Understanding Gestational Hypertension, IUGR, and Placental Infarcts: A Case Study

Question
Age 34, one child born at 30 weeks 2.1 oz due to growth restriction. Started with elevated AFP at 18 week test with two vessel cord. Took him at 30 wks after it was determined there had been very little growth in last month, amniotic fluid was decreasing and I developed PIH. Two weeks on hospital bedrest w/no improvement. Following birth, placenta was found to have multiple infarcts. How do all of these issues relate to each other and which was most likely the cause of all the problems?

Answer
The elevated AFP at 16 weeks merely indicated the possibility of neural tube defects in the baby and would have prompted your doctor to perform more tests. However, if the baby did not have any neural tube defects (spina bifida, anencephaly, etc) there is no reason for concern. The AFP would not indicate IUGR or PIH. It is always possible to develop pre-ecclampsia during pregnancy and, I wish we know what causes any PIH. Certainly, the decision to deliver you at 30 weeks was based on the IUGR and the lack of adequate growth. Usually multiple infacts in the placenta is due to a mature placenta, but it could have occurred out of the blue. I do not believe these problems were interconnected at all.