More Related Content
What's hot
What's hot (20)
Similar to Fgr case discussion
Similar to Fgr case discussion (20)
Recently uploaded
Recently uploaded (20)
Fgr case discussion
- 3. Maternal Hypertensive disorders Diabetic vasculopathy CRF Collagen vascular disease Thrombophilia Fetal Aneuploidy Viral infections Heart Disease Placental Placental abnormalities Thrombosis Chorioangioma Placental Dysfunction
- 7. ULTRASOUND BIOMETRY…… A C Highest sensitivity Highest NPV Serial measurement Smallest measurement
- 9. FETAL DOPPLER…. Reduced diastolic flow-30 % villi affected Absent/reversal-70% affected Reduces fetal death by 29% Intervention based on fetal doppler
- 10. MCA
- 11. MCA Hypoxia – Cerebral Vasodilation Brain Sparing / Cephalisation flow liver & kidneys, “Hind limb reflex” Oligohydramnios
- 12. MCA Does not predict more than umb A alone -ve predictive value Worsening of hypoxia – normalisation of previously abn MCA doppler MCA – PSV remains abnormal as fetus decompensates
- 13. VENOUS DOPPLER Ductus Venosus •Forward flow throughout cardiac cycle •Reflects cardiac function
- 14. DUCTUS VENOSUS
- 15. VENOUS DOPPLER Reversed ‘a’ wave backflow in venous circulation leads to pulsations in umbilical vein & reversed flow in IVC - foetal right heart faliure. Associated with metabolic acidosis Venous doppler evaluation most beneficial in early onset IUGR
- 16. DOPPLER INDICES < PNM Doppler Parameter Increased UA resistance Absent UA EDF Decreased MCA Reversed UA EDF IAUV Pulsations Abnormal DV a-wave Perinatal Mortality 5.6% 11-13% 21% 20-24% 35% 30-38%
- 17. ANTEPARTUM SURVEILLANCE EARLY N umblical art Uterine art. notching Elevated doppler index Brain sparing N MCA N DV N UV DOPP LER FHR –delayed maturation AFV – no changes BPS – delayed maturation of
- 18. ANTEPARTUM SURVEILLANCE LATE Umb art. AREDF DV elevated index Loss of variability Umb V- pulsatile flow Absent/rever sed a wave Late deceleratio n oligohydram nios anhydramni os Declining activity Loss of tone Loss of movement Loss of breathing DOPP LER AFV FHR BP S
- 19. MANAGEMENT Rest stress, quit smoking Low dose aspirin Antenatal corticosteroids – word of caution Doppler waveform abn precede abn in BPP & NST by several weeks
- 21. MANAGEMENT Abn UA waveforms Late decelaration • Lagtime is more in Preterm • Less in term
- 22. GRIT TRIAL 500 Women • Randomized • A / R EDF in UA • Immediate Vs Delayed Delivery Outcome • No difference in perinatal mortality • At 2 years no difference in neurological outcome > 31 wks
- 23. GRIT TRIAL < 31 wks immediate delivery in disability(14% vs 5 %) GA is the greatest determinant of intact survival Awaiting TRUFFLE study results
- 24. ALGORITHM DECREASED EDF NST Bi weekly BPP weekly UA doppler weekly Fetal growth every 3 weeks AREDF Hospitalisation Frequent / continuous fetal monitoring Steroids MCA doppler weekly DV doppler every 3-4 days BPP daily FGR > 24 wks UMBLICAL ART DOPPLER
- 25. MODE OF DELIVERY UA EDF normal OCT successful induction of labour A / RED EDF ----- LSCS
- 28. THANK YOU….