FETAL GROWTH DISORDERS

(SMALL AND LARGE FOR

GESTIONAL AGE)

By

Dr: Labeeba Kasem El-Sayed

Lecturer of Obst. and Gyn. Department

Benha faculty of medicine
 OBJECTIVES

* Definitions.

• Etiology.

• Classification.

• Diagnosis.

• Complications.

 Management of fetal growth disorders.

 Fetal Growth Disorders

 Small for gestational age (IUGR).

(Fetal weight < than 10 th percentile for GA)

 Large for gestational age (Fetal Macrosomia).

(Fetal weight > than 90 th percentile for GA)
 Fetal Cell Growth

 3 Phases:
- < 20 Wks : hyperplasia ( cell number )

- 20-28 Wks : hyperplasia and hypertrophy

- > 28 Wks : hypertrophy and fat & glcogen deposition

-
 Definitions

 low birth weight (LBW)

(birth weight < 2500gm whatever GA)

 Small for gestational age (SGA)

(fetal weight <10th percentile for GA)

 Fetal growth restriction (FGR)

(fetuses whose growth velocity slows down or stops
completely due to inadequate oxygen and nutritional
supply)
 SGA

 Normal SGA: no structural anomalies, normal

liquor, and normal UA doppler.

 Abnormal SGA: structural and genetic

abnormalities.

 FGR: impared placental function detected by

abnormal UA doppler.
 Classification of SGA

 Symmetric (type 1) : 20%

Both head and abdomen are equally affected.
Early during hyperplasia phase.
Chromosomal abnormalities and TORSCH infections.

 Asymmetric (type 2) : 80%

Brain sparing effect (small abdomen).
UP insufficiency late (hypertrophy phase).

 Intermediate : least common

Combination bet. 2types.
 Etiology

 Maternal Factors:

- Alcohol 12folds
- Smoking
- Anemia
- Malnutrition ( WT gain ) 9folds
- Systemic diseases ( H, L, K, L)
- Previuos infant with IUGR
 Etiology

 Fetal Factors:

- Genetic disorders (osteogenesis imperfecta).

- Chromosomal abnormalities (trisomies 13, 18,
21).
- Congenital anomalies (GIT).
- Fetal infections (TORSCH).
- Multiple gestations 15-25% (TTTS).
 Etiology

 Uterine and placental Factors:

- Mullerian anomalies (septate uterus).

- Placental abnormalities.
- Placental infarction and infection.
- Chorioangioma.
- Multiple gestations.
 Etiology

 Uteroplacental hypo-perfusion:

- Chronic HTN.
- Preeclampsia.
- DM.
- Connective tissue disease.
 Etiology

 Cord causes:

- Single umbilical a.
- Partial true knot.
- Cord hematoma.

 Idiopathic
 Diagnosis

1. Proper history taking (risk factors or causes

or small sized abdomen).

2. Clinical examination:
- Decrease maternal weight gain in pregnancy.
- SFH ( at 18-30Wks SFH=GA + 2Wks).
 Diagnosis

3. Ultrasound assessment:
- Fetal Biometry
- Liquor volume
- Placental growth
- Doppler study
- 3D ultrasound

4- Laboratory testing :
- Fetal karyotyping.
- Maternal serum Abs for TORSCH.
 Ultrasound assessment

- Fetal Biometry:

- AC
- TCD (= GA up to 24Wks)
- HC/AC (more accurate in PI)
- FL/AC not specific
- Serial measurements of AC & EFW
 Abdominal Circumference

 The single most important measurement to make in

late pregnancy.

 It reflects more of fetal size and weight rather than

age.

 Serial measurements are useful in monitoring growth

of the fetus.
 Abdominal Circumference

 Measurement technique :

 It is measured in a transverse plane at the level of

umbilical vein entering liver, fetal stomach, fetal spine
and last rib.

 Measured from the outer diameter to outer diameter

either by :
- Use the ellipse.
- 2 diameters AP and TD.
 Ultrasound assessment

- Liquor volume:
Earliest sonographic sign
 Oligohydramnios ( fetal kidney perfusion
and UP flow)

 FGR + polyhydramnios in structural and

chromosomal anomalies
 Ultrasound assessment

- Placental growth:

G3 before 35 Wks gestation

 Ultrasound assessment

- Doppler study:

- Uterine A.
- Fetal vessels Umbilical A.
MCA
Umbilical vein
Ductus venosus
Uterine A Doppler

Normal
ABNORMAL (EARLY DIASTOLIC NOTCH)
Umbilical A Doppler

Normal
MCA ( increased EDV)
Umbilical V Doppler (nicking sign, very late
in VF)
Ductus venosus ( RBF is ominous sign)
ABNORMAL
Complications
 Definitions

 High birth weight (HBW)

(birth weight > 4000 to 4500gm whatever GA)

 Large for gestational age (LGA)

(fetal weight > 90th percentile for GA)
Pre and gestational DM
Post term
Advanced maternal age
 Types of LGA

 Generalized all over the body.

 Localized: hydrocephalus, ascities, fetal tumors and

hydrops fetalis.
 Diagnosis

Neonatal BW is the only accurate diagnostic sign

 History.

 Examination (SFH).

 US assessment - AC, EFW

- AF
- Cong. anomalies

 LAB tests (OGTT)

 Serial US / 3-4 Wks Limb-body wall complex

Complications
MANAGEMENT
 S
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