Dr.Yussra Fetal growth disorder 17/4/2016
1
BY:TAHER ALI TAHER
Obstetrics
Definition of fetal growth disorder:
-Is strictly defined as the failure of a fetus to grow according to its
genetic potential.
-Three percentile thresholds are commonly employed :less than 3rd,
less than the 5
th
, and less than the 10
th
percentile and the equivalent
upper limits used for large infants.
-Fetuses outside the given threshold are called small for gestational
age(SGA)
-Fetal growth restriction would be fetuses whose growth velocity shows
down or stops completely because of inadequate oxygen and nutritional
supply or utilization .
-Normal SGA :no structural anomalies, with normal liquor, normal
umbilical artery doppler waveforms and normal growth velocity
-Abnormal SGA : those with structural or genetic abnormalities
-FGR: those with impaired placental function identified by abnormal
UADWs and reduced growth velocity.
Aetiology :
Maternal factors:
*nutrition
*smoking
*alcohol and drugs of abuse
*maternal therapeutic drug administration
*maternal disease
Dr.Yussra Fetal growth disorder 17/4/2016
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BY:TAHER ALI TAHER
Fetal factors:
*fetal abnormality
*infection
Placental factors:
*placental mosaicim often associated with chromosomes 16 and 22
Prediction
1- history \examination
2- maternal serum screening:alpha- fetoprotein(AFP) oestriol (E3),
human placental lactogen (HPL) and human chorionic gonadotrophin
(HCG)
3-ultrasound markers: abnormal uterine artery doppler
velocimetry(reduced end diastolic flow or notching of woveform
Screening and detection :
1-Clinical assessment
2-Ultrasound assessment
3-Liquor volume
4-Umbilical artery doppler studies :reduced flow in the diastolic
component of fetal cardiac cycle in umbilical artery or absent end
diastolic flow or the most extreme , reversed end – diastolic flow
Dr.Yussra Fetal growth disorder 17/4/2016
3
BY:TAHER ALI TAHER
Management :
1- Prophylaxis and treatment:
Low dose aspirin ,smoking cessation , anti malarial treatment in high-
risk areas, protein energy supplementation in poor nourished
2- monitoring the normal SGA fetus:
Conservative management by fetal surveillance is appropriate.
assessment should include biometry, UADW analysis and liquor
assessment.also use computeriized CTG assessment is superior to
conventional CTG
Monitoring the growth –restricted fetus
Management options are limited to timely delivery and as follow :
-If a diagnosis of FGR IS MADE AFTER 34 weeks gestation,delivery is
indicated.
-Under 34 weeks , steroids should be administered, there is no clear
evidence to guide management. Between 28 and 34 weeks,the presence
of REDF should prompt delivery
-Long term follow up of fetuses demonstrating increased middle
cerebral artery flow
-Examination of fetal venous systems:increased pulsatility in the
umbillical veins and vena cava and reversed flow during atrial
contraction in ductus venous
Dr.Yussra Fetal growth disorder 17/4/2016
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BY:TAHER ALI TAHER
Labour and delivery :
GRF are at high risk of intrapartum hypoxia and acidaemia.
-
-At gestations under 37 weeks, delivery by caesarean section is usually
the best option.
-It would appear that fetuses with normal UADW tolerate labour well,
making induction of labour a possibility at more advanced gestations
-Continual electronic fetal monitoring with early recourse to fetal scalp
sampling is strongly advisable
-Because of the risk of uterine hypertonicity, prostaglandins and
oxytocin must be used with great care
…THE END…