1. Intrauterine Growth Retardation The Biophysical Profile Ectopic Pregnancy

2. It is defined as an estimated fetal weight at one point in time during pregnancy being at or below the 10th percentile for gestational age 3. Symmetric Growth Retardation Asymmetric Growth Retardation 4. A type of IUGR where all fetal biometric parameters tend to be less than expected (below the 10th Percentile) for the given gestational age. Both length as well as weight parameters are reduced. 5. Is a type of IUGR where some fetal biometric parameters are disproportionately lower than others as well as falling under the 10th centile. The parameter classically affected is the abdominal circumference (AC). It tends to present more in the 3rd trimester (later than the symmetrical IUGR pattern) and is the more commoner of the two main types of IUGR. 6. Maternal Conditions Maternal diseases /DM , HTN Maternal narcotic / alcohol use / smoking Maternal malnutrition / starvation Certain medications Placental insufficiency : commonest cause Abnormal utero-placental circulation Abnormal feto-placental circulation 7. Other Placental Causes Increased incidence with a single umbilical artery Fetal Conditions Multi fetal pregnancy Intrauterine infection Chromosomal anomalies 8. ANTENATAL ULTRASOUND - Non Doppler Features -Doppler Features 9. Presence of Oligohydramnios without ruptured membranes Increased Head Circumference (HC) to Abdominal Circumference (AC) ratio (in asymmetrical type) Advanced placental grade 10. Umbilical Artery Doppler Assessment - Increased S/D ratio(s) - Increased Resistance Index (RI) Uterine Arterial Doppler Assessment -presence of notching in mid to late pregnancy Umbilical Venous Doppler Assessment - Presence of Pulsatility 11. The biophysical profile (BPP) is a noninvasive test that predicts the presence or absence of fetal asphyxia and, ultimately, the risk of fetal death in the antenatal period. When the BPP identifies a compromised fetus, measures can be taken to intervene before progressive metabolic acidosis leads to fetal death 12. Fetal gross body movement Fetal tone Fetal breathing Amniotic fluid volume Fetal Heart Rate 13. The four fetal characteristics develop from different CNS centers during embryogenesis. These centers are not fully developed until 26-28 weeks of gestation so that the BPP is a third trimester evaluation. 14. If the fetus is normally responsive the study can be completed within 10 minutes but if the fetus is not moving, however, it is necessary to continuously observe the fetus for the full 30 minutes. 15. Each assessment is graded either 0 or 2 points, and then added up to yield a number between 0 and 10. A BPP of 8 or 10 is generally considered reassuring. 16. Biophysical Variable Normal (Score = 2) Abnormal (Score = 0) Fetal breathing movements 1 or more episodes of 20 s within 30 min Absent or no episode of 20 s within 30 min Gross body movements 2 or more discrete body/ limb movements within 30 min < 2 episodes of body/limb movements within 30 min Fetal tone 1 or more episodes of active extension with return to flexion of fetal limb(s) or trunk No movements or movements slow and incomplete Reactive FHR 2 or more episodes of acceleration of 15 bpm and of >15 s associated with fetal movement within 20 min Less than 2 episodes of acceleration of fetal heart rate or acceleration of < 15 bpm within 20 min Amniotic Fluid Volume 1 or more pockets of fluid measuring 2 cm in vertical axis Either no pockets or largest pocket < 2 cm in vertical axis 17. Amniotic fluid index (AFI) is a rough estimate of the amount of amniotic fluid and is an index for the fetal well-being. It is a Four quadrant analysis of the amniotic fluid. Four different pockets(free of fetal parts or umbilical cord) are measured and the added together. Normal Value 7-25. 18. Ectopic pregnancy occurs when a fertilized ovum abnormally implants outside the endometrium of the uterus. Ectopic pregnancy remains the leading cause of death during the first trimester of pregnancy, with a 9%14% mortality rate 19. Prior ectopic pregnancy History of pelvic inflammatory disease History of gynecologic surgery Infertility Use of intrauterine device History of placenta previa 20. In vitro fertilization Congenital uterine anomalies History of smoking Endometriosis Exposure to diethylstilbestrol 21. Classic clinical triad of ectopic pregnancy in a patient with history of Amenorrhea; Pelvic Pain Abnormal Vaginal Bleeding An Adnexal Mass 22. Tubal Interstitial Ovarian Cervical Scar Intra abdominal Heterotopic 23. TVS can visualise a gestational sac as early as 4-5 weeks from LMP. During this time the lowest serum beta HCG is 2000 IU/L. When beta HCG level is greater than this and there is an empty uterine cavity on TVS, ectopic pregnancy can be suspected. 24. In such a situation, when the value of beta HCG does not double in 48 hours ectopic pregnancy will be confirmed. 25. Pseudogestatinal sac sign. Free fluid. Tubal ring sign. Ring of fire sign. Interstitial line sign. 26. is an intrauterine anechoic sac-like structure that may be mistaken for an early viable pregnancy. It actually represents endometrial breakdown in the presence of an ectopic pregnancy. A pseudogestational sac may be differentiated from a true gestational sac by its central location, oval shape, and lack of a thick chorionic ring 27. Free fluid in the pelvic cul-de-sac is a frequent normal physiologic finding in women. However, free fluid is also associated with both ruptured (more commonly) and unruptured ectopic pregnancies. Additionally, the likelihood of rupture increases along with the increase in quantity of free fluid. 28. The fallopian tube is the most common location for an ectopic pregnancy (95%-97%), usually in the ampullary or isthmus regions, however ectopic implantation can occur anywhere in the tube. An adnexal mass that is separate from the ovary and the tubal ring sign are the most common findings of a tubal pregnancy. A related finding is the ring of fire sign, which is recognized by peripheral hypervascularity of the hyperechoic ring. 29. Interstitial pregnancies occur when the gestational sac implants in the intramyometrial segment of the fallopian tube (2%4%). Eccentrically located gestational sac. GS surrounded by a thin layer of myometrium that measures less than 5 mm. Interstitial line sign, which represents an echogenic line that extends into the upper regions of the uterine horn and borders the margin of the intramural gestational sac 30. An ovarian pregnancy occurs when an ovum is fertilized and is retained within the ovary(3%). Serum -hCG level >1000 mIU/mL. The presence of a gestational sac, chorionic villi, or an atypical cyst with a hyperechoic ring within the ovary. Normal fallopian tubes. 31. Cervical pregnancy occurs when implantation takes place within the endocervical canal (less than 1%). Normal endometrial stripe. Gestational sac within the cervix with cardiac activity. Hourglass-shaped uterus. Cardiac activity below the internal os. 32. Implantation takes place within the scar of a prior cesarean section, separate from the endometrial cavity (Less then 1%). Gestational sac located within the lower anterior segment of the uterus at the site of a prior cesarean section. Thinning of myometrium anterior to the gestational sac. 33. In an intra abdominal pregnancy, implantation occurs within the intra peritoneal cavity, excluding tubal, ovarian, and intra ligamentous locations (1.4%). Absence of a normal intrauterine gestational sac. Gestational sac located within the intraperitoneal cavity. Abdominal or pelvic hemorrhage. 34. Heterotopic pregnancy occurs when an intrauterine and and extrauterine pregnancy occur simultaneously