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Fetal growth8th December 2013
Fetal growth
Intrauterine fetal growth abnormality > fetal abnormalities
Failure to detect --> neonatal morbidity to IUD
Causes:
Utero placental insufficiency
Chromosomal abnormalities
Fetal abnormality
Fetal infection
IUGR
Features of IUGR on ultrasound:
Reduction in growth velocity
Oligohydramnios
Reduced bio-physical profile
Mild cardiomegaly
Hyperechoic bowel and dilatation
Doppler changes
IUGR
IUGR
DEFINITION:
Birth weight <10th centile for gestational age
Problem:
10% normal also included
The majority of fetuses with uteroplacental insufficiency has measurement above 10th centile
IUGR
Solution:
Better to use customised growth chart
Based on mother's weight, parity, birth wt of previous children
E.g. A fetus that weighs 2.9kg at 39 w is probably growth restricted if mother is 6ft tall, weighs 65kg and has a previous child weighing 4.2kg at birth
IUGR
Growth velocity:
A fetus with falling growth velocity that is crossing centile lines
Correct pregnancy dating is essential
IUGR
Symmetrical growth restriction:
Equivalent reduction in growth velocity of both fetal head circumference & abd circumference (H:A ratio)
Distinguishing between normal and abnormal pregnancy
Constitutionally small fetus- growth velocity continues on same centile
Pathologically small fetuses:
Growth velocity continues to fall and cross lower centiles
IUGR
Asymmetrical growth restriction:
Differential reduction in growth velocities of the fetal head to abd circumference = uteroplacental insufficiency
Biophysical profile
< 6 - abnormal
7-8 - suspicious