Fetal growth restriction (FGR), formerly called intrauterine growth restriction (IUGR), refers to a condition in which an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb.
Mild FGR usually doesn't cause long-term problems. In fact, most babies who have it catch up in height and weight by age 2. But severe FGR can seriously harm a baby before and after birth. The extent of the problems depends on the cause and how severe the growth restriction is. It also depends on what point in the pregnancy it starts.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Fetal growth restriction (FGR), formerly called intrauterine growth restriction (IUGR), refers to a condition in which an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb.
Mild FGR usually doesn't cause long-term problems. In fact, most babies who have it catch up in height and weight by age 2. But severe FGR can seriously harm a baby before and after birth. The extent of the problems depends on the cause and how severe the growth restriction is. It also depends on what point in the pregnancy it starts.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
This ppt may help in understanding Rh negative women during pregnancy, labour and postpartum. Great advancements have been made in the detection and management of this condition, and many of our Rh-negative women can now have a happy obstetric career.
Lecture by Dr Sujoy Dasgupta in BOGSCON 2015, the Annual Conference of Bengal Obstetric and Gynaecological Society, held at Hotel Novotel, Kolkata in January, 2015; where he had been invited as FACULTY to deliver his lecture
Selective progesterone receptor modulators (SPRMs)
Stimulates growth :
Up regulating epidermal growth factor (EGF)
Down regulating tumour necrosis factor-alpha expression
Inhibits growth :
Downregulating insulin-like growth factor-1 (IGF-1) expression
NO EFFECT ON ESTRADIOL LEVELS
Mifepristone : 5 or 10 mg per day for 1 year
Ulipristal acetate: 5-10mg/day for 13 weeks
Pro apoptotic and anti-proliferative effects on fibroid cells
Embryo implantation in the region of a previous caesarean section scar is a rare but potentially catastrophic complication of a previous cesarean birth.
This ppt may help in understanding Rh negative women during pregnancy, labour and postpartum. Great advancements have been made in the detection and management of this condition, and many of our Rh-negative women can now have a happy obstetric career.
Lecture by Dr Sujoy Dasgupta in BOGSCON 2015, the Annual Conference of Bengal Obstetric and Gynaecological Society, held at Hotel Novotel, Kolkata in January, 2015; where he had been invited as FACULTY to deliver his lecture
Selective progesterone receptor modulators (SPRMs)
Stimulates growth :
Up regulating epidermal growth factor (EGF)
Down regulating tumour necrosis factor-alpha expression
Inhibits growth :
Downregulating insulin-like growth factor-1 (IGF-1) expression
NO EFFECT ON ESTRADIOL LEVELS
Mifepristone : 5 or 10 mg per day for 1 year
Ulipristal acetate: 5-10mg/day for 13 weeks
Pro apoptotic and anti-proliferative effects on fibroid cells
Case Report on Invasive Mole. Gestational Trophoblastic Neoplasia (GTN) encom...Niranjan Chavan
Gestational Trophoblastic Neoplasia (GTN) encompasses a suite of rare but significant gynecological malignancies arising from aberrant placental trophoblast cells. As medical professionals and researchers, our comprehension of GTN's complexities is crucial for accurate diagnosis and effective treatment. This introduction serves to illuminate the key features, diagnostic procedures, and treatment protocols associated with GTN, helping to navigate the intricate landscape of this disease.
Peripartum cardiomyopathy (PPCM) is a rare form of heart failure that occurs during the last month of pregnancy or within the first five months postpartum. It presents significant challenges in diagnosis and treatment due to its overlap with symptoms of normal pregnancy and postpartum changes. This condition varies in incidence across different racial groups and geographical locations, with a notable occurrence in the United States and southern India.
DR. NNC LAPAROSCOPY IN PREGNANCY IAGE VARANASI, 17TH MARCH 2024.pptxNiranjan Chavan
Our journey will navigate the evolution of laparoscopy in the context of pregnancy, detailing key milestones, breakthroughs, and advancements in technology and techniques. The presentation highlights how laparoscopy has revolutionized the diagnosis and treatment of conditions such as ectopic pregnancy, ovarian cysts and other gynecological disorders during pregnancy.
Optimising Delivery Of 1kg Fetus - Special Considerations.pptxNiranjan Chavan
After an uncomplicated vaginal birth in a health facility, healthy mothers and newborns should receive care in the facility for at least 24 hours after birth.
VACCINE IN WOMEN TOWARDS SDG 2030 DR.N N CHAVAN 10012024 AICOG HYDERABAD.pptxNiranjan Chavan
In our presentation today, we will unravel the transformative power of vaccines in women, aligning with the Sustainable Development Goals (SDGs) for 2030. By exploring the pivotal role of vaccinations, we aim to elucidate how they contribute to women's health, empowerment, and overall well-being. Through this lens, we envision a future where widespread vaccine access propels us closer to achieving the SDGs and ensures a healthier, more equitable world for women globally.
RRRR IN OBSTETRIC HEMORRHAGE 09012024 AICOG 2024 HEYDERABAD.pptxNiranjan Chavan
This presentation focuses on a critical aspect of maternal care: "Reducing Maternal Mortality through Rapid Response in Obstetric Haemorrhage" (RRRR). As we navigate through this presentation, let us collectively work towards advancing our understanding and application of RRRR in obstetric care to safeguard the well-being of mothers during childbirth.
Anemia is a condition in which the number of red blood cells and/OR their oxy...Niranjan Chavan
Anemia is a condition in which the number of red blood cells and/OR their
oxygen-carrying capacity is insufficient to meet the body’s physiological needs.
HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It ...Niranjan Chavan
HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It usually occurs during the third trimester of pregnancy. But it also can develop in the first week after childbirth
Guidelines & Identification of Early Sepsis DR. NN CHAVAN 02122023.pptxNiranjan Chavan
Here is a highly informative session on guidelines and identification of early sepsis as it is critical for timely intervention and improved patient outcomes.
PAST, PRESENT AND FUTURE IN OBGYN INFECTIONS 01102023.pptxNiranjan Chavan
Today, we face new infectious threats; but also benefit from advanced diagnostics and treatments. Looking ahead, it’s crucial to continue
adapting to emerging pathogens, implement stringent preventive measures, and
leverage cutting-edge technologies to ensure the safety and well-being of our patients in the ever-evolving landscape of obstetrics and gynecology.
Vaccination during pregnancy is crucial to protect both the mother and the developing baby. It helps prevent serious complications and ensures a healthier start in life. #VaccinateForTwo 🤰💉
Explore a comprehensive presentation on Invasive Cervical Carcinoma, shedding light on its causes, symptoms, diagnosis, treatment options, and preventive measures.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Dilemmas in Diagnosis and Management of FGR Dr NNC 06082022.pptx
1. DILEMMAS IN DIAGNOSIS
AND MANAGEMENT OF FGR
Dr. Niranjan Chavan
National FOGSI Conference – Obstetric Dilemmas
06th August 2022
2. Professor and Unit Chief, L.T.M.M.C & L.T.M.G.H, Sion Hospital
Joint Treasurer, FOGSI (2021-2024)
President, MOGS (2022-2023)
Member Oncology Committee, SAFOG (2021-2023)
Joint Secretary, AFG(2022-2023)
Dean AGOG & Chief Content Director, HIGHGRAD & FEMAS Courses
Editor-in-Chief, FEMAS, JGOG & TOA Journal
60 publications in International and National Journals with 109 Citations
National Coordinator, FOGSI Medical Disorders in Pregnancy Committee (2019-2022)
Chair & Convener, FOGSI Cell Violence Against Doctors (2015-16)
Member, Oncology Committee AOFOG (2013-2015)
Coordinator of 11 batches of MUHS recognized Certificate Course of B.I.M.I.E at L.T.M.G.H (2010-16)
Member, Managing Committee IAGE (2013-17), (2018-20), (2022-2023)
Editorial Board, European Journal of Gynaec. Oncology (Italy)
Course Coordinator of 3 batches of Advanced Minimal Access Gynaec Surgery (AMAS) at LTMGH
(2018-19)
DR. NIRANJAN CHAVAN
MD, FCPS, DGO, MICOG, DICOG, FICOG, DFP,
DIPLOMA IN ENDOSCOPY (USA)
3. “
”
EVERY CHILD COMES WITH THE MESSAGE THAT GOD
IS NOT YET DISCOURAGED OF MAN
Rabindranath Tagore
4. FETAL GROWTH RESTRICTION
• Fetal growth restriction (FGR) is a pathological condition in
which a fetus fails to achieve its genetic growth potential
• It comes under a much broader concept of small for
gestational age (SGA) fetuses
• SGA also carries under it babies that are constitutionally small
but have achieved their growth potential and hence are not
associated with adverse perinatal outcomes, much unlike FGR
fetuses
• FGR can be classified grossly as ones beginning before 32 of
gestation (early FGR) vs the ones after (late FGR)
5. • 3 - 5% of all pregnancies
• 20 % of still borns are growth restricted
• 1/3 of infants with BW < 2750 gms are growth
restricted and not premature
• Only 20-30% of growth restricted fetuses are small
due to pathological restriction of growth
• Perinatal mortality is 8 - 10 times higher for these
fetuses
INCIDENCE
6. AETIOLOGY
• General-
• Racial / Ethnic origin, Small maternal / paternal height
/weight, Fetal sex
• Maternal causes
• Fetal causes
• Placental causes
• Idiopathic - In a majority of cases (40%) the cause is
unknown– probably due to placental insufficiency
7. • Previous baby who suffered from
IUGR
• Extremes of age
• Is small in size (Ht & Wt)
• Has poor weight gain and
malnutrition during pregnancy
• Is socially deprived
• Has a low total blood volume
during early pregnancy
MATERNAL RISK FACTORS
8. • Uses substances (like tobacco,
narcotics, alcohol) that can cause
abnormal development or birth
defects
• Multiple Gestation
• High altitude
• Has a cardio-vascular disease-
preeclampsia, hypertension,
cyanotic heart disease, cardiac
disease Grade III & IV, diabetic
vascular lesions
9. • Chronic kidney disease
• Chronic infection- UTI, Malaria, TB, genital
infections
• Has an antibody problem that can make
successful pregnancy difficult (antiphospholipid
antibody syndrome, SLE)
MATERNAL RISK FACTORS
10. • Intrauterine infections - German measles (rubella), cytomegalovirus, herpes
simplex, tuberculosis, syphilis, or toxoplasmosis, TB, Malaria, Parvo virus
B19
• A birth defect (cardiovascular, renal, anencephaly, limb defect, etc)
• A chromosome defect - Trisomy-18 (Edwards’ syndrome), 21(Down’s
syndrome), 16, 13, XO (Turner’s syndrome)
• Primary disorder of bone or cartilage
• Chronic lack of oxygen during development (hypoxia)
• Placenta or umbilical cord defects
• Exposure to Teratogens/Drugs(Anti-convulsant, Anticoagulants, Alcohol,
Narcotics)
FETAL RISK FACTORS
11. • Uteroplacental insufficiency resulting from -
• Improper / inadequate trophoblastic invasion
and placentation in the first trimester
• Lateral insertion of placenta
• Reduced maternal blood flow to the placental
bed
• Fetoplacetal insufficiency due to -
• Vascular anomalies of placenta and cord
• Decreased placental functioning mass
• Small placenta, abruptio placenta, placenta
previa, post term pregnancy
PLACENTAL FACTORS
12. NORMAL INTRAUTERINE GROWTH PATTERN
• Stage I (Hyperplasia)
• 4 to 20 weeks
• Rapid mitosis
• Increase of DNA content
• Stage II (Hyperplasia & Hypertrophy)
• 20 to 28 weeks
• Declining mitosis
• Increase in cell size
• Stage III ( Hypertrophy)
• 28 to 40 weeks
• Rapid increase in cell size
• Rapid accumulation of fat, muscle and
connective tissue
95% of fetal weight gain occurs during last 20 weeks of gestations
13. • The optimal definition of growth restriction, in particular the differentiation between physiological (SGA) and
pathological (IUGR) small fetal size, is one of the most common, controversial, and complex problems in modern
obstetrics
• There is greement internationally that an EFW <10th centile for gestation should alert clinicians to potential small
fetal size
• All fetuses with an EFW <3rd centile, or those fetuses with a combination of EFW <10th centile and abnormal
UA Doppler, are at increased risk of either adverse perinatal outcome or NICU admission when compared to
those with EFW or AC <10th or <5th centiles or normal UA Doppler indices
14. DEFINING FGR USING USG
For less than 32 weeks:
1. AC/EFW < 3rd centile or,
2. AEDF in the Umbilical Artery (UA) or,
3. AC/EFW < 10th centile + Uterine Artery (UtA) and/or UA PI > 95th centile
For more than 32 weeks:
1. AC/EFW < 3rd centile or,
2. AC/EFW < 10th centile + UA PI > 95th centile or CPR < 5th centile
15.
16. INDIVIDUAL DOPPLER INDICES AND FGR
Placental Development Indicators:
• Uterine Artery Doppler: Carries a moderate
degree of predictive value for adverse perinatal
outcome when performed between 20-24
weeks of gestation. Persistence of these
changes carries higher risk.
• Umbilical Artery Doppler: With increasing
gestation, a gradual decrease in PI is normally
seen. Whereas in patients with poor
trophoblastic invasion, this is reversed
17. Fetal Indices:
• Middle Cerebral Artery Doppler: Normally the PI increases with
course of gestation, but as a result of chronic hypoxemia, there is
cerebral vasodilation and decreased PI and CPR, leading to brain
sparing effect.
• Develops before 32 weeks when there was already impaired
placentation or after 32 weeks when fetal metabolic demands
exceed normal placental limits
• Ductus Venosus Doppler: Increased PI and retrograde a wave
reflects onset of overt cardiac compromise
18. AFI AND FGR
• Amniotic fluid index is an indicator of fetal renal
perfusion, which lower values reflecting
shunting of blood from kidneys to the brain
• Deepest vertical pocket is a better indicator
than AFI as a predictor of fetal well being over
last 2-3 weeks
19. Early-Onset FGR Minimum Surveillance
Frequency
UA Doppler PI >95th centile, no other
testing abnormalities
Every 2 weeks Doppler, weekly
BPS or cCTG
Low MCA PI or CPR Weekly Doppler with BPS or cCTG
UA absent end-diastolic flow
(AEDF)
Consider admission, twice weekly
Doppler with BPS or cCTG
UA reversed end-diastolic flow,
increased DV or oligoamnios
(deepest pool <2 cm)
Admission, 3 times per week Doppler
with BPS, daily CTG or cCTG
Absent or reversed DV
a-wave
Daily Doppler with BPS or cCTG
in preparation to delivery
Late-Onset FGR Minimum Surveillance
Frequency
UA Doppler PI >95th centile, no other
testing abnormalities
Weekly Doppler with BPS
Low MCA PI or CPR 2-3 times/week Doppler with BPS
Minimum Surveillance Frequency Prior to the
Delivery Threshold
23. ROLE OF DOPPLER IN SELECTIVE FGR
• sFGR, conventionally, is defined as a condition in which
one fetus has EFW < 10th centile and the intertwin EFW
discordance is > 25%
• According to the NICE guidance (year), EFW
discordance should be calculated and documented at
every scan from 20 weeks onwards.
• If this discordance reaches 25% or more, increased fetal
surveillance, including fetal Doppler, and planning of
delivery when appropriate , is warranted
24. CLASSIFICATION OF MONOCHORIONIC TWIN
PREGNANCY COMPLICATED BY SFGR
Classification of sFGR in monochorionic twins
depends on the pattern of end-diastolic velocity
at umbilical artery Doppler -
In Type I, the umbilical artery Doppler waveform
has positive end-diastolic flow. The survival rate
in Type-I sFGR is greater than 90% (in-utero
mortality rates of up to 4%).
25. • In Type II, there is absent or reversed
end-diastolic flow (AREDF).
• Type-II, sFGR is associated with
• A high risk of IUD of the growth-
restricted twin a and/or
• Very preterm delivery with associated risk
of neurodevelopmental delay if the other
twin survives (IUD of either twin in up to
29% and
• Risk of neurological sequelae in up to
15% of cases born prior to 30 weeks)
26. • In Type III, there is a cyclical/intermittent
pattern of AREDF.
• Type-III sFGR is associated with a 10–20%
risk of sudden death of the growth-
restricted fetus, which is unpredictable
(even in cases in which ultrasound features
have been stable).
• There is also a high (up to 20%) associated
rate of neurological morbidity in the
surviving larger twin
27. MONITORING CASES WITH SFGR
• In monochorionic twin pregnancy complicated by sFGR, fetal growth
should be assessed at least every 2 weeks, and fetal Doppler (umbilical
artery and MCA) at least weekly
• If the umbilical artery Doppler is abnormal, an assessment of the DV blood
flow should be undertaken
• The aim in managing these pregnancies is to prolong the pregnancy at
least until viability is achieved, while at the same time avoiding a single IUD
with its associated severe consequences for the surviving cotwin
28. • 8.8% neonates delivered had birth weight of<2.5 kg out of which 20% had intrauterine growth restriction and
22.4% were preterm
29. • 40% babies delivered had birth weight of <2.5 kg out of which 13.33% had IUGR and 26.66% were preterm
30. CASE 1
• 32 year G2P1L1 k/c/o GDM on
PI 8-8-8 came at 38 weeks by
scan
• On examination BP was
160/100 mm Hg
• P/A –
• Ut 34 weeks, Cephal, FHS
regular 150-160 bpm, relaxed
• Doppler Findings –
• Raised PI of Umbilical Artery
• Absent End Diastolic flow (AEDF)
at fetal site
• Raised PI of Left uterine artery
with Early Diastolic notch
• Pathological CPR with Reduced
PI of MCA s/o brain sparing
effect
• What is the next step in Management?
31. • Features are suggestive of Late onset IUGR
• Immediate delivery by caesarean section after steroid cover if CTG facility available
32. CASE 2
• 26 year old primigravida 32
weeks B/S came with BP-
160/110 with premonitory
symptoms
• P/A- Ut 24-26 weeks,
Cephal, fhs regular 140-150
bpm, relaxed
USG Findings –
• Single live intrauterine gestation of
approximate gestational age of 29-
30 weeks
• Scanty liquor – AFI 1-2
• Relatively smaller abdominal
parameter
• EFW – 1137+/- 166gms
• Above findings suggest IUGR
• Fetoplacental insufficiency with
absent diastolic flow on Colour
Doppler
• No evidence of utero-placental
insufficiency on Colour Doppler
What is the next step in management?
34. CASE 3
• 24 year primigravida with 32.3
weeks BS came with raised BP of
140/90 mm Hg for the first time,
UA trace, knee jerks normal, no
PMS
• P/A- Ut 30 week size, cephal, FHS
regular at 130-140 bpm, relaxed
• USG Obs doppler done
Doppler Findings –
• Raised PI of Umbilical Artery
• B/L Uterine artery shows Early
Diastolic Notch
What will be your plan of action?
35. • Late Onset IUGR with only Raised PI of Umbilical Artery
• Weekly Doppler with Biophysical Score
36. TAKE HOME MESSAGES
• Fetal growth restriction (FGR) is a pathological condition in which a fetus
fails to achieve its genetic growth potential
• FGR can be Early or Late Onset depending upon gestational age at occurrence
• Abnormal Umbilical Artery Doppler and EFW < 3rd centile were strongly and most
consistently associated with adverse perinatal outcome
• All fetuses with an EFW < 3rd centile, or those fetuses with a combination of EFW
< 10th centile and abnormal UA Doppler, are at increased risk of either adverse
perinatal outcome or NICU admission when compared to those with EFW or AC <
10th or < 5th centiles or normal UA Doppler indices
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