Discrepancy in uterine size

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A tutorial on concepts related to when the uterine size shows a discrepancy with gestational dates

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Discrepancy in uterine size

  1. 1. DISCREPANCY IN UTERINE SIZEAn understanding of the issues involved when auterus doesn’t correspond to its gestational age
  2. 2. Associate Professor Dr Hanifullah Khan
  3. 3. Objectives To understand the  To understand the  The important points to definitions involved implications of this situation consider
  4. 4. Discrepancy – what isit?When the uterine size does notcorrespond to the expected gestationMay be larger or smallerObjective measurement - > 2 cmvariation with symphysiofundalheight (SFH)
  5. 5. Implications of this situation Implications of this situation Is the fetus Is the fetus Has there Has there Is there an Is there an Is there a Is there a at risk? at risk? been a been a underlying underlying problem problem •If so, when •If so, whenmistake in mistake in problem problem causing this with the do we do wecalculatingcalculating causing this with the discrepancy? mother? discrepancy? mother? deliver it? deliver it?gestation?gestation?
  6. 6. Points to consider The patient has been found to have a gestation which does not correspond to calculations. This may be a feature of an underlying problem The problem may be related to the mother, fetus or placenta It is our job to determine the underlying cause of this problem
  7. 7. In all cases, always begin byDates confirming the datesBe absolutely positive The mother remembers the exact LMP (1st day) The periods have been regular The onset of pregnancy symptoms & quickening correspond to the dates That an early pregnancy ultrasound (if done), confirmed the dates Subsequent antenatal check ups have noted previous corresponding growth of
  8. 8. Remember, an early pregnancyultrasound scan is the definitive decider of dates
  9. 9. IUGR Intrauterine growth restriction or Fetal growth restriction Leads to uterus < dates  A manifestation of underlying problem  Maternal, fetal or placental  Most commonly caused by placental insufficiency (unknown cause), hypertensive disease, maternal disease, fetal anomaly Most non-fetal causes lead to asymmetrical FGR (the so-called head-sparing effect) 9
  10. 10. Fetal Growth RestrictionLeads to long term problems
  11. 11. The left ear
  12. 12. Big baby• If fetal macrosomia is the cause in an uterus > dates, it is most often a consequence of gestational diabetes• GDM can also lead to polyhydramnios on its own• It is mandatory to look hard for GDM in such cases
  13. 13. Macrosomia 13
  14. 14. Fetal anomalies Any discrepancy in uterine size must lead to an extensive search for fetal anomalies 14
  15. 15. Multiples Any large uterus may be caused by a multiple pregnancy  There may be more than one See for yourself 15
  16. 16. The diagnosis of SGA A constitutionally small fetus is a diagnosis of exclusion  This is the last diagnosis in your list of differentials Always rule out disease before you can say its normal These fetuses display linear growth despite being small Usually, the mother is also small (this is logical) 16
  17. 17. Summary
  18. 18. Discrepancy in uterine size This denotes a uterine size not corresponding to gestational age It may be a sign of an underlying problem This problem could be of maternal, fetal or placental origin One common cause is wrong dates Rule out disease before diagnosing a constitutionally small fetus 18
  19. 19. THE END Thank You Very Much

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