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INTRODUCTION
- Fetal growth is dependent on genetic, placental and maternal factors.
- Fetal growth restriction is the second leading cause of perinatal morbidity and mortality.
ASSESSING FETAL GROWTH
HISTORY
PHYSICAL EXAM
USES OF ULTRASOUND
- Mothers age
a) General Exam
- Diagnosis and confirmation
- Accuracy of LMP
b) Obstetrical Exam
of viability in early pregnancy
date
Uterine Fundal Height
- Determination of gestational
- Infections during
- Obtaining serial uterine fundal height
age and assessment of fetal
pregnancy
measurements.
size
- Multiple
- The Mcdonalds rule in pregnancy is a
- Intrauterine or Ectopic
pregnancy
rough determination of fetal age in weeks
pregnancy.
- ANC and visits,
Uterus size: by pelvic examination in the
- Multiple pregnancy
Supplements
first trimester and subsequent antenatal
- Diagnosis of fetal
- Past obs. Hx, Past visits.
abnormalities
Med Hx, Drug Hx,
Misleading in: Full bladder, obesity, deep
- Placental localization
Family Hx,
masses, uterine fibroids & multiple
- Assessment of fetal wellSocioeconomic Hx. pregnancy
being
DETERMINATION OF GA AND ASSESSMENT OF GROWTH
UP TO 13TH WEEKS GA
FROM 16 24 WEEKS GA
CROWN-RUMP LENGTH
BIPARIETAL DIAMETER
HEAD CIRCUMFERENCE
FEMUR LENGTH
(CRL)
(BPD)
(HC)
(FL)
From Crown to
The transverse width Not affected by the
- Better than BPD
shape of the head.
in accuracy and
Coccyx (Rump)
of the head at its
timing.
(longitudinal axis).
widest (the distance
- Accurate only
Accurate up to 14
between the parietal
when the image
bones eminence of
wks (1st TM).
shows two blunted
the skull).
It is the most
ends of the femur.
Accurate
up
to16-24
accurate
wks.
parameter.
Accuracy of +/- 7
Accuracy of +/- 5
days.
days from the GA.
It is affected by the
shape of the head.
FETAL VIABILITY
Detection of :
Gestational sac (45wks)
Yolk sac (5wks)
Embryo (5-6wks)
Visible heart beat
(6wks).
ABDOMINAL
CIRCUMFERENCE (AC)
Made at the widest
points in the
abdomen.
Most accurate
single predictor of
fetal weight.
PREMATURITY (10%)
INTRAUTERINE
GROWTH
RESTRICTION (20%)
SYMMETRICAL IUGR
(20%)
ASYMMETRICAL IUGR
(80%)
Congenital
Grand multiparity
Parity
insertions
Hemoglobinopathies
malformations:
Low pregnancy
(primiparous,
- Umbilical
- High altitudes
Ex: Anencephaly, GI
weight
weigh less than
vascular thrombosis
atresia, Potters
Drugs
Previous h/o
subsequent
& hemangiomas
syndrome, and
preterm IUGR baby - Cigarettes, alcohol,
siblings)
- Premature
pancreatic agenesis.
heroin, cocaine
placental
separation
- Teratogens,
Fetal Cardiovascular
- Small Placenta
antimetabolites and
anomalies
therapeutic agents such
Congenital Infxn:
as trimethadione,
mainly TORCH.
warfarin, phenytoin.
Inborn error of
Chronic illness (DM,
metabolism:
renal failure, cyanotic
- Transient neonatal
heart disease etc.)
diabetes
- Galactosemia
- PKU
DIAGNOSIS
History, Physical examination, Investigations
Ultrasound
Abdominal circumference is the single most
effective parameter for predicting fetal weight
because its reduced in both symmetrical &
Asymmetrical IUGR .
In the presence of normal head and femur
measurements, abdominal circumference (AC)
measurements of less than 2 standard deviations
below the mean appear to be a reasonable cutoff to
consider a fetus asymmetric.
COMPLICATIONS
ANTENATAL
NEONATAL
Metabolic changes 1- Related to hypoxia and
acidosis:
(acidosis etc).
a- Meconium aspiration.
Oligohydramnios
b- Persistent fetal
(80%)
circulation.
Abnormal fetal
c- Hypoxic ischemic
heart patterns.
encephalopathy.
Abnormal Doppler
2- Metabolic: Hypoglycemia,
studies.
HypoCa, Hypothermia,
IUFD
Hyperviscocity syndrome
INTRAPARTUM
3- Related to the etiology:
Abnormal CTG.
a- Chromosomal
Fetal death.
abnormalities.
Meconium stained
b- Infection.
liquor.
c- Congenital anomalies.
incidence of
instrumental and
caesarean
deliveries.
PRE-PREGNANCY
Modify lifestyle
habits.
Detect and
treat medical
disorders.
MANAGEMENT
ANTEPARTUM
Regular antenatal care.
Serial fetal growth assessment.
Serial fetal wellbeing assessment
1- Biophysical profile
2- Computerized CTG
3- Umbilical artery Doppler
Timing of delivery.
Mode of delivery.
Induction of labor
Continuous heart rate monitoring and scalp pH
monitoring optimize success of vaginal delivery