This document discusses fetal growth retardation (FGR), providing information on definition, incidence, causes, complications, diagnosis using ultrasound and Doppler, and management including timing of delivery. Key points include:
- FGR is defined as failure of a fetus to reach its genetic growth potential, putting it at risk of perinatal mortality and morbidity.
- Major causes include placental insufficiency and fetal/chromosomal abnormalities. It increases perinatal mortality and long-term health risks.
- Ultrasound is used to assess fetal size and growth, look for anomalies, and monitor amniotic fluid levels. Doppler studies of the umbilical artery, middle cerebral artery, and ductus venosus can
1. Intrauterine growth restriction (IUGR) refers to fetuses that are small for gestational age and display signs of chronic hypoxia or failure to thrive. It occurs in approximately 3-5% of pregnancies.
2. IUGR can be classified as symmetrical/intrinsic or asymmetrical based on whether growth restriction affects all parameters equally or causes brain sparing. The causes include placental insufficiency, infections, genetic and structural fetal anomalies, and various maternal medical conditions and lifestyle factors.
3. Complications of IUGR include perinatal mortality and morbidity as well as long term risks of metabolic and cardiovascular diseases. Diagnosis involves identifying high risk mothers, accurate dating by ultrasound,
tubal factor is almost 30% of all female infertility causes.Hence evaluation of tubes is usulally the first of the testings.
this presentation evaluates all the methods for evaluation of fallopian tubes
This document provides information from Dr. Kirtan Vyas about fetal growth restriction (FGR). It discusses the challenges in identifying and managing FGR. Key points include:
1) Timely identification of FGR is difficult but crucial for proper management and a favorable neonatal outcome, as it is the second leading cause of perinatal mortality after prematurity.
2) FGR remains extensively studied but still confusing and controversial to researchers.
3) The major concern with FGR is not the small size of the fetus but the possibility of life-threatening fetal compromise.
4) Screening approaches, management recommendations, and postnatal care for babies with FGR are discussed.
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.
USG AND DOPPLER IN DIAGNOSIS AND MANAGEMENT OF IUGRshiv lasune
This document discusses the use of ultrasound and Doppler in the diagnosis and management of intrauterine growth restriction (IUGR). It defines small for gestational age (SGA) as a fetus below the 10th percentile and describes how Doppler of the umbilical artery can help identify fetuses with IUGR, monitor disease progression, and predict outcomes. Doppler of other fetal vessels like the middle cerebral artery and ductus venosus can further evaluate the fetus and help guide management decisions. Together, Doppler studies provide both diagnostic and prognostic information useful in the care of growth restricted fetuses.
This document discusses color Doppler ultrasound techniques for fetal surveillance. It describes the anatomy of fetal and placental circulation and examines the uterine, umbilical and middle cerebral arteries. Waveform analysis using indices like S/D ratio, resistance index and pulsatility index is discussed. Normal and abnormal Doppler findings are presented along with their clinical significance and management. Precise techniques for imaging and interpreting various fetal blood vessels are provided.
The document discusses fetal growth restriction (FGR) and summarizes an expert panel discussion on the topic. The panelists discuss various aspects of FGR including definitions, phases of fetal growth, factors that can influence growth, ultrasound evaluation techniques, use of Doppler ultrasound, monitoring protocols, and criteria for delivery. Key points addressed include differentiating FGR from SGA, importance of serial ultrasounds and growth curves, criteria for diagnosing growth restriction, and fetal response to hypoxia involving blood flow redistribution.
1. Intrauterine growth restriction (IUGR) refers to fetuses that are small for gestational age and display signs of chronic hypoxia or failure to thrive. It occurs in approximately 3-5% of pregnancies.
2. IUGR can be classified as symmetrical/intrinsic or asymmetrical based on whether growth restriction affects all parameters equally or causes brain sparing. The causes include placental insufficiency, infections, genetic and structural fetal anomalies, and various maternal medical conditions and lifestyle factors.
3. Complications of IUGR include perinatal mortality and morbidity as well as long term risks of metabolic and cardiovascular diseases. Diagnosis involves identifying high risk mothers, accurate dating by ultrasound,
tubal factor is almost 30% of all female infertility causes.Hence evaluation of tubes is usulally the first of the testings.
this presentation evaluates all the methods for evaluation of fallopian tubes
This document provides information from Dr. Kirtan Vyas about fetal growth restriction (FGR). It discusses the challenges in identifying and managing FGR. Key points include:
1) Timely identification of FGR is difficult but crucial for proper management and a favorable neonatal outcome, as it is the second leading cause of perinatal mortality after prematurity.
2) FGR remains extensively studied but still confusing and controversial to researchers.
3) The major concern with FGR is not the small size of the fetus but the possibility of life-threatening fetal compromise.
4) Screening approaches, management recommendations, and postnatal care for babies with FGR are discussed.
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.
USG AND DOPPLER IN DIAGNOSIS AND MANAGEMENT OF IUGRshiv lasune
This document discusses the use of ultrasound and Doppler in the diagnosis and management of intrauterine growth restriction (IUGR). It defines small for gestational age (SGA) as a fetus below the 10th percentile and describes how Doppler of the umbilical artery can help identify fetuses with IUGR, monitor disease progression, and predict outcomes. Doppler of other fetal vessels like the middle cerebral artery and ductus venosus can further evaluate the fetus and help guide management decisions. Together, Doppler studies provide both diagnostic and prognostic information useful in the care of growth restricted fetuses.
This document discusses color Doppler ultrasound techniques for fetal surveillance. It describes the anatomy of fetal and placental circulation and examines the uterine, umbilical and middle cerebral arteries. Waveform analysis using indices like S/D ratio, resistance index and pulsatility index is discussed. Normal and abnormal Doppler findings are presented along with their clinical significance and management. Precise techniques for imaging and interpreting various fetal blood vessels are provided.
The document discusses fetal growth restriction (FGR) and summarizes an expert panel discussion on the topic. The panelists discuss various aspects of FGR including definitions, phases of fetal growth, factors that can influence growth, ultrasound evaluation techniques, use of Doppler ultrasound, monitoring protocols, and criteria for delivery. Key points addressed include differentiating FGR from SGA, importance of serial ultrasounds and growth curves, criteria for diagnosing growth restriction, and fetal response to hypoxia involving blood flow redistribution.
The document discusses fetal growth abnormalities such as intrauterine growth restriction (IUGR). IUGR is defined as birth weight below the 10th percentile for gestational age but this definition includes 10% of normal babies. It is better to use customized growth charts based on maternal characteristics. Features of IUGR seen on ultrasound include reduced growth velocity, oligohydramnios, and Doppler changes. Symmetrical IUGR shows equivalent reduction in head and abdominal circumference growth while asymmetrical IUGR shows differential growth. A biophysical profile score of less than 6 is abnormal.
MANAGEMENT OF VAULT PROLAPSE BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the management of vault prolapse, which is the descent of the vaginal cuff after a hysterectomy. It defines vault prolapse and lists risk factors. Conservative management includes pessaries but surgery is often needed. Surgical options include vaginal approaches like sacrospinous ligament fixation or abdominal approaches like sacral colpopexy. The document compares techniques and factors to consider in surgical planning like prolapse severity and patient factors. Prevention techniques like culdoplasty at time of hysterectomy are also discussed.
Focused approach to antenatal care - First trimester screeningBharti Gahtori
This document discusses focused antenatal care and first trimester screening. It describes the essential elements of antenatal care including targeted assessments based on individual risk factors. First trimester screening aims to detect conditions like aneuploidy through measuring the nuchal translucency, analyzing maternal serum markers, and assessing fetal heart rate between 11-13 weeks of gestation. Screening tests are evaluated based on their sensitivity, specificity, and rates of false positives and negatives.
This document discusses antepartum fetal assessment. It begins by defining antepartum fetal surveillance as the assessment of fetal well-being before labor onset. The goals are early detection of at-risk fetuses to allow timely management and avoiding unnecessary interventions. It then lists various maternal, fetal, and pregnancy conditions that warrant fetal surveillance. The document goes on to describe multiple methods of antepartum assessment including ultrasound, non-stress tests, biophysical profiles, and Doppler studies. It provides details on interpreting and acting on the results of these tests to monitor fetal health and determine need for delivery.
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)Sujoy Dasgupta
Dr Sujoy Dasgupta invited to deliver a lecture on "RPL- ESHRE Guideline" in the Annual Conference of RCOG (Royal College of Obstetricians and Gynaecologists) IRC (International Representative Committee) India East held on 20-21 May, 2023
Fibroids are the most common benign tumors of the female reproductive system. They arise from the smooth muscle cells of the uterus and affect 20-40% of women of reproductive age. The exact cause is unknown but risk factors include age, family history, obesity, and black race. Symptoms include heavy menstrual bleeding, pain, and a pelvic mass. Diagnosis is usually made clinically or with ultrasound. Treatment depends on symptoms and desire for future fertility, and may include medication, surgery such as myomectomy or hysterectomy, uterine artery embolization, or watchful waiting.
- Induction of labor is recommended for post-term pregnancies (greater than 42 weeks) due to increased risks of complications. Risks increase further as pregnancy progresses beyond 42 weeks.
- For low-risk pregnancies between 41-42 weeks, induction can be considered but is not necessarily recommended since perinatal outcomes do not significantly differ from 40-41 weeks. The risks and benefits should be discussed with the patient.
- Fetal surveillance with non-stress tests and ultrasound amniotic fluid measurements twice weekly is recommended for pregnancies beyond 42 weeks declining induction. Delivery is recommended if any test results cause concern for the fetal environment.
Intrapartum sonography can be used to more accurately assess fetal head position, station, descent, and rotation during labor compared to digital examination alone. It also helps predict success of induction of labor and instrumental delivery. The document outlines the basic technique, objectives, and various clinical applications of intrapartum sonography during different stages of labor.
1. Tubal anastomosis or IVF-ET must be considered based on factors like age, tubal damage extent, cost, and patient preference.
2. IVF-ET has a higher per-cycle success rate while tubal anastomosis has a higher cumulative success rate and may be more cost-effective.
3. Both have risks and neither is clearly superior, so options should be discussed individually to help couples feel they explored all options.
Basic ultrasound in O&G can be used to confirm and date pregnancies, screen for abnormalities, and evaluate problems in early pregnancy. Key applications include using scans from 4-5 weeks to detect a gestational sac and fetal pole, measuring the crown-rump length from 6-12 weeks to date the pregnancy, screening for issues like ectopic pregnancy or miscarriage, and assessing fetal growth and anatomy later in pregnancy. Ultrasound is also used for gynecological conditions like fibroids, cysts and infertility workups.
Acute fatty liver of pregnancy is a rare but potentially lethal condition that affects 1 in 7,000 to 20,000 pregnancies. It commonly presents after 30 weeks of pregnancy with nausea, vomiting, abdominal pain and jaundice. Liver function tests show elevated enzymes and hypoglycemia is present in 70% of cases. Prompt delivery improves outcomes for both mother and baby, with supportive care including treatment of coagulopathy and hypoglycemia before delivery. Recurrence is possible in subsequent pregnancies if the mother has an underlying fatty acid oxidation disorder.
Cervical length for preterm birth prevention Aboubakr ELNASHARAboubakr Elnashar
This document discusses cervical length screening during pregnancy to prevent preterm birth. It begins by explaining that a short cervical length is a strong predictor of preterm birth, especially for women with a prior preterm birth history. Transvaginal ultrasound is described as the gold standard for accurately measuring cervical length. The document then provides steps for proper cervical length measurement and recommends assessing length between 16-24 weeks of gestation. It outlines cervical length screening guidelines for women with a prior preterm birth, which is to screen every 1-2 weeks from 16-24 weeks. The document discusses debate around universal cervical length screening and notes insufficient evidence for screening in some high-risk situations.
This document discusses techniques for diagnosing endometriosis, including current and new methods. It provides details on:
1) Primary locations of endometriosis, their prevalence, clinical features, and differential diagnosis according to studies. Common locations include the ovaries and retrocervical region.
2) Four basic sonographic steps for examining patients with suspected deep infiltrating endometriosis, including evaluating transvaginal tenderness and mobility and assessing the "sliding sign".
3) Studies showing substantial agreement between observers using transvaginal sonography to diagnose endometriosis in various pelvic locations, with high accuracy for the rectosigmoid colon.
1. The document discusses various methods for evaluating tubal patency in infertile patients, including hysterosalpingography (HSG), laparoscopy, and tests like Chlamydia antibody testing.
2. HSG is the most common screening test but has limitations like radiation exposure and false positives. Findings on HSG like mucosal rugae can provide prognostic information.
3. Laparoscopy allows direct visualization but is more invasive. It remains the gold standard for diagnosing conditions like endometriosis.
4. For treatment, IVF is now often preferred over surgery for moderate to severe tubal damage, while laparoscopic surgery may be considered for milder issues
This document discusses the diagnosis and management of morbidly adherent placenta (MAP). It notes that the incidence of MAP has increased substantially in recent decades. Ultrasound is the primary tool for antenatal diagnosis, with findings like myometrial thinning and placental lacunae. MRI can be used as an adjunct. Treatment options include preterm cesarean hysterectomy or conservative approaches like leaving the placenta in situ or attempting placental resection. Conservative approaches aim to reduce morbidity while preserving fertility but carry risks of hemorrhage.
This document provides information on intrapartum fetal monitoring techniques including fetal heart rate monitoring, indications for continuous electronic fetal monitoring, interpretation of fetal heart rate patterns, and management of non-reassuring fetal status. It discusses techniques like intermittent auscultation, electronic fetal monitoring, fetal scalp pH testing, pulse oximetry, and lactate testing. The goal of intrapartum monitoring is timely identification and rescue of fetuses at risk for neonatal morbidity from hypoxic insult during labor and delivery.
Intrauterine Growth Restriction (IUGR) / Small For gestational Age POOJA KUMAR
This document discusses fetal growth restriction (FGR), also known as intrauterine growth restriction (IUGR). It defines FGR as fetal weight below the 10th percentile for gestational age, indicating failure to reach genetic growth potential and increased risks. It describes the normal phases of fetal growth and classifications of IUGR. It outlines risk factors, potential complications, diagnostic methods including ultrasound assessments, and management approaches including monitoring, medical interventions and timing of delivery.
This document outlines fetal growth restriction (FGR), including its causes, diagnosis, and management. FGR refers to a fetus that has failed to reach its growth potential and can be diagnosed based on measurements below the 10th percentile. It is a leading cause of stillbirth and newborn complications. Diagnosis involves frequent ultrasounds to monitor fetal size, proportions, and Doppler blood flow. Management depends on the severity and includes surveillance, dietary changes, medications to improve placental function, and timing of delivery. The goal is to balance fetal risks with the benefits of maintaining the pregnancy.
The document discusses fetal growth abnormalities such as intrauterine growth restriction (IUGR). IUGR is defined as birth weight below the 10th percentile for gestational age but this definition includes 10% of normal babies. It is better to use customized growth charts based on maternal characteristics. Features of IUGR seen on ultrasound include reduced growth velocity, oligohydramnios, and Doppler changes. Symmetrical IUGR shows equivalent reduction in head and abdominal circumference growth while asymmetrical IUGR shows differential growth. A biophysical profile score of less than 6 is abnormal.
MANAGEMENT OF VAULT PROLAPSE BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the management of vault prolapse, which is the descent of the vaginal cuff after a hysterectomy. It defines vault prolapse and lists risk factors. Conservative management includes pessaries but surgery is often needed. Surgical options include vaginal approaches like sacrospinous ligament fixation or abdominal approaches like sacral colpopexy. The document compares techniques and factors to consider in surgical planning like prolapse severity and patient factors. Prevention techniques like culdoplasty at time of hysterectomy are also discussed.
Focused approach to antenatal care - First trimester screeningBharti Gahtori
This document discusses focused antenatal care and first trimester screening. It describes the essential elements of antenatal care including targeted assessments based on individual risk factors. First trimester screening aims to detect conditions like aneuploidy through measuring the nuchal translucency, analyzing maternal serum markers, and assessing fetal heart rate between 11-13 weeks of gestation. Screening tests are evaluated based on their sensitivity, specificity, and rates of false positives and negatives.
This document discusses antepartum fetal assessment. It begins by defining antepartum fetal surveillance as the assessment of fetal well-being before labor onset. The goals are early detection of at-risk fetuses to allow timely management and avoiding unnecessary interventions. It then lists various maternal, fetal, and pregnancy conditions that warrant fetal surveillance. The document goes on to describe multiple methods of antepartum assessment including ultrasound, non-stress tests, biophysical profiles, and Doppler studies. It provides details on interpreting and acting on the results of these tests to monitor fetal health and determine need for delivery.
ESHRE Guideline on Recurrent Pregnancy Loss (RPL)Sujoy Dasgupta
Dr Sujoy Dasgupta invited to deliver a lecture on "RPL- ESHRE Guideline" in the Annual Conference of RCOG (Royal College of Obstetricians and Gynaecologists) IRC (International Representative Committee) India East held on 20-21 May, 2023
Fibroids are the most common benign tumors of the female reproductive system. They arise from the smooth muscle cells of the uterus and affect 20-40% of women of reproductive age. The exact cause is unknown but risk factors include age, family history, obesity, and black race. Symptoms include heavy menstrual bleeding, pain, and a pelvic mass. Diagnosis is usually made clinically or with ultrasound. Treatment depends on symptoms and desire for future fertility, and may include medication, surgery such as myomectomy or hysterectomy, uterine artery embolization, or watchful waiting.
- Induction of labor is recommended for post-term pregnancies (greater than 42 weeks) due to increased risks of complications. Risks increase further as pregnancy progresses beyond 42 weeks.
- For low-risk pregnancies between 41-42 weeks, induction can be considered but is not necessarily recommended since perinatal outcomes do not significantly differ from 40-41 weeks. The risks and benefits should be discussed with the patient.
- Fetal surveillance with non-stress tests and ultrasound amniotic fluid measurements twice weekly is recommended for pregnancies beyond 42 weeks declining induction. Delivery is recommended if any test results cause concern for the fetal environment.
Intrapartum sonography can be used to more accurately assess fetal head position, station, descent, and rotation during labor compared to digital examination alone. It also helps predict success of induction of labor and instrumental delivery. The document outlines the basic technique, objectives, and various clinical applications of intrapartum sonography during different stages of labor.
1. Tubal anastomosis or IVF-ET must be considered based on factors like age, tubal damage extent, cost, and patient preference.
2. IVF-ET has a higher per-cycle success rate while tubal anastomosis has a higher cumulative success rate and may be more cost-effective.
3. Both have risks and neither is clearly superior, so options should be discussed individually to help couples feel they explored all options.
Basic ultrasound in O&G can be used to confirm and date pregnancies, screen for abnormalities, and evaluate problems in early pregnancy. Key applications include using scans from 4-5 weeks to detect a gestational sac and fetal pole, measuring the crown-rump length from 6-12 weeks to date the pregnancy, screening for issues like ectopic pregnancy or miscarriage, and assessing fetal growth and anatomy later in pregnancy. Ultrasound is also used for gynecological conditions like fibroids, cysts and infertility workups.
Acute fatty liver of pregnancy is a rare but potentially lethal condition that affects 1 in 7,000 to 20,000 pregnancies. It commonly presents after 30 weeks of pregnancy with nausea, vomiting, abdominal pain and jaundice. Liver function tests show elevated enzymes and hypoglycemia is present in 70% of cases. Prompt delivery improves outcomes for both mother and baby, with supportive care including treatment of coagulopathy and hypoglycemia before delivery. Recurrence is possible in subsequent pregnancies if the mother has an underlying fatty acid oxidation disorder.
Cervical length for preterm birth prevention Aboubakr ELNASHARAboubakr Elnashar
This document discusses cervical length screening during pregnancy to prevent preterm birth. It begins by explaining that a short cervical length is a strong predictor of preterm birth, especially for women with a prior preterm birth history. Transvaginal ultrasound is described as the gold standard for accurately measuring cervical length. The document then provides steps for proper cervical length measurement and recommends assessing length between 16-24 weeks of gestation. It outlines cervical length screening guidelines for women with a prior preterm birth, which is to screen every 1-2 weeks from 16-24 weeks. The document discusses debate around universal cervical length screening and notes insufficient evidence for screening in some high-risk situations.
This document discusses techniques for diagnosing endometriosis, including current and new methods. It provides details on:
1) Primary locations of endometriosis, their prevalence, clinical features, and differential diagnosis according to studies. Common locations include the ovaries and retrocervical region.
2) Four basic sonographic steps for examining patients with suspected deep infiltrating endometriosis, including evaluating transvaginal tenderness and mobility and assessing the "sliding sign".
3) Studies showing substantial agreement between observers using transvaginal sonography to diagnose endometriosis in various pelvic locations, with high accuracy for the rectosigmoid colon.
1. The document discusses various methods for evaluating tubal patency in infertile patients, including hysterosalpingography (HSG), laparoscopy, and tests like Chlamydia antibody testing.
2. HSG is the most common screening test but has limitations like radiation exposure and false positives. Findings on HSG like mucosal rugae can provide prognostic information.
3. Laparoscopy allows direct visualization but is more invasive. It remains the gold standard for diagnosing conditions like endometriosis.
4. For treatment, IVF is now often preferred over surgery for moderate to severe tubal damage, while laparoscopic surgery may be considered for milder issues
This document discusses the diagnosis and management of morbidly adherent placenta (MAP). It notes that the incidence of MAP has increased substantially in recent decades. Ultrasound is the primary tool for antenatal diagnosis, with findings like myometrial thinning and placental lacunae. MRI can be used as an adjunct. Treatment options include preterm cesarean hysterectomy or conservative approaches like leaving the placenta in situ or attempting placental resection. Conservative approaches aim to reduce morbidity while preserving fertility but carry risks of hemorrhage.
This document provides information on intrapartum fetal monitoring techniques including fetal heart rate monitoring, indications for continuous electronic fetal monitoring, interpretation of fetal heart rate patterns, and management of non-reassuring fetal status. It discusses techniques like intermittent auscultation, electronic fetal monitoring, fetal scalp pH testing, pulse oximetry, and lactate testing. The goal of intrapartum monitoring is timely identification and rescue of fetuses at risk for neonatal morbidity from hypoxic insult during labor and delivery.
Intrauterine Growth Restriction (IUGR) / Small For gestational Age POOJA KUMAR
This document discusses fetal growth restriction (FGR), also known as intrauterine growth restriction (IUGR). It defines FGR as fetal weight below the 10th percentile for gestational age, indicating failure to reach genetic growth potential and increased risks. It describes the normal phases of fetal growth and classifications of IUGR. It outlines risk factors, potential complications, diagnostic methods including ultrasound assessments, and management approaches including monitoring, medical interventions and timing of delivery.
This document outlines fetal growth restriction (FGR), including its causes, diagnosis, and management. FGR refers to a fetus that has failed to reach its growth potential and can be diagnosed based on measurements below the 10th percentile. It is a leading cause of stillbirth and newborn complications. Diagnosis involves frequent ultrasounds to monitor fetal size, proportions, and Doppler blood flow. Management depends on the severity and includes surveillance, dietary changes, medications to improve placental function, and timing of delivery. The goal is to balance fetal risks with the benefits of maintaining the pregnancy.
1) IUGR is caused by genetic or environmental factors that inhibit a fetus from reaching its growth potential, resulting in birth weight below the 10th percentile.
2) The leading causes of IUGR are placental insufficiency due to conditions like preeclampsia, diabetes, and chronic hypertension.
3) Diagnosis of IUGR involves assessing risk factors, ultrasound to evaluate fetal growth and dating, and Doppler ultrasound of the umbilical artery, uterine artery, middle cerebral artery, and ductus venosus to detect signs of placental insufficiency or fetal stress.
The document discusses intrauterine growth restriction (IUGR), including its definition, epidemiology, etiology, pathophysiology, classification, diagnosis, management, and complications. IUGR, also known as fetal growth restriction, is diagnosed when a fetus is estimated to weigh less than the 10th percentile for gestational age based on ultrasound. Proper diagnosis involves serial fundal height measurements and ultrasound assessment of fetal size, amniotic fluid levels, and umbilical and cerebral doppler studies. Management may include monitoring, delivery timing based on test results, and treatment of any underlying maternal conditions. Complications of IUGR include stillbirth, neonatal difficulties, and long-term developmental issues.
1) Fetal surveillance techniques like biophysical profile (BPP) and Doppler velocimetry help assess fetal well-being and risk of complications like intrauterine growth restriction (IUGR). Abnormal results increase rates of operative delivery, neonatal morbidity and mortality.
2) The BPP evaluates fetal movement, tone, breathing and reactivity and is interpreted based on fetal sleep cycles. Abnormal results on Doppler of the umbilical artery, middle cerebral artery, ductus venosus or uterine arteries also indicate placental insufficiency risk.
3) Despite wide individual variation, regular antenatal testing aims to predict wellness rather than just illness and time deliveries for highest chances of good outcomes
This document provides information about Prof. Narendra Malhotra, including his academic and professional qualifications, positions held, awards received, publications, lectures given, and organizations founded. It then provides an objectives and agenda for a talk on using color doppler to assess fetal growth restriction (FGR). The talk covers doppler principles, applications in evaluating the uteroplacental and fetal circulations in FGR, implications of abnormal doppler waveforms, and new applications such as in assessing fetal anemia and 3D doppler. It proposes a staging system for FGR based on doppler findings to determine timely delivery.
Intra uterine growth restriction (iugr) Doppler sudy Ryan Mulyana
Intra Uterine Growth Restriction (IUGR) and SGA:
Doppler Management and Prediction of Outcome
Ryan Saktika Mulyana, dr, M.Biomed, SpOG(K)
Maternal and Fetal Medicine, Obstetrics and Gynecology Department,
Udayana University Hospital, Udayana University
1) Intrauterine growth restriction (IUGR) refers to babies whose birth weight is below the 10th percentile for gestational age. It can affect preterm, term, or post-term babies.
2) The causes of IUGR include maternal conditions, fetal abnormalities, infections, placental dysfunction, and unknown etiologies in about 40% of cases.
3) Diagnosis involves clinical assessment, ultrasound measurements of fetal size and growth, biophysical profile testing, and Doppler studies of umbilical and uterine blood flow.
1) Intrauterine growth restriction (IUGR) refers to babies whose birth weight is below the 10th percentile for gestational age. It can affect preterm, term, or post-term babies.
2) The incidence of IUGR is about 3-10% in developed countries. IUGR babies have an increased risk of perinatal mortality and morbidity that progressively increases as birth weight percentile decreases.
3) IUGR can be symmetrical, affecting growth uniformly, or asymmetrical, where the head is larger than the abdomen indicating preferential shunting of nutrients to the brain. Causes include placental insufficiency, infections, and genetic/structural abnormalities.
This document discusses fetal growth restriction (FGR), also known as intrauterine growth restriction (IUGR). It defines FGR as failure of a fetus to reach its genetic growth potential in utero, putting it at risk for perinatal mortality and morbidity. The document covers causes, diagnosis, surveillance, and management of FGR, with a focus on the role of Doppler ultrasound in assessing the fetus and timing of delivery. Key points include using umbilical, uterine, middle cerebral artery and ductus venosus Doppler to evaluate the fetus's circulation and response to placental insufficiency. Abnormal Doppler findings help determine the need for interventions like corticosteroids or timing of preterm delivery.
Intrauterine growth restriction (IUGR) refers to failure of the fetus to reach growth potential and is associated with increased morbidity and mortality. It affects 3-10% of pregnancies and is a major contributor to stillbirths and perinatal mortality. IUGR can be symmetrical, affecting head, length and weight proportionally, or asymmetrical, affecting weight more than length and head. Causes include fetal abnormalities, infections, placental dysfunction, and maternal conditions like hypertension, malnutrition and smoking. Diagnosis involves serial ultrasounds to monitor fetal growth and Doppler studies to assess placental function. Management focuses on treating underlying maternal conditions, monitoring fetal wellbeing, and delivery planning if indicated.
The document discusses the importance and various uses of ultrasound in pregnancy. It describes how ultrasound can be used in each trimester to evaluate fetal growth and anatomy, detect abnormalities, and assess amniotic fluid levels. It also discusses Doppler ultrasound and its role in predicting preeclampsia, fetal growth restriction, and anemia. Ultrasound-guided procedures like amniocentesis and chorionic villus sampling are summarized.
Doppler ultrasound is used to manage fetal growth restriction by monitoring umbilical and middle cerebral artery blood flow. Abnormal Doppler readings suggest worsening conditions and increased risk of complications. Monitoring continues until delivery to identify progression that could threaten the fetus. Growth restricted infants face increased short-term risks like death and long-term risks like developmental and health issues.
Intrauterine Growth Restriction (IUGR) is defined as failure of the fetus to reach growth potential and is associated with increased morbidity and mortality. It affects 3-10% of pregnancies and increases perinatal mortality rate by 5-20 times. Causes include fetal, placental and maternal factors like infections, structural anomalies, vascular diseases, nutritional deficiencies, and thrombophilias. Diagnosis involves assessing risk factors, fetal measurements and Doppler ultrasound. Management focuses on treating underlying causes, fetal monitoring, timing of delivery and neonatal care. Complications include stillbirth, fetal distress, hypoglycemia and long term risks of metabolic and neurological disorders. Prognosis depends on gestational age and prematurity, with increased
This document presents a case of a 23-year-old pregnant woman in her third trimester who is presenting with cessation of menses for 8.5 months and ghabrahat (anxiety) for 3 days. Her obstetric history and examination are presented. Based on her last menstrual period and ultrasound dating, her gestational age does not match. Doppler ultrasound of the umbilical and middle cerebral arteries will be performed next to investigate possible fetal growth restriction, oligohydramnios, or intrauterine fetal demise. Abnormal Doppler findings would indicate increased risk of adverse perinatal outcomes.
The document discusses Doppler ultrasound findings for a 25-year-old pregnant female with uncontrolled hypertension. Key findings include oligohydramnios, elevated head circumference to abdominal circumference ratio, and abnormal Doppler readings of the umbilical artery, middle cerebral artery, and ductus venosus indicating fetal hypoxia and intrauterine growth restriction. The summary provides an overview of the patient details and significant ultrasound findings reported in the document.
The document summarizes Doppler ultrasound findings for a 25-year-old pregnant female with uncontrolled hypertension. Key findings included oligohydramnios, elevated head circumference to abdominal circumference ratio, and abnormal uterine and umbilical artery Doppler readings indicative of fetal hypoxia/intrauterine growth restriction. The summary discusses various Doppler measurements used to evaluate fetal well-being and placental function, including implications of abnormal readings. Middle cerebral artery Doppler was noted as useful to monitor fetal compensation for deteriorating placental function through blood flow redistribution.
The document discusses various methods for fetal monitoring during pregnancy. It describes the aims of fetal monitoring including assessing fetal well-being, growth, abnormalities, and gestational age. Common monitoring methods discussed include weight gain monitoring, fundal height measurements, fetal kick counts, diagnostic ultrasound scans, and cardiotocography. The document provides details on various ultrasound measurements and assessments that can be made including fetal anatomy, growth, amniotic fluid, umbilical cord doppler, and biophysical screening tests.
The document discusses various methods for fetal monitoring during pregnancy. It describes the aims of fetal monitoring including assessing fetal well-being, growth, abnormalities, and gestational age. Common monitoring methods discussed include weight gain monitoring, fundal height measurements, fetal kick counts, diagnostic ultrasound scans, and cardiotocography. The document provides details on various ultrasound measurements and assessments that can be made including fetal anatomy, growth, amniotic fluid, umbilical cord doppler, and biophysical screening tests.
Doppler in obstetric power point presentation (4)RiyadhWaheed
Doppler ultrasound is used in obstetrics to evaluate fetal growth and well-being. It assesses blood flow in the umbilical artery (placental circulation), middle cerebral artery (fetal circulation), and uterine arteries (maternal circulation). Abnormal Doppler readings include increased resistance and absent/reversed end diastolic flow in the umbilical artery, which indicate placental insufficiency and fetal growth restriction. The middle cerebral artery Doppler shows the brain-sparing effect in hypoxic fetuses. Together, Doppler ultrasound provides important information about the fetus's condition and helps time delivery.
Similar to FETAL GROWTH RETARDATION In Modern Practice –Made Simple (20)
The Newer Concepts In Endometriosis Management : Dr Sharda JainLifecare Centre
The Newer Concepts In
Endometriosis Management
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DELEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
The Newer Concepts forReduced Surgery to preserve fertility in Endometrios...Lifecare Centre
The Newer Concepts forReduced Surgery to preserve fertility in Endometriosis
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DILEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...Lifecare Centre
Important Highlights
Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving compliance to IFA and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet and/or fortified foods (d) ensuring delayed cord clamping .
Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents.
Addressing non-nutritional causes of anaemia
in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
Liver Dialogue for Gynaecologists : Dr Sharda JainLifecare Centre
This document discusses the functions of the liver and various liver function tests. It notes that the liver has important metabolic, excretory, protective, hematological, synthetic and storage functions. It then describes several common liver function tests including SGPT, SGOT, GGT, ALP, bilirubin, total protein, albumin, PT, bleeding time and clotting time. It provides details on the clinical significance, normal ranges and potential causes of interference for each of these tests. The document emphasizes that liver function tests can help screen for and diagnose liver dysfunction, assess prognosis, and monitor response to therapy.
National Tuberculosis elimination programme (NIKSHAY)Big Challenge to GOI : ...Lifecare Centre
India has a high tuberculosis (TB) burden, accounting for approximately 50% of global cases. The Government of India's National Tuberculosis Elimination Program (NTEP) aims to eliminate TB in India by 2025 through programs like NIKSHAY and NIKSHAY MITRA SCHEME. However, India faces significant challenges to eliminating TB, including delays in diagnosis, drug-resistant strains, poor treatment adherence, stigma, comorbidity with HIV/AIDS, weaknesses in healthcare infrastructure, and social determinants like poverty and overcrowding. Overcoming these challenges will require sustained political will, funding, and strengthened surveillance and monitoring systems.
This document discusses innovations and breakthroughs in in vitro fertilization (IVF). It covers the following topics in 3 sentences or less:
Genetic screening techniques like preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS) are discussed to select embryos without genetic disorders or the highest chance of implantation. Time-lapse monitoring is presented as a way to continuously monitor embryo development in real-time without disruptions. Stem cell therapy and its potential role in inducing ovarian regeneration and sustained ovarian function is briefly covered.
Strategies for Improving Success Rates in ART PARTLifecare Centre
Strategies for Improving Success Rates in ART
Part - 2
Strategies for Improving Success Rates in ART
Tailoring Controlled Ovarian Stimulation
Strategies for Luteal Phase in ART cycles
Endometrial Receptivity Array
20 Simple ways for the Indian public to save water on World Water Day : Dr Sh...Lifecare Centre
Simple ways for the Indian public to save water on World Water Day include fixing leaks, installing faucet aerators to reduce water flow, and taking shorter showers. Other tips are to turn off taps when not in use, collect rainwater, and reuse greywater from washing for gardening. People should also use buckets instead of hoses for tasks like washing vehicles and water plants wisely to minimize evaporation.
Vaccination during Pregnancy & its Importance : Dr Sharda JainLifecare Centre
This document discusses the importance of vaccination during pregnancy. Some key points:
- Global and national health authorities recommend vaccines for influenza, tetanus, diphtheria, and pertussis during pregnancy to protect both mother and baby. Maternal immunization provides passive immunity to newborns.
- Pregnant women and young infants are especially vulnerable to certain infections. Vaccination of mothers during pregnancy is the most effective strategy to protect newborns who are too young for certain vaccines.
- Clinical trials have shown vaccines such as the Tdap and influenza vaccines to be generally safe and effective for pregnant women and their infants. Maternal immunization has significantly reduced disease in newborns for illnesses like
How to optimize success rates in ART? : Dr Sharda JainLifecare Centre
How to optimize success rates in ART? : Dr Sharda Jain
How to improve success rates in ART?
The big debate कार्य में आनंद
Evolution of In-vitro Fertilization (IVF)
Factors Influencing IVF Success Ist Part
Strategies for Improving Success Rates in ART Second Part
Innovations & Breakthroughs in IVF Part Three
OPEN DEBATE
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda JainLifecare Centre
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
Introduction
Social egg freezing (oocyte cryopreservation for non-medical reasons) has evolved as a proactive option for women looking to extend their reproductive possibilities past their peak childbearing years
It is the process of saving or protecting eggs, or reproductive tissues so that a person can use them to have biological children in future
White Coat Hypertension During Pregnancy : Dr Sharda JainLifecare Centre
During pregnancy, white coat hypertension has an average prevalence of 15% to 30%. While 60-70% of detected cases of white coat hypertension actually have true gestational hypertension or pre-existing essential hypertension that require monitoring and treatment. Choices of anti-hypertension medication during pregnancy need to be considered carefully.
White Coat hypertension Why it is Important? : Dr Sharda JainLifecare Centre
This document outlines an epidemiology and definitions presentation on hypertension. It discusses types of hypertension like white coat hypertension, where anxiety in a medical environment causes abnormally high readings. Isolated systolic hypertension is also covered, noting that systolic blood pressure is a more important risk factor after age 50. Statistics are provided on hypertension being a major cause of premature death worldwide and its prevalence in India. The summary concludes that white coat hypertension has a prevalence of 20-35% and is associated with minimal increased risk, though 60-70% of cases ultimately have true hypertension requiring treatment and monitoring.
Know Your Blood Pressure Understanding Blood Pressure Reading : Dr Sharda JainLifecare Centre
Hypertension, or high blood pressure, affects over a quarter of the global adult population. A blood pressure reading contains two numbers that indicate systolic and diastolic pressure. There are different types of hypertension including primary or essential hypertension and secondary hypertension caused by an underlying medical condition.
This document provides an overview of stillbirths including definitions, epidemiology, etiology, approaches to management of stillbirth cases and subsequent pregnancies. It notes that the stillbirth rate in India in 2021 was 12.4 per 1000 births. Investigating the causes of stillbirth involves examining the mother, fetus, placenta and membranes through history, examinations, tests and potentially an autopsy. Managing subsequent pregnancies after a stillbirth includes increased surveillance and optimizing any medical conditions to reduce recurrence risks. The aim is to reduce India's stillbirth rate to 10 per 1000 births by 2030.
IRON DEFICIENCY ANEMIA OVERVIEW WITH FOCUS ON PARENTRAL IRON THERAPY : Dr ...Lifecare Centre
This document provides an overview of iron deficiency anemia with a focus on parental iron therapy. Some key points:
- Iron deficiency anemia affects around 2 billion people globally and has a prevalence of 50.1% among pregnant women in India.
- Parenteral iron therapies like ferric carboxymaltose are recommended for pregnant women who are anemic late in pregnancy or those with low compliance to oral iron due to the ability to deliver a complete replacement dose in a single infusion.
- Ferric carboxymaltose has advantages over earlier parenteral iron formulations as it is a robust carbohydrate-iron complex that allows for higher dosing, has a shorter infusion time, and has a
CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...Lifecare Centre
The document provides a checklist for an ART specialist to follow before performing IVF-ICSI treatment for patients. It outlines several areas to evaluate including conducting medical evaluations of both partners, assessing fertility through testing, providing psychological evaluation and counseling, reviewing lifestyle factors and making modifications, ensuring vaccinations are up to date, screening for infections, considering genetic testing, providing preconception care, discussing financial aspects and consent forms, explaining the ovarian stimulation and embryo transfer processes, and scheduling follow up appointments. The specialist should tailor the checklist to each patient's specific needs and circumstances and provide clear communication and support throughout the IVF-ICSI process.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
6. FETAL GROWTH RETARDATION
• Is defined as FAILURE OF A FETUS TO REACH
TO ITS FULL GENETIC GROWTH POTENTIAL
IN-UTERO,PUTTING IT AT RISK OF
PERINATAL MORTALITY & MORBIDITY.
I.U.G.R...X / S.G.A. / L.B.W. (<2.5 kg )
• WHO
• ACOG
S.G.A.< 10 th percentile for gestational age
SGA <3rd centile
8. 3-10 % SINGLETON
12 -40 % TWINS
True FGR
INCIDENCE
MORTALITY 6-8
TIMES MORE
& majority we
loose in ist 24 hrs
only bcz
Hypoxia /academia
9. MAJOR CONCERN IN FGR
• Cause of concern is not the size ,but the
possibility of life threatening fetal compromise
Hypoxia /Acedemia which we fail to detect.
• Timely identification of fetal compromise is
difficult but crucial for proper management & a
favourable neonatal outcome as it is 2nd leading
cause of Perinatal mortality after prematurity.
No treatment ,diagnosis difficult
10. FGR Babies pose Big Challenge !
• 50% of still births
• 75% of unexplained fetal
deaths
• 8-10 times Increased Perinatal
morbidity and mortality
Bcz of considerable advances , to detect fetal
compromise in FGR fetus still remains COFUSING!
11. WHY GYNAECOLOGISTS
ARE CONCERNED ?
ABNORMAL LONG TERM
• NEURODEVELOPMENTAL OUTCOME.
• LONGTERM CARDIOVASCULAR DYSFUNCTION
• METABOLIC SYNDROME
12. WHY WE ARE UNABLE TO PICK UP THE
BABY AT RISK ?
13. FUNCTIONAL CLASSIFICATION
of SMALL FETUS
• Contitutional Small FETUS ( normal ) 70%
• ABNORMAL SMALL FETUS – symmetrical
(10%)
• FROWTH RESTRICTED FETUS-Asymmertrical
(20%)
15. NORMAL SMALL FETUS
• No Structural abnormality.
Normal umbilical Doppler.
Normal AFI.
• Less than 10th percentile
• Good prognosis.
• No increased risk.
• No special care Needed.
70% INDIA -2.6 KG
USA 3.6 KG
16. ABNORMAL SMALL FETUS
• Chromosomal
abnormality or
structural defect or
infection with small
size.
• Poor prognosis
10%
17. GROWTH RESTRICTED FETUS
• Small due to placental dysfunction.
• Variable prognosis. ( late -80% sail through)
(early 20% -bad prognosis)
• Appropriate and timely treatment can
improve outcome.
20%
18. CLASSIFICATION of SGA
HEALTHY SGA (70% )
HEALTHY SMALL
TYPE- 1
• SYMMETRICAL FGR
( 10 %)
TYPE -2
ASYMMETRICAL FGR (20 % )
TRUE FGR
20. TRUE FGR
SYMMETRICAL FGR
• Less common, 20% cases.
• Both head & abdomen are
small
• HC/AC RATIO IS NORMAL
• FL: AC ratio is normal
• Etiology : Chromosomal,
fetal infection ?chemical
exposure
• POOR PROGNOSIS
ASYMMETRICAL FGR
• More common & 80% cases
of FGR
• Abdomen is smaller than head
• HC/AC ratio increases
• FL: AC ratio increases
• Placental insufficiency
(e.g pre-eclampsia)
• FAIR to GOOD
PROGNOSIS
21. In SEVERE symmetrical FGR
karyotyping , malformation
& infection screen (Very Bad Prognosis)
Symmetrical
FGR Asymmetrical
FGR
10
–
12
%
Poor prognosis
Fair prognosis
35. COMPLICATIONS
MOTHER
• NIL
• LIFE-THREATENING IN
Severe PET / Eclampsia
• 2 FOLD > Of FGR in next
pregnancy
BABY-6 to 8 fold
Increase in Intra partum &
Postpartum Deaths
ANTEPARTUM –
CHRONIC HYPOXIA /DEATH
INTRAPARTUM
HYPOXIA & ACIDOSIS
POSTPARTUM
MORBIDITY RATE IS > 50 %
36. DIAGNOSIS OF FGR
Accurate dating /Risk factors
Accurate measuring: Clinical
examination/Close Monitoring
Imaging : Biometry and Doppler
38. CLINICAL EXAMINATION
• 4 OR MORE DISCREPANCY
• SYMPHYSEO-FUNDAL HEIGHT 18 to 30 wks
if 2-3 cm less - FGR suspected.
• ACOG –SPECIFICITY- 96 % ,SENSITIVETY –
70 to 85 %
• Maternal wt –stationary or decrease
• ABDOMINAL GIRTH –Stationary or decrease
39. ULTRASOUND
• Estimated FETAL WT < 10 TH OR 3 rd CENTILE
ON GROWTH CHARTS
• NO INCREASE IN HEAD OR ABDOMEN
SIZE ON TWO SCANS 2 WKS APART.
45. Ultrasound has revolutionized the
practice of obstetrics
• It has high negative
predictive value to
r/o FGR
• Cochrane database
(2000) reveals that
there is 40 %
improvement in
perinatal mortality by
judicious use of
doppler
46. Dating is important i trimester
Compare USG GA with LMP GA
Assign LMP
EDD
< 1wk
> 1wk
Re assign
EDD
VARIBILITY +/- 5-7 days
48. Abdominal cirumference has the
highest sensitivity and greatest
negative predictive value for
diagnosing FGR
49. Growth – dates uncorrected
Routine Foetal Biometry
Based on customised Growth Curve “VISUAL EFFECT”
50. DOPPLER STUDY : GOLD STANDARD
To identify hypoxia & fetal adaptation
To plan timing of delivery
51. Highest accuracy is required in
assessment of the
Degree of Fetal Deterioration
Degree of fetal Hypoxia
- Fetal arterial doppler
Degree of fetal Acidemia
–Fetal Venous doppler
Each additional day gained in utero can
significantly increase neonatal survival
52. First sign of hypoxia is picked up by
Umbilical Artery forward wave flow
1º trimester
Absent Diastolic
Flow
early 2ºtrimester
Low Diastolic Flow
late 2º and 3º trimester
Resistance further reduces
more diastolic flow
53. DECREASED EDF ABSENT EDF REVERSED EDF
Abnormal Umb. A doppler appears when at least
60 % of the placental vascular bed is obliterated
PositiveDiastolic Flow 10 - 12% Hypoxic
00% Acidemic
Absent/ Reverse Diastolic
Flow
80% Hypoxic
40 – 45 % Acidemic
54. UMBILICAL ARTERY DOPPLER SHOULD BE THE
PRIMARY SURVEILLANCE TOOL
• If umbilical artery flow is normal repeat every 15
days
• If abnormal repeat it twice weekly if end diastolic
velocity is present
• Should be done daily with absent or reversed end
diastolic velocity
• In low risk , no conclusive evidence that routine
umbilical artery doppler benefits either mother or baby
55. Overstressed fetus can lose the “brain sparing effect”
Disappearance of brain sparing effect
very critical event Precedes Fetal Death
MCA has tremendous implication for
determining the proper timing of delivery
56. CEREBRO-PLACENTAL RATIO
Although S/D ratio, RI, and PI have been reported when
computing CPR, more recently
PI is the computation of choice
Greggory R et al. American Journal of Obstetrics & Gynecology, July 2015
Cerebroplacental ration (CPR) =
middle cerebral artery Pl
Umbilical artery Pi
58. DUCTUS VENOSUS DOPPLER
With worsening placental vascular insufficiency
• “a” wave velocity in DV doppler reduces &
finally reverses b’cos of increased afterload &
preload
• Has excellent predictive value for acidemia
• In preterm fetus it is used to time delivery
59. A retrograde “a - wave” and pulsatile flow in umbilical
vein signifies the onset of overt fetal cardiac
compromise
Double pulsatile patternEND POINT
Cardiac Failure : Impending Death
60. Good correlation Between Doppler & Hypoxia
Umbilical artery
50% placenta is not functioning
Mild Hypoxia
MCA
> 70% placenta not functioning
Compensatory redistribution
Moderate Hypoxia
DV > 90% placenta not functioning
Failure of Compensatory redistribution
Severe Hypoxia & acidemia
IMPENDING DEATH
61. What does
DOPPLER tell In
FGR ?
UMBLICAL ART DOPPLER , MCA
DOPPLER,DUVTUS VENOSUS DOPPLER
62. 1To identify etiology of IUGR
• Placental / non placental
• To identify hypoxia & fetal adaptation
• To plan timing of delivery?
• To identify fetuses at risk of perinatal
complications
DOPPLER IN FGR
67. Early – Onset FGR
Problem #2 (Neurological) Morbidity
67
Role of Magsulf (<32 weeks)
To decrease
Neurological morbidity
24 hours
68. IN FGR : AIM OF DELIVERY
A live fetus
That Grows & survives !
Riskof intrauterine compromisehas tobe
weighed against the potential risksfrom
iatrogenic prematuredelivery
Best Time Is When Fetal Redistribution
Mechanism Starts Failing
70. When to deliver ?
There is a better outcome with timely
intervention & delivery for fetus who shows
sign significant compromise
71. Time to Deliver
Factors to decide time to deliver
• Degree of Prematurity
• NICU facility
• Degree of Hypoxia, acidemia,
hepatic metabolic derangement (mother)
Challenge to weigh the risks and benefits of
interventions
72. Gestational age at decompensation is the
primary determinant of perinatal survival
Ft < 32
weeks
• Every day gained is Bonus
• Every week gained improves outcome by 40%
• Here venous Doppler's help delay delivery
32 – 34
wks
• Deliver once Umb A ABSENT / REDV
At
term
• Prompt delivery at 37 wks of gestation
• Even when Umb.AD is normal
Steroid cover
73. 24 – 28 weeks
Monitor
Abn doppler
/ BPP
Discuss with
family
28 – 32 weeks
Monitor
Arrested fetal
growth
A / R EDV UA
Abn. DV
Abn BPP
Steroids- Deliver
magsulph
Neonatal care
32 – 34 weeks
Monitor
Deliver
Arrested growth
Oligo hyd
Abn CTG
A /R EDV
76. MODE OF DELIVERY
depends on
Mode of
Delivery
• Parity
• Cervical score
• Degree of growth restriction
Vaginal
Delivery
• In well compensated babies with reassuring fetal well
being tests and diastolic flow--
LSCS
• IF HYPOXIC FETUS - AVOID TRIAL OF LABOUR
• – RISK OF DECOMPENSATION IN LABOUR IS VERY HIGH AS RESERVE
IS POOR
• THERE IS ROLE OF LSCL IN THE PRESENCE OF SIGNIFICANT
ABNORMALITIES OF UADW
78. is 5-20 times greater than for AGA, mainly
due to
• intrauterine death,
• perinatal asphyxia,
• Congenital anomalies.
Perinatal mortality for FGR infants
79. Is 5-10 times higher than for AGA infants, especially for infants with
↓ head circumference at birth.
Intellectual and motor function (excluding those with congenital
infections, chromosomal abnormalities) depends on adverse perinatal
events and on the specific cause of growth restriction.
Early identification and treatment of hypoglycemia and polycythemia
improves outcome. Neurologic abnormalities are usual with genetic and
infectious causes of IUGR.
NEUROLOGIC MORBIDITY
80. Catch-up growth occurs fast after birth
but these patients usually remain smaller than expected.
FGR: With placental causes of IUGR
81. Recent studies implicate FGR with adult onset of
• Hypertension,
• Coronary heart disease,
• Hypercholesterolemia,
• Diabetes.
These studies suggest that Fetal growth retardation has long term
affects on endocrine development and homeostasis.
Fetal “Programming”
of cardiovascular disease:
82. TAKE HOME MESSAGE
• Timing of delivery in FGR:
• Before 32-34 weeks, base delivery on ductus venosus
• After 34 weeks, absent/reversed EDF indication to deliver
• If umbilical artery normal but MCA at or below 5th centile – sign
of cerebral redistribution – offer delivery at 37 weeks
(RCOG, 2013)
• No role of aortic isthmus as yet