1.2 abnormal fetal growth avenue
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8/7/2019 1.2 Abnormal Fetal Growth avenue
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Abnormal Fetal GrowthAbnormal Fetal Growth
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Normal range considered:10th 90th percentile
Small: < 10th
Large: >90th
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LARGE BABIES
LGA: Large for gestational age
Above 90th percentile
Macrosomia:
Estimated weight is >4000g. (Aprox 9lbs.)
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Risk factors: Maternal Obesity
Maternal Diabetes ***
Previous LGA fetus
Prolonged pregnancy
+++ pregnancy weight gain
Multiparity
Maternal age >35yrs
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Morbidity & MortalityPerinatal complications:
oPerinatal mortality
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Diagnosis:Estimation of fetal weight
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Relationship b/w Diabetes & Macrosomia
Uncontrolled or gestational diabetes high level ofglucose exposure to fetus
-leads to overgrowth of fetal trunk & organs(N size head & extremities)
- +++ growth beginning between 28 32 weeks GA
Macrosomia: 25 42% from diabe
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Small Babies
IUGR (intrauterine growth restriction)
< 10th percentile for GA
orAC <2 standard deviations for GA
SGA (small for gestational age)
same
Term infant: < 2500g (aprox. 4 lbs.)
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3 main causes of IUGR3 main causes of IUGR1. Placental insufficiency
2. Chromosomal anomaly
3. Intrauterine Infection
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Significance:Significance:
Mortality:Mortality: 4 8 xs that of non IUGR
Morbidity:Morbidity:Short term meconium aspiration pneumonia
Long term metabolic disorders
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ClinicalClinical detection of IUGR wt. gain
symphysis fundal height
history ( risk if previous IUGR baby)
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Two types of IUGR
Symmetrical
Asymmetrical
1. SymmetricSymmetric proportionately size
both head & body smaller
¼ of all IUGR babies
cause usually due to:chromosomal anomalyinfection
***1st tri insult or < 28weeks GA
usually more anomalies present
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2. Asymmetric Head spared ( normal in size)
Body q size
¾ of all IUGRbabies *** begins late 2nd or 3rd tri
-usually after 30 wks
Usually due to placental insufficiency
preferential blood flow to the head
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How to predict IUGR not easy
For diagnosis: accurate LMP needed (for GA)accurate CRL ( for GA)
serial U/S (for growth)
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3 key Parameters for diagnosis
1. Estimated fetal weight
2. Amniotic fluid volume
3. Maternal blood pressure
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Use of Doppler for IUGR**for prognosis (not reliable for diagnosis)
For prognosis:1. Reverse flow in Umb. A. Grave prognosis
2. Absent Diastolic Flow.Fetal Distress
3. Increased S/D ratio..Fetal distress
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Fetal DopplerIf finding:
q resistance to MCAoresistance in Umb. A and aorta
Results in Head SparingAbdominal growth retardation
Asymmetrical IUGR
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N abN
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Relationship of AFV & IUGR
Typically IUGR babies have
Oligiohydramnios or q AFV
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Follow-up after IUGR diagnosed1. Look for etiologyMaternal: physical, blood tests.??hypertension, renal disease
Fetal: U/S ???viral or chromosomal anomalies
2. MonitoringWeekly or semi weekly
- AFV-Biophysical Profile-EFW-umb. A. doppler