Uss Features of Iugr and Macrosomia

Embed Size (px)

Citation preview

  • 7/30/2019 Uss Features of Iugr and Macrosomia.

    1/11

    USS FEATURES OF IUGR

    AND MACROSOMIA.

  • 7/30/2019 Uss Features of Iugr and Macrosomia.

    2/11

    IUGR Various conventional and Doppler ultrasonographic

    criteria have been proposed for diagnosing IUGR.

    Proposed conventional criteria include estimated fetal

    weight below the tenth percentile for gestational age.

    Elevated ratio of femur length to abdominal circumference

    Elevated ratio of head circumference to abdominalcircumference

  • 7/30/2019 Uss Features of Iugr and Macrosomia.

    3/11

    Ratio of FL/AC after 20wks GA of 0.21-0.24 is

    considered appropriate for GA.

    FL/AC less than 0.21 is considered as macrosomia.

    FL/AC greater than 0.24 is considered as

    asynmetrical IUGR.

  • 7/30/2019 Uss Features of Iugr and Macrosomia.

    4/11

    Doppler criteria include elevated ratio of systolic: diastolic

    blood flow velocity in the umbilical artery or in the uterine

    artery.

    No single criterion however, has a sufficiently high

    positive predictive value for IUGR to permit a confident

    exclusion of IUGR

    Diagnosis or exclusion of IUGR can best be achieved by

    the combined use of three parameters: estimated fetal

    weight, amniotic fluid volume and maternal B.P

  • 7/30/2019 Uss Features of Iugr and Macrosomia.

    5/11

    Intrauterine growth retarded

    fetus with absent end-

    diastolic flow in the fetalumbilical artery.

  • 7/30/2019 Uss Features of Iugr and Macrosomia.

    6/11

    Low etimated fetal birth weight, oligohydraminousand high maternal B.P are pointers towards IUGR.

    After extrinsic causes of IUGR,like smoking,alcoholism in the mother, DM and HBP have beenexcluded ; USS should attempt to exclude intrinsic

    causes. Intrinsic causes includes aneuploidy Particular

    attention should be paid to the fetal hands andtone

  • 7/30/2019 Uss Features of Iugr and Macrosomia.

    7/11

    Overlapping fingers or strangely postured

    hands in a small fetus should immediately

    elicit a concern for trisomy.

    isolated fetal anomalies can cause IUGR.

    Anything that disrupts the fetal abdomen leads

    to apparent IUGR because the abdominalcircumference is altered Examples are

    gastrochisis and omphalocele.

  • 7/30/2019 Uss Features of Iugr and Macrosomia.

    8/11

    Fetal macrosomia. Defined as estimated fetal birth weight greater than

    4000gm.

    Various methods have been developed to achieveaccurate weight estimates of the average-sized

    fetus.

    Unfortunately, there is no one excellent way ofprecisely predicting macrosomia. The problem lies in

    the fact that the best ultrasound estimation of weight

    can be as much 10% discrepant of the actual weight.

  • 7/30/2019 Uss Features of Iugr and Macrosomia.

    9/11

    Extrinsic causes like diabetes in the mother,and

    familial tendencies must be bore in mind.Some

    genetic causes includes

    Beckwith-Wiedemann syndrome usually is a

    sporadic abnormality. It is seen with

    macroglossia and occasionally umbilicalhernia, which may appear on ultrasound as a

    small omphalocele.

  • 7/30/2019 Uss Features of Iugr and Macrosomia.

    10/11

    Marshall-Smith syndrome is a sporadic disease in

    which markedly accelerated skeletal maturation

    results in a long, relatively thin newborn.Anoverestimation of weight is made because the head

    and femur are so much larger than anticipated.

    Sotos' syndrome is associated with profound

    macrocephaly and mild dilation of the cerebralventricles, but there is no consistent pattern of brain

    malformation. The hands and feet are also very large

    for gestational age.

  • 7/30/2019 Uss Features of Iugr and Macrosomia.

    11/11

    The physician should be aware of these

    syndromes and search for the associated

    anomalies.

    Above all, the physician should always look at

    the parents when assessing a fetus with

    macrocephaly or isolated large hands or feet.Often, large size is simply an expression of

    familial propensity.