Fetal Growth Disorders

Dr. Daisy J. Dulnuan

Obstetrician-Gynecologist
Perinatologist/Sonologist
THREE PHASES OF FETAL GROWTH

FIRST 15 WEEKS OF LIFE

Rapid cell hyperplasia
BETWEEN 16TH-32ND WEEK
Cellular hyperplasia and hypertrophy
FROM 32 WEEKS UNTIL TERM
Rapid cell hypertrophy
 FETAL WEIGHT GAIN (grams per day)
40

FIRST TRIMESTER 35

Rate of growth is greatest 30

25

third

SECOND TRIMESTER 20 second

first

Constant 15

10

THIRD TRIMESTER 5

Accelerates 0
 GROWTH POTENTIAL OF FETUS

GENETIC MAKE-UP

MODIFIED BY
MATERNAL,
FETAL AND
PLACENTAL CONDITION
SMALL FOR GESTATIONAL AGE LARGE FOR GESTATIONAL AGE

Used to described a fetus One weighing 4 500

weighing 2SD below grams or the above 90th
expected weight, or just percentile
at 5th or 10th percentile of
widely used curves
 MALNUTRITION
ORGAN-SYSTEMIC DISORDERS
PREGNANCY-INDUCED
MATERNAL HYPERTENSION
CONTRIBUTIONS ENVIRONMENTAL FACTORS
POOR QUALITY OF PRENATAL
CARE
 CHROMOSOMAL ABNORMALITIES
EXPOSURE TO INFECTIONS
FETAL TORCH
FACTORS HIV
OTHER BACTERIAL INFECTIONS
 PLACENTAL ABRUPTION
ABNORMAL IMPLANTATION SITE
PLACENTAL CIRCUMVALLATE PLACENTA
SPECIFIC VASCULAR OR
CONDITIONS INFLAMMATORY LESIONS
TRANSFUSION SYNDROMES
 DEGREE OF
DURATION AND DEGREE OF INSULT
INTRAUTERINE
TIME THE INSULT WAS INCURRED
GROWTH DURING GESTATION
RESTRICTION
SYMMETRIC OR TYPE I
TYPES OF IUGR ASSYMETRIC OR TYPE II
Manifest during early gestation
Affect cellular hyperplasia
Head circumference, length
and weight are affected in
equivalent degrees
Intrinsic factors
Gene and chromosomal
disorders
Anomalad syndromes
Inborn errors of metabolism
Infections
Associated with insult of
later onset
Relative sparing of the head
as somatic organ growth and
body weight are altered,
presumably following
redistribution of blood flow
in a compromised fetus
Extrinsic to the fetus
Chronic maternal disease
 TYPES OF IUGR
SYMMETRIC OR TYPE I ASSYMETRIC OR TYPE II

Increase incidence of Increased incidence for

preterm delivery
Higher morbidity rate
Lower mean birth rate at
term
Incidence of small placentas
asphyxia
Abnormal hypoglycemia
Higher association of
preeclampsia
 COMBINED SEVERE MALNUTRITION
SYMMETRICAL TERATOGENIC DRUG EXPOSURE
and
ASSYMETRICAL Timing of occurrence is more
important.
GROWTH
RESTRICTION
 DIAGNOSIS
PRESENCE OF RISK FACTORS
ESTIMATED FETAL SIZE LESS THAN EXPECTED
HISTORY OF PREVIOUS SGA BABY
PREPREGNANCY WEIGHT IS LOW
PREGNANCY WEIGHT GAIN IS POOR
PARITY IS HIGH
PRETERM LABOR
 DIAGNOSIS

FUNDIC
ULTRASOUND
HEIGHT
 ULTRASOUND
OLIGOHYDRAMNIOS AND/OR CONGENITAL
MALFORMATIONS
FETAL ABDOMINAL CIRCUMFERENCE
Reflects liver size and therefore correlates with the
degree of fetal nutrition and volume of subcutaneous
tissue
LOW PROFILE BPD
MORPHOMETRIC RATIOS (HC/AC and FL/AC)
ULTRASONIC WEIGHT CURVE
DOPPLER VELOCIMETRY
 MANAGEMENT
Correction of etiology
Fetal karyotype
Watchful surveillance
Serial sonography, nonstress test, doppler velocimetry, bps
Bedrest mostly on left lateral decubitus position
Administration of oxygen
Deliver close to term as possible
Termination at 37 weeks and beyond
 Nonreactive NST, Positive CST,
FETAL STATUS absent or reversed end-diastolic
blood flow

MATERNAL
CONDITIONS
MODE OF
DELIVERY RIPENESS OF
THE CERVIX

CESAREAN EVIDENT DISTRESS AND CERVIX

SECTION IS UNFAVORABLE
 FETAL
MACROSOMIA
CHALLENGES CONDITIONS
PROLONGED LABOR MATERNAL DIABETES
DIFFICULT FORCEPS MELLITUS
DELIVERY POSTMATURITY
SHOULDER DYSTOCIA MULTIPARITY
MATERNAL TRAUMA MATERNAL OBESITY
FETAL TRAUMA
 DIAGNOSIS
FUNDIC HEIGHT
ULTRASOUND
FAC correlates well with accelerated somatic growth
Ultrasonic weight curve
Chest circumference minus BPD = >1.4 (87 % is > 4 000 gms)
 MANAGEMENT
GLUCOSE SCREENING TEST
ELECTIVE INDUCTON FOR GRAVIDA WITH A RIPE CERVIX
CESAREAN SECTION FOR EFW > 4 500GMS
SUMMON NECESSARY PERSONNEL