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