Fetal Growth Discrepancy

Question 1

Estimated Fetal Weight: done via ultrasound. Most use a combination of __ length, __ circumference and __ measurements.

Answer 1

Estimated Fetal Weight: done via ultrasound. Most use a combination of femur length, abdominal circumference and head measurements.

Question 2

suspected LGA Ddx

Answer 2

Suspected LGA DDX

True large for gestational age fetus (macrosomia)

Wrong dates

Twins

Polyhydramnios

Fibroids

Pelvic mass

Question 3

defintiion for SGA

Answer 3

Birth weight <10th %ile for specific gestational age

If constitutionally small: not at risk for morbidity and mortality. Must take into consideration ethnicity or parental stature. Normal interval growth and sonographic features of well-being.

Intrinsic Fetal Etiology: chromosomal disorders/ genetic syndromes

Question 4

definition of intrauterine growth restriction

Answer 4

Fetuses that have failed to reach genetically determined potential size

Consequences of IUGR: still birth, intolerance to labour, neonatal morbidity, consequences of iatrogenic prematurity

Early dating is important! Symphysis-fundal measurements, ultrasound assessment.

Question 5

birth complications for LGA

Answer 5

Shoulder dystocia

Clavicle/humerus fracture

Brachial plexus injury

facial palsy

Mortality increased when birth weight >5000 grams

Maternal complications: operative vaginal delivery, c-section, pelvic floor trauma, post partum hemorrhage

Question 6

when to offer a prophylactic Csection for LGA

Answer 6

When to offer a csection

Prophylactic C-section. EFW>5000gm non diabetc, EFW >4500 gm in diabetic

Question 7

4. Appropriate delivery timing for SGA management

Answer 7

Management Principles for the growth restricted fetus

1. Diagnose and differentiate why fetus is smaller than expected

Smoking, alcohol, spacing pregnancies appropriately, decreased multiple gestations in IVF

2. Fetal surveillance
3. Antenatal Steroids for preterm deliveries

4. Appropriate delivery timing

• Ideally at >37 weeks. Earlier if non-reassuring fetal testing–pattern of which will depend on gestational age, maternal conditions.
• Continuous FHR monitoring in labour
• Higher chance of C section

5. Appropriate delivery location

Need a pediatric team for resuscitation.