OBS: Fetal Medicine -- Abnormal Growth Flashcards
USG features for anencephaly
- “Frog eye” sign
- Absent cranium, no brain tissue
- Polyhyraminios
What are some examples of neural tube defects?
Anencephaly, Spina bifida, Meningocele, Encephalocele, Hydrocephalus…
How to counsel a couple having a fetus with ancephaly?
- Explain ancephaly (incidence: 1/2000 - 1/4000 birth)
- Cause: usually sporadic, possibly folate deficiency
- Consequence: not viable after birth
- Management:
- 2nd trimester TOP
- Grief counselling, psychological support
- Preparation for next pregnancy:
- Folate supplement
- Early morphology scan
- Prepare for 5-10% recurrence rate
38 female, para 2, gestation 34 week referred for large for date. From overseas so no antenatal screening, 2 spontaneous deliveries (2.7kg and 3.2kg).
What are the reasons for referral?
Large for date, AMA, Investigations for causes
What should be looked for in USG in a large-for-date fetus?
- Number of fetus
- Growth parameters, Estimated fetal weight
- Presentation
- Any abnormal morphology
- Placenta position, Liquor
Biochemical test for large-for-date fetus
OGTT for GDM
DDx for fetal head not engaging
- Cephalopelvic disproportion
- Macrosomia
- Obstructing fibroid
- Floating head due to polyhydramnios
Normal range of AFI
8-24cm
Diagnostic criteria of GDM
- Fasting glucose 5.1-7.0 mmol/L
- 1-hour OGTT >=10.0 mmol/L
- 2-hour OGTT 8.5-11.0 mmol/L
Management of GDM
- FU in GDM clinic
- History & HbA1c review
- Maternal monitoring
- H’stix 7 times per day for 2 days a week
- Ketone monitoring if significant weight loss
- Fetal monitoring
- USG for growth and liquor Q4w in 28-36w if poor control
- CTG Q1w in >=36w if insulin required
- Referral
- Nurse for education on lifestyle modifications & medications
- Dietitian for diet control
- Lifestyle modifications
- GDM diet: 3 meals + between meal snacks, 1500 kcal/day in 1st sem, 1800 kcal/day afterwards
- Regular exercise
- Medications (if lifestyle modifications fail)
- Insulin: Actrapid pre-meal + Protaphane before bed
+/- Meformin
- Insulin: Actrapid pre-meal + Protaphane before bed
What are the fetal structural abnormalities that may cause polyhydramnios?
- Esophageal atresia
- Duodenal atresia
- Anencephaly
- Omphalocele
What congenital syndrome should you suspect when macrosomia and organomegaly are observed?
Beckwith-Wiedemann syndrome
Diagnostic criteria of early onset FGR
(<32w) either of below:
1. AC or EFW <3rd %ile
2. UmA: absent / reverse EDF
3. AC or EFW <10rd %ile + PI of UmA or UtA >10th %ile
Management of early FGR
- Rule out dating problem
- Investigations for causes:
- Chromosomal abnormalities: USG morphology, amniocentesis
- Placental insufficiency: USG Doppler
- Fetal infections: Toxoplasmosis Ab, CMV Urine sampling
- APS: lupus anticoagulant, anticardiolipin Ab, anti-beta2 GP1 Ab
- If timing of delivery not optimal:
- Fetal: stage FGR with USG monitoring weekly / twice weeking / daily according to staging
- growth scan, liquor, umbilical artery, ductus venosus, middle cerebral artery PI
- urgent delivery if UmA REDF, reverse a-wave in DV, pathological CTG
- Maternal: BP + Urine dipstix every visit, HBPM
- [<32w] MgSO4
- [24-33w] Steroid
- Fetal: stage FGR with USG monitoring weekly / twice weeking / daily according to staging
- Mode of delivery:
- CS (if abnormal Doppler result, severe FGR, poor fetal well-being, immediate delivery required) or IOL
- send cord blood gas analysis + placenta for workup
T13 vs T18 in terms of hyper-/hypotelorism
T13: hypotelorism, T18: hypertelorism
