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Fetal Growth Restriction: Definition, Risk Factors, Screening, and Management

Learn about fetal growth restriction, including its definition and risk factors. Discover screening methods and management techniques for both near-term and remote-term cases. Additionally, explore the risk factors and management options for macrosomia.

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Fetal Growth Restriction: Definition, Risk Factors, Screening, and Management

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  1. 태아발육이상

  2. Fetal Growth Restriction

  3. Definition • Low birthweight • 출생체중이 2,500 그램 미만 • High birthweight (Macrosomia) • 출생체중이 4,000 그램 이상 • SGA(small-for-gestational-age) • 10th percentile 미만의 출생체중 • 주산기 예후가 나쁜 경우는 대부분 3 percentile 미만

  4. Definition • Symmetrical • Malformation, infection, severe maternal malnutrition, smoking • Asymmetrical • Placental insufficiency or poor uteroplacental perfusion • “Brain sparing" effect

  5. Risk Factors • Constitutionally small mothers • Poor maternal weight gain and nutrition • Social deprivation • Fetal infection • Rubella, cytomegalovirus, hepatitis A, B, toxoplasmosis, syphilis • Congenital malformations • Chromosomal abnormalities

  6. Risk Factors • Primary disorders of cartilage and bone • Osteogenesis imperfecta • Chondrodystrophy • Vascular disease • Chronic vascular disease with superimposed preeclampsia • Chronic renal disease • Chronic hypoxia • High altitude, cyanotic heart disease

  7. Risk Factors • Maternal anemia • Sickle cell disease • Placental and cord abnormalities • Multiple fetuses • Extrauterine pregnancy • Chemical teratogens • Tobacco, narcotics, alcohol • Some anticonvulsants

  8. Screening & Identification • Uterine fundal height • Safe, simple, inexpensive, reasonable screening method • 40 % detection rate • Inability to differentiate between symmetrical & asymmetrical G. R. • 18th-30th wks : fundal height in cm ≒ weeks of gestation

  9. Screening & Identification • 초음파 검사 • 임신 16-20주: 임신주수 확인, 선천성 기형 확인 • 임신 32-34주: 태아발육지연 확인 • Abdominal circumference • Ductus venosus level에서 측정 • 태아발육지연의 most reliable index

  10. Screening & Identification • 초음파 검사 • Amniotic fluid volume • Fetal hypoxia  Reduced renal blood flow by redistribution  Diminished urine output  Oligohydramnios • Oligohydramnios: highly suggestive of fetal growth failure

  11. Screening & Identification • Doppler Velocimetry • Fetal hypoxia  Redistribution of blood flow  Increased peripheral vascular resistance • Umbilical artery S/D ratio 증가 • Diastolic flow 소실 또는 reversed diastole

  12. Management • Near term • Prompt delivery • Severe oligohydramnios • 34주 이상이면 분만시킴

  13. Management • Remote from term • Hospitalization & Decrease physical activity, Adequate diet • Meticulous search for etiology • Monitor with fetal surveillance test • 살 수 있을 만큼 충분히 성숙되었으나 심한 발육지연이 있는 경우  빨리 분만시켜 신생아 치료를 잘하는 것이 예후에 좋다

  14. Macrosomia

  15. Risk Factors • Large parents, especially obese mother • Multiparity • Prolonged gestation • Maternal age • Male fetus • Previous macrosomia • Race and ethnicity

  16. Prognosis & Management • Prognosis • Shoulder dystocia • Cesarean delivery • Management • Prophylactic labor induction • Not recommended • Elective cesarean delivery • Diabetic mother with estimated fetal weights exceeding 4250 g

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