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7/30/2019 Uss Features of Iugr and Macrosomia.
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USS FEATURES OF IUGR
AND MACROSOMIA.
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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
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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.
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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
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Intrauterine growth retarded
fetus with absent end-
diastolic flow in the fetalumbilical artery.
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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
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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.
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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.
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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.
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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.
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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.