period of pregnancy.

Here we need an explanation of what percentiles are. If, for example, you conduct an ultrasound examination of one hundred pregnant women at 28 weeks of pregnancy, the measurements of their fetuses will be different. It turns out that for some the sizes will be minimal, for others they will be maximum for this stage of pregnancy. Now imagine that, based on these data, they built a graph where they drew a relationship between the number of women with the same fetal parameters and the value of these parameters. And it turned out that in a large number of women the dimensions of the fetus (for example, head circumference) are such and such - this will be the median, and in all other women the dimensions may deviate to the right and left (be larger, smaller), which is not always a pathology. Thus, for a better understanding of the graph, it was divided into 100 parts - centiles (percentiles). Percentiles are mistakenly called percentages, although this is not an entirely accurate definition. The norm was taken to be the indicator that occurs in the largest number of fruits, and 10 centiles to the left and 10 centiles to the right (and all indicators that are included in this graph between the two centiles) will also be considered the norm.

Based on these data, graphs of changes in fetal size indicators with gestational age are constructed. Thus, a graph of, for example, the same head size has three lines: the middle, one at the top and one at the bottom (10 centiles up and down). When measuring the size of the fetus, the doctor looks at the graph and determines what this size should be at a certain stage of pregnancy. If the size does not go beyond the two percentile curves, then there are no deviations from the norm. What if it comes out? This does not always mean that there are deviations. This is where the analysis of measurement indicators over time is important.

Again, the inquisitive reader will ask, what does the child’s weight and growth retardation have to do with it? Where is the connection between the size of the fetus, its height and weight? Unfortunately, the modern approach to diagnosing intrauterine growth restriction syndrome suffers from the fact that weight is still taken as the main criterion for assessing fetal development. However, more and more doctors take into account the size of the fetus, its changes in dynamics, and not just the calculated weight of the child.

Why is the dynamics of indicators important?

Firstly , when you analyze many cases, it turns out that neither the woman nor the doctor really knows the exact duration of pregnancy. Some doctors still use old formulas for calculating the gestational age, and if a woman visits several doctors, then each one sets the dates in their own way. Let me remind you that during natural conception of pregnancy with a normal regular menstrual cycle, the gestational age is determined by the first day of the last menstrual period. Ultrasound at 12 weeks of pregnancy is the most accurate method in determining the gestational age. Therefore, it is always necessary to proceed either from the last menstruation or an ultrasound scan at 12 weeks. So it turns out that when you check the gestational age, often all the given indicators are normal, and not ahead or behind compared to the norm.

Secondly, any measurement may be an error. This must be taken into account when almost all indicators are normal, with the exception of one or two. After all, when taking measurements, the position of the fetus is important, which is not always obtained “by order”, the skills of the doctor, his knowledge of the branch of medicine that studies fetal diseases, the correct settings of the ultrasound machine are important.

Thirdly , what is more important from the point of view of pregnancy prognosis: a sharp drop in the child’s weight from a normal level to an abnormal level in a short period of time or a constantly low weight that does not change sharply according to the level of the graph (not beyond the initial percentile) over a long period of pregnancy? Rapidly developing changes should always cause concern to doctors, since it is very difficult to predict a favorable prognosis in such cases, and this is usually a poor indicator. In such cases, it is often necessary to take urgent treatment measures or delivery.

The child’s weight is calculated based on measurements of abdominal circumference, head diameter, femur length and many other parameters. This is usually done by a computer program entered into the ultrasound machine automatically during measurement. Modern ultrasound machines have programs with graphs where you can enter the woman’s measurement data and then monitor the size of the fetus over a certain period. Ultrasound images (images) are stored in the device’s computer and can also be transferred to other computer databases, where they can be viewed by other doctors. Almost any measurements, if necessary, can be rechecked without additional ultrasound. It all depends on the doctor’s skills to understand what he sees on an ultrasound image.

Often women ask to check certain ultrasound measurement numbers because they are not sure that the measurements are normal, especially in cases where doctors make different diagnoses and offer different treatments. No need to find fault with one indicator! It is important to look at indicators in combination with others. Since the child’s weight is calculated using computer programs (one device can have 7 equations for calculating weight), even with some measurement data, the doctor cannot accurately determine the weight of the fetus. There are websites where a pregnant woman is asked to enter a series of ultrasound examination data and calculate the weight of the fetus. This weight is called an estimated weight, not an exact weight. The longer the pregnancy, the greater the calculation error. Therefore, the weight is recorded with acceptable deviations: plus or minus so many grams to the average weight.

Abbreviated ultrasound measurements of parameters that are often used to determine gestational age and baby weight are as follows:

• BPD - biparietal head size
• LZR (OFD) - fronto-occipital size
• OG (HC) - head circumference
• DlB (FL) - thigh length
• AC (abdominal circumference)
• SVD (GS) - average internal diameter of the ovum
• KTP (CTP, CRL) - coccygeal-parietal size of the embryo/fetus

There are also a number of other options. Of course, for many of you, these parameters and their abbreviations mean nothing and are not understandable at all. But very often, when you receive the results of an ultrasound examination, you ask questions about what they mean for the future of pregnancy, you try to find answers to questions by researching books and the Internet to compare your results with the norm. Modern pregnant women, constantly going through tests, often artificially created by their environment, including medical workers, do not leave unnoticed even such specific indicators as ultrasound data and test results.

To make it easier for you to determine whether your baby's measurements are normal, I have provided a chart that many obstetricians use. Please note that the size of your fetus may be smaller or larger, especially if the gestational age is calculated incorrectly. But there is no need to be upset. As I mentioned earlier, fetal growth must be monitored over time, that is, over a period of time.

Who is to blame and what to do?

Thus, if, according to several independent ultrasound scans, the child’s weight is below the 10th percentile for a certain period of pregnancy, then they speak of intrauterine growth retardation syndrome. The question logically arises: is this bad or is it normal for a particular fetus? If the gestational age has been clarified, and the fetus is indeed stunted, it is necessary to find out the reason: why?

There is a misconception that small mothers have small children, and big mothers have big children (large fruits). This is not entirely true. Weight is not inherited and does not depend on the constitution of the mother. However, for mothers with small stature and build, the frequency of birth of large children is lower, and, conversely, smaller children are born more often to such mothers, but very rarely their weight goes beyond the 10th percentile.

All causes of fetal growth restriction can be divided into three groups :

• maternal (poor nutrition, smoking, drug abuse, alcohol abuse, cardiovascular diseases, uncompensated diabetes mellitus, pulmonary failure and other diseases),
• maternal-fetal (any diseases that can lead to placental insufficiency - hypertension, kidney diseases, placental abruption, impaired development of the placenta and others)
• fruit (viral diseases of the fetus, multiple pregnancies, congenital malformations).

Establishing the cause is very important, because treatment will depend on it, although most often there is no treatment as such if causes from the fetus and placenta are detected. But maternal diseases, bad habits and lifestyle can be changed.

If there is some factor that adversely affects the growth and development of the fetus, the processes of survival and self-preservation in the child intensify, the child resists this factor and tries to survive and live to the due date - a redistribution of blood volume begins: it flows in greater quantities to vital organs. organs - the heart and brain, and the blood supply to other organs is reduced (liver, kidneys, intestines), and unnecessary fetal movements and energy consumption are eliminated. By understanding the process of adaptation of the fetus to a harmful factor (or factors), it is possible to determine its physical state (biophysical profile) even before the appearance of pronounced deviations in growth and development.

There are two types of fetal growth restriction syndrome - symmetric and asymmetric.

Symmetrical delay , which occurs in 20% of cases, is called growth retardation of the first type. At the same time, the sizes of the head and torso lag behind normal values ​​equally, and such growth retardation is observed already from the second trimester of pregnancy. It is often associated with viral infections and fetal malformations. In most cases (80%), asymmetric fetal growth retardation is observed - the second type, when the brain (head) develops normally, but the torso (abdominal circumference) is stunted, and the head/abdomen ratio will be increased. This type of delay is observed in the presence of maternal and placental causes, and occurs in late pregnancy. However, the forecast for this type of delay is much better than the first type of delay.

Previously, doctors used the measurement of uterine growth (height of the uterine fundus), according to which they diagnosed fetal growth restriction: if the height of the uterine fundus lagged behind the indicators for a given stage of pregnancy, it means that all is not well with the fetus - this is usually how intrauterine retardation was diagnosed growth. Often, calculating the child's weight from measuring the mother's external parameters had large errors (an error of 400-500 g), and not all doctors knew how to carry out such measurements correctly. With the advent of ultrasound, it is possible to measure the size of the child itself, regardless of the external parameters of the woman, as well as assess the condition of the placenta and the amount of amniotic fluid, which is also important in making a diagnosis. After all, it is not so important to state the fact of fetal growth retardation, but to find out the reason that caused it, because further tactics and treatment of the pregnant woman or fetus will depend on this.

Thus, if fetal growth restriction is suspected, what should be done?

First of all , don’t panic, don’t be nervous and suffer, but check the gestational age first. Secondly , it is necessary to perform a repeat ultrasound in 2-4 weeks. Thirdly, approach the question analytically: are there reasons for fetal growth retardation? If such causes exist, the next question is: how can they be eliminated or reduced? This is where the choice of treatment begins, if such a choice exists. It is also important to determine the child’s “well-being” - how does he react to growth retardation, in addition to the fact that he lags behind in weight and other parameters? This is where Doppler ultrasound, CTG, and determination of the biophysical profile of the fetus come to the rescue.

The further tactics of doctors will depend on the degree of fetal growth retardation, and in some cases, in the interests of the child, emergency delivery is carried out (most often by cesarean section, because a premature and underdeveloped child may not cope with the process of self-survival during natural childbirth, which is often sluggish and lengthy , since neither the uterus nor the cervix are ready for childbirth).

In some cases, a woman may be recommended bed rest, but this does not mean that the woman should constantly be in the hospital. Typically, women whose fetal growth restriction syndrome is significantly expressed are sent to the hospital for examination.

Unfortunately, there are no universal medications that could help in the treatment of fetal growth restriction syndrome, since there are many causes of this problem, and therefore treatment is always individual.

All the traditional arsenal that doctors of the Soviet and post-Soviet school still use (chimes, hofitol and many other drugs) are completely ineffective, but are just a tribute to the old tradition, a manifestation of dogmatism. The less a pregnant woman is loaded with medications, the safer it is for her and her baby.

In cases where there are factors of poor nutrition and bad habits, it is easier to prevent fetal growth retardation than to cure it later. Therefore, prevention of fetal growth restriction begins with proper preparation for pregnancy.

What can happen if fetal growth restriction is not taken into account? These babies, although they can be carried to term, are often weaker and therefore may suffer from asphyxia (suffocation) during childbirth, have more health problems after birth, and have a higher mortality rate as well as stillbirth. Mental retardation is also observed more often in this group of children.

A few words about macrosomia

The opposite of growth restriction syndrome is the fetal condition of advanced growth, or large fetal size, when the weight falls outside the 90th percentile. This condition is called macrosomia. It is a mistake to think that the larger the fetus, the healthier it is (and a fetus that weighs more than 4000 grams at birth is also considered large).

Causes of macrosomia other than fetal growth restriction. In women suffering from 1-2 degrees of obesity, the size of the fetus can be large, but in women with a high degree of obesity, on the contrary, fetal growth is often delayed. Obese women often suffer from diabetes mellitus (type 2), so macrosomia is also observed in such pregnant women. There is also a dependence between previous pregnancies: if a woman had a large pregnancy, then the next pregnancy can also have a large fetus. Also, the more pregnancies there are, the heavier the baby usually is. Macrosomia is diagnosed by ultrasound with the construction of graphs of the child’s growth and changes in his weight during pregnancy. Treatment exists only in cases of gestational diabetes, when the woman strictly monitors her blood sugar levels.

High weight during pregnancy is not dangerous for the fetus itself, but during childbirth serious problems can arise, which can lead to fetal death and stillbirth, or lead to fractures of the newborn’s collarbone, ruptures in the woman’s birth canal and other complications. Therefore, it is always important to choose the right method of delivery in such women and very carefully monitor the condition of the fetus during childbirth.

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