Small for date of uterus
DISCUSSION
S U P E RV I S O R ’ S N A M E : D R A M A N I A LG H A R I B
P R E PA R E D BY G RO U P A 1
M O H A M M E D A L B ROA D – H U S A M BA S M I D I – M U K H TA R M U H O R EQ
Case scenario
A 32-year-old primigravida is seen in your office at 33 weeks’
gestation for a routine prenatal visit. Her gestational age (GA) was
calculated by her LMP. She has continued to smoke one pack or
more of cigarettes daily. She states that she has been feeling normal
fetal movement and no uterine contractions.
On examination, her height 170 cm, her weight is 53.5 kg , and her
blood pressure (BP) is 90/60 mm Hg. Her fundal height is 26 cm.
Qs of case
»What we can call this condition?
»What the lost info. To support your answer? (early U/S was 33wks)
»What are the DDx of this case?
»What is the most likely diagnosis?
»What other important items should be noted on the ultrasound?
» What is the next step in the management of this patient?
»What are potential complications of the patient’s disorder?
IUGR
Definition:
Fetal weight less than 10 percentile for GA or at term weight <2.500g
Causes and risk factor:
Idiopathic%50(most common)
Reduced fetal growth potential:
Fetal cause( symmetric)
Reduced fetal growth support :
Placental and maternal cause (asymmetric).
Classification of IUGR
Symmetrical
Asymmetrical
30%
70%
Occurs early in pregnancy<20w.
Occurs late in pregnancy>20w.
Reduced growth of head and abdomen.
Fetal abdomen smaller than fetal head.
May be normal in ratio
Head and abdomen ratio increase
associated with:
Associated with:
Congenital anomaly or TORCH infection
placental Insufficiency
investigation
Symphysial fundal height (SFH)
1-Routine: CBC , urine analysis, ,,,,,,
2 -U/S:
BPD, Head and abdominal circumference ratio.
Femur length, AFV, weight.
3-Doppler analysis.
4-aminocentsis.
5-BPP
MANAGEMENT
prevention by risk modification prior to pregnancy.
control for risk factor:
(Smoking , alcohol, nutrition and maternal disease)
Bed rest in left lateral decubitus.
Biophysical profile. And determined cause
delivery
C/F
HX: decreased perception of fetal movement.
EXAMINATION:
SFH and Weight not increasing.
Uterine tone is deminished.
Fetal movement are not fell during palptation
Investigation
High MSAFP.
U/S:
Absent cardiac activity and fetal movement, oligohydraminos
What is the next step?
Timing of death and determine secondary cause
Spalding sign: after 7 dayes
IUFD
Definition:
In utero death of fetus after 20 w.
Epidemiology:
1%
Causes and risk factor:
Idiopathic 50%
Identifiable causes can be attributed to:
Fetal cause:(3cs)
Congenital infection, chromosomal abnormalities,congenital anomaly
Cont,,,,,
PLACENTAL CAUSE
MATERNAL CAUSE
1-placenta insufficiency.
1-APS
2-placentaprevia or abruption
2-HTN , DM, SLE
3-cord accidents
3-Truma,
4-chorioamnionitis
Investigation and management
Routine:
CBC, urine
DM, TSH. ANA , kleihauer- Btake
Serum and urine toxicology
TORCH Screen
Cervical and vaginal culture.
Fetal karyotype, genetic evaluation, amniotic fluid culture for cmv and parvo b19, herpes
Bacterial culture.
Monitor for maternal coagulopathy.
DIC
Other Obstetric causes:
Gestational HTN, PPH,abruption
BLOOD WORK:
Platelet, pt , ptt
Treatment
IOL: and psychological support
Bishope score:
>6cm
<6cm
Blood product>>pph