Uterine Artery Notching - my experience

[Marleysgirl]

Just wanted to include my "gestational complication" in case anybody else is experiencing the same ... (I'm 40, first pregnancy)

My 12 & 20 week u/sound scans showed a healthy baby, no problems. My blood tests showed a Downs score of 1 in 5, but we decided against an amnio.

I had an additional u/sound scan at 21 weeks as part of the SCOPE research project. This included dopplers, and it was found that I had "notching" on the uterine blood-flow, i.e. my blood-flow to the placenta. Obviously this would affect the quality of the placenta and, as a result, baby's growth.

I was switched from Community Midwife care to a new Placenta Clinic set up here in Manchester, where I could have regular monitoring of this situation. I underwent dopper u/sounds every 4 weeks to start, and this would increase as the pregnancy progressed. Baby would most likely be induced slightly premature.

However, at 28 weeks the doppler showed that the resistance to the blood-flow had increased to the point of some reversal of flow - not good, life-threatening for baby. I received steroid injections to help develop his lungs and was given a doppler u/sound every 2 days for a week. Things did improve slightly.

At 29+1, the doppler showed the reverse flow had started again, and we received the warning that baby should be brought out at that point or we risked losing him completely. I underwent an emergency c/section that night, and Andrew was born weighing just 1lb 6oz (having IUGR).

Andrew is in NICU, he's doing just fine and we hope he'll be home soon.

The consultant at the Placenta Clinic carried out my 6wk post-natal review, and has warned us that the uterine artery notching will probably recur with each pregnancy, though probably not so badly next time as my body will be more used to the situation.

If anybody else has developed this situation, I'd be happy to discuss our experiences further.

What amazes me is that, were it not for me volunteering for the research project, it wouldn't have been picked up - our first clue would have been reduced movement at the point when my placenta eventually failed. We were soooooooooooooo lucky.

 

[quail]

really glad your little boy is doing well.xxx

 

[franm101]

I am sorry you have experienced this but very glad it was picked up when it was and that baby is doing well!! Hugs

 

[suzib76]

i had my 20 week scan at 21+3 and they picked up on notching so i am back up on thursday (29+3) for a rescan to see how things are

the thing i have been told most is about baby not growing properly - although according to midwife she is doing ok) - and to look out for pre eclampsia as i am more at risk
i was really worried when i first found out, but have managed to get through nearly 8 weeks now and had calmed down a lot but its fast approaching thursday so am slightly upping the worry again

 

[Marleysgirl]

Thanks for replying Suzi - in a way it's nice to hear from somebody else that's experienced this, as it doesn't seem that common!

I wish you all the best for your scan - and if you are at all worried, insist on regular doppler scans from this point onwards.

Nobody ever said I was more at risk of pre-eclampsia! But Andrew did have IUGR, even now (at term) he's only 4lb 8oz. However, he was fine - absolutely perfect, just small - and he comes home on Thursday, just two days after his original due date!

 

[suzib76]

Thanks for replying Suzi - in a way it's nice to hear from somebody else that's experienced this, as it doesn't seem that common!

I wish you all the best for your scan - and if you are at all worried, insist on regular doppler scans from this point onwards.

Nobody ever said I was more at risk of pre-eclampsia! But Andrew did have IUGR, even now (at term) he's only 4lb 8oz. However, he was fine - absolutely perfect, just small - and he comes home on Thursday, just two days after his original due date!

wow thats brilliant and fab to know he is doing so well will post an update after i have been, i was led to believe when they told me about the notching that it was common, but now i have realis its not a much as they tried to mak out

 

[suzib76]

ooops didnt realise i hadnt posted - preg brain lol

all was well at the scan, and the notcking is no longer present, but i have to go back at 34 weeks for another

bbay is measuring 2 weeks bigger so they are keeping an eye on that

 

[Marleysgirl]

Woooohoooo that the notching has gone!

 

[Chester]

Hi all, just wanted to share my experience of this complication too.

I am originally from the UK, but had my first baby while living in NZ, so the maternity care here is a bit different from the NHS.

So I was 28 and had no trouble conceiving and turned up for my first 13 week scan thinking everything would be fine, and it was, apart from they thought baby had a single umbilical artery in the cord, which was enough to prompt an extra detailed anatomy scan at 20wks. NT measurement was fine. I felt great throughout pregnancy, no morning sickness etc.

At 20 weeks scan was told that cord was ok afterall, but that I had "bilateral notched uterine artery dopplers". My LMC was an independent midwife and told me that she would need to refer me to the obs at the local hospital.

So I went to the appointment, was examined by a lovely obs who told me they would see me every month, but not to worry. He didn't even mention pre-eclampsia/hypertension, so I did (ain't google a wonderful thing.) He told me that basically, they still don't know what causes pre eclampsia, and that during his career they had had all sorts of screening policies which had later been dumped for lack of effectiveness.

I saw the midwife, obs, every month and had an ultrasound every month to track baby's growth. My blood pressure remained at 80/50 (i.e. very low) At 36 weeks I was signed off by the obs back to full midwife care as I had no signs of pre eclampsia, or high blood pressure, on the last visit the obs said "if the baby was born now he'd be happy as larry".

One morning at 38 weeks I woke up to a puffy face, hands I could barely clench into a fist, and ENORMOUS feet. Strangely one foot was much larger than the other. I called midwife who told me to come and see her an hour later. My blood pressure was 140/100. I had to do 24hour urine tests for protein and attend hospital for CTG monitoring every 48 hours. I did not meet the official criteria for pre eclampsia but was told they thought it was just around the corner. I would not be allowed to go overdue. I went in to labour naturally five days early.

I didn't have a bad birth, had to have an epidural to lower my bp. DD was born a tiny 6lbs, smaller than you'd expect for my family. She was in prem sized clothes. I was told she wasn't an IUGR baby but she did have problems like low blood sugar, trouble feeding and trouble keeping herself warm, so I think maybe she did have mild IUGR. She spent a couple of nights in an incubator and had a couple of tube feeds. Interestingly the midwife said my placenta was very gritty and that means it has started to deteriorate, so my baby needed to be born.

...........but now she's absolutely fine. 11 months old and a terror! Has gradually caught upto the 40th centile for size. So I've written a novel but it has a happy ending.

 

[AshTen]

With Nothching there is resistance also in this case.

My wife ent through the 24th week scan and found this to be one of the resons to be unhappy with a low level of amniotic fluid. Our visit to the gayne is tommrow but we are getting mixed signals on what is to be done. Some (inlcuding our ultrasonologist) recommends she should be walking more so that the blood flow and resitance is reducded (mainly beacouse this is only 20 weeks) and most of the websites surfred tell that she should be on bed rest (but those are for 30 weeks and above). Hopefully the Gynae witll tell us more tommrow.

But i belive the issue is clear here....1) there is less of amniotic fluid and 2) there is notching and ressitance in the Bilateral Utrine.
For 1 we probably would be prescribed ARG 9 a powder to be had thrice a day..(she will confime tommrow) and for 2) i am not sure...how impactful is this at this stage (20weeks) and what are we expceting now...

It would also helpo if someone knows about sites where there are doctors who respond to these queries.... your words and experinces surely help...

Cheers.!!

 

[weeH]

Hi there, if any one can help put my mind at rest as "googling" is a dangerous thing to do!
I had my 20+4day scan last friday and the scan went well and the consultant seemed not worried at all, so i never asked any questions. Now i wish i had after a weekend on Google this has me worried and my midwife (rural and district nurse) had never heard of the term and did not know what it was. Next week i will contact the consultant but if anyone has any advise or good questions to ask, that would be great.
I have Uterine Artery Notching - i do not know the scale but he just said he hoped it would clear up but he wishes to see me in 8wks - which now seems like a lifetime away. He did outline that pre-eclampsia can be an issue and they will keep an eye on me for that.
I am also concerned with my birth weight i am 21 +4 days and have only gained 8lb - again is this normal, i think it could be low but,,,,, i do not know, not weighed since 12.5wks and not again until 28wks.

In addition I also have a low placenta - again it was not explained how low and again he hoped it would raise itself.
As i have had previous laser surgery on my cervix and intensive bowel surgery for Crohns Disease i know i may be a candidate for a C-section but this funnily enough i think is the least of my worries!

Staying positive due to the fantastic posts on this web site and not working myself back up into a tissy.
But if anyone has some great advice, be great to hear.x

 

[Marleysgirl]

Hi there WeeH,

I have no advice other than to say "Google is not your friend" What you have to remember is that, like holiday reviews, the bad stories tend to end up on the internet whereas the good stories don't because those people are getting on with life as normal.

One of the other posters above reported that she had notching that then disappeared at a later scan, so the advice to go away for 8 weeks is quite usual. I received more scans and more monitoring because I had a combination of notching, high DS score (1 in 5) and an obviously IUGR baby.

AshTen,

I would agree that the advice is conflicting as regards to exercise vs. bed-rest. When mine was diagnosed, the Consultant said that neither would make much difference as the situation had already arisen, his only constructive suggestion was not to stress about it.

I am interested in that your wife might be prescribed something (ARG9?), and would like to hear more about that if you don't mind re-posting.



We are now thinking about trying for no.2, and I have an appointment back with the same Consultant at the Placenta Clinic to discuss whether there is anything I can do or take to try and prevent the situation recurring.

 

[fluffyblue]

Ive got a UAD scan next wednesday and am a bit edgy - hands up I have googled but only seen positive stories of how it has prevented a lot of losses of babies.

I have growth scans at 24/28/32 and 36 weeks also.

do u think im covered??

 

[Marleysgirl]

Fluffy, I think you're well covered with those!

How come they have arranged so many scans? Do they know that you have placenta problems from your other angels, or is it simply because you've been so horrendously unlucky in the past? (if you'll pardon the crass phrasing)

I would expect to have that kind of schedule of scans but that's because of my past problems.

 

[fluffyblue]

I dont know and to be honest they havent really given me a reason.

My previous losses were all early (before 10 weeks) 3 were MMC one chemical and one hetrotopic (womb and ectopic loss). 3 losses were due to my APS - blood clotting.

The only thing I can think of is I am under Professor Siobhan Quenby (miscarriage expert)and she is very thorough. This was a Clomid baby and i believe, although never published, that there are some links between slow growth and clomid babies. She put this in my care plan at 6 weeks.

I have asked and just been told "be grateful" so I just am !!

Ive carried two children to birth no problems whatsoever so I am unaware of any underlying problems apart from my current blood clotting disorder.

I suppose alot of it is just precaution. I know I am lucky but sometimes its uneccessary worry!

What happens at the scan do they rescan you after a period to compare scans or can they tell from just the one scan if there are any complications ?

 

[Marleysgirl]

They can pretty much tell from one scan. They'll take loads of measurements of the baby's size and your uterus size, and compare those against known averages. And the UAD to show the bloodflow, this will obviously show the current flow and they'll see instantly whether there is a problem. Get them to explain the UAD pictograph to you, it's actually quite interesting in a nerdy way!

I love that they haven't given you a reason. I was referred to our Placenta Clinic but nobody ever told me why, I found out when talking to the midwife six months after A's birth that it was because I declined the amnio after the blood test for DS - they wanted to scan me more often to check for soft markers. It was at the first of these extra clinic scans that they found the problems with the bloodflow, so I'm grateful for their concern. It still scares me that it might never have been picked up, I could have had a stress-free pregnancy but have lost Andrew in the womb.

 

[fluffyblue]

Well had my scan good news no notching but my indices for both uterine artery dopplers are raised but apparently because there is no notching this rules probs out, he said that my arteries are working harder than normal to get nutrients and blood flow through. To be honest I dont get it lol !

 

[Marleysgirl]

Yayyy, that's good news Fluffy

 

[Marleysgirl]

Been to see the Foetal Health consultant today (pre-conception discussion). He has suggested that I start taking baby-dose Aspirin now, and continue it through any potential pregnancy. They've taken some blood from me that they are going to scan for clotting disorders and, if they find something, then I could be prescribed daily injections of Heparin during the pregnancy.

 

[fluffyblue]

Im on the same thing and apparently because i have been takin aspirin since 4 weeks it puts me in a better situation.

I have been told to keep my stress levels down too, so although i have no notching it can affect my arteries !!