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FETAL GROWTH RESTRICTION for MBBS students

FETAL GROWTH RESTRICTION for MBBS students. Definition. Fetuses that have failed to achieve their growth potential because of inadequate oxygen and nutritional supply. FGR is divided into two groups. Type 1: Fetus is symmetrically small Type2:Fetal growth is asymmetrical.

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FETAL GROWTH RESTRICTION for MBBS students

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  1. FETAL GROWTH RESTRICTIONfor MBBS students

  2. Definition Fetuses that have failed to achieve their growth potential because of inadequate oxygen and nutritional supply

  3. FGR is divided into two groups • Type 1: Fetus is symmetrically small • Type2:Fetal growth is asymmetrical. Abdomen is small as compared to the head

  4. Approximate Weight of Normal Fetus

  5. Factors Affecting Fetal Growth And Size • Physiological • Genetic • Fetal Sex • Parental Height and Weight • Maternal Age • Birth Order • Socioeconomic Status

  6. Causes of FGR Primary Fetal • Chromosomal Abnormalities • Infection • Structural malformations

  7. Maternal Causes of FGR • Chronic Illnesses ., APAS,HTN,chronic renal,cardiac diseases etc • Infections. • Endocrine disorders e.g. diabetic nephropathy, hyperthyroidism. • Malnutrition. anorexia nervosa and bulimia • Smoking,alcoholism • Drug Abuse . Cocaine, amphetamines, betal chewing • Therapeutic drugs like B-blockers,Phenytoin

  8. Placental causes • Placento fetal causes placental mosaicism failure of second wave of invasion ( pre-eclampsia) fibroids • Fetoplacental causes defective angiogenesis single umbilical artery

  9. Hazards of FGR • IUD,15 fold increased risk • Intrapartum hypoxia • Neonatal Complications • Respiratory distress syndrome • Meconium aspiration syndrome • Post asphyxial seizures • Hypoglycemia, hypocalcemia • DIC ,Polycythemia • Necrotizing enterocolitis • Renal complications

  10. Long term complications • Impaired neurodevelopment • Diabetes mellitus • Hypertension • Cardiovascular disease • Obesity

  11. Management

  12. Prediction of FGR History to find risk factors • Low S.E.C • Family h/o FGR. • BMI < 19 • Smoking • Poor pregnancy weight gain • Medical complications • Obstetric complications

  13. Maternal serum screening If level of AFP is 2.5 or > of the median risk of FGR is 5-10 times more • USG markers Abnormal uterine artery Doppler velocimetry Echogenic fetal bowel

  14. Screening & diagnosis • Clininical assessment Fundal Height Measurement • Ultrasound assessment fetal biometry HC,AC,HC/AC ratio AC ,Femur ratio, EFW • Liquor volume • Umbilical artery Doppler studies

  15. DIAGNOSIS Fetal AC < 5th centile Fetal growth velocity < 1.5 S.D in 2 wks AFI < 5 Abnormal umbilical artery Doppler waveform

  16. Management Find the cause • Chromosome analysis • MSAFP • Screening for TORCH • Anticardiolipin antibodies, lupus anticoagulant • Anomaly scan

  17. Management • Bed Rest • Frequent AN Checkup • Nutritional Supplements • Beta Adrenergic Drugs • Fetal Monitoring

  18. Assessment of Fetal Growth Serial measurement of: • mother’s weight • fundal height • fetal biometry

  19. Assessment of fetal well-being • Fetal movement record • NST, CST • BPS • Doppler studies

  20. Management Options Depends on • Fetal Size • Liquor Volume • Umbilical artery doppler

  21. SGA With all Indices Normal If > 37 wks Deliver

  22. SGA and all indices are normal < 37 weeks No risk factors Steroids if < 34 wks 2. Monitor fortnightly by: Fetal biometry UADW Liquor assessment

  23. If Reduced EDF • Admit the patient • Steroids • CTG & BPS daily • Doppler twice weekly • Growth scan after one week • 40 % Humidified Oxygen

  24. If absent or reversed end diastolic flow • Admit • Plan Delivery

  25. Mode of delivery Depends on : • Gestational age • Presence of acidaemia • Bishop score

  26. Indications of an elective CS • Any obstetric indication like CPD, APH,PIH etc. • Low BPS,abnormal CTG • Poor Bishop Score

  27. Induction of Labour • At > 37 wks of gestation • In a well equipped hospital • Short trial of labour • Continuous intrapartum fetal monitoring • Early amniotomy to detect the presence of meconium stained liquor and apply scalp electrode for internal CTG .

  28. Cont. • Narcotic analgesics to be avoided • Epidural analgesia is safe but maternal hypotension and hypovolaemia should be avoided . • Senior paediatrician should be in the L.R to do proper resuscitation so that meconium aspiration is avoided.

  29. Immediate neonatal period First 72 hours are very critical .

  30. Prevention • TOP • AID • Avoidance of maternal hyperthermia at time of NT closure • Avoidance of contact with infected individuals. • Girls immunized against Rubella,Cytomegalovirus. • Women seronegative for toxoplasmosis should avoid contact with animals • Alcohol, cigarette smoking avoided • Treatment of medical problems

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