Oligohydramnios and IUGR
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Transcript of Oligohydramnios and IUGR
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Uterus smaller than date
Oligohydramnios & Intrauterine Growth Restriction (IUGR)
M. Kamil
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Amniotic fluid • Function• Physical space for fetal movement -> important for normal musculoskeletal
development• Permits fetal swallowing
• Important for GI tract development• Permits fetal breathing
• Necessary for lung development• Prevent umbilical cord compression• Protect from trauma
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Amniotic fluid evaluation• Component of fetal testing for 2nd and 3rd trimester sonogram.
• Measurements 2 ways:• Single deepest vertical fluid pocket (nl 2 – 8 cm)• AFI - The sum of the deepest vertical pockets from each of four equal uterine
quadrants (nl 5 – 24 cm)
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Gestational-age-specific nomogram of AFI
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Oligohydramnios• Definition• AFI 5 cm (or < 5th percentile)/• The absence of a fluid pocket 2-3 cm in depth/• Fluid volume of less than 500 mL at 32 – 36 weeks.
• Anhydramnios – No measurable pocket of amniotic fluid is identified
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Clinical manifestation and diagnosis
• Uterine size < expected for gestational age
• Performed ultrasound to assess AF volume• AFI 5 cm• Single deepest pocket of amniotic fluid 2 cm• Gestational age specific nomogram: < 2.5th percentile• A fluid volume of less than 500 mL at 32-36 weeks.
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Evaluation• Thorough maternal history• Targeted physical examination•Ultrasound evaluation with fetal biometry and fetal
anomalies• Fetal growth restriction• Aneuploidy - nuchal translucency • Placental abnormalities (abruption)
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Management• Admission for investigation
• Rule out ROM
• Amniocentesis - > Karyotyping
• Doppler ultrasound for fetal distress
• Evidence of fetal distress- > immediate C-sec
• If no fetal distress, induced and delivered via SVD
• Send placenta for pathological examination
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Complications of oligohydramnios• Early onset of oligohydramnios• Potter sequence syndrome• Limb deformities• Abdominal wall defects
• Pulmonary hypoplasia
• Cord compression
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Intrauterine Growth Restriction (IUGR)
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Intrauterine Growth Restriction (IUGR)• Introduction• Detection usually on routine U/S• Important for prenatal care• Confirming diagnosis• Determining the cause and severity of fetal growth restriction (FGR)• Counseling the parents• Closely monitor fetal growth and well-being• Determining the optimal time for route of delivery
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IUGR VS SGA• Definition of IUGR: • A fetus or infant whose weight is less than the 10th percentile at a given GA as
determined by U/S• Or Infants whose growth velocity < expected
• SGA: An infant with a birth weight at the lower extreme of the normal birth weight distribution.• BW <10th % • BW < 2SD below the mean (3rd %)
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Beckmann, C., Herbert, W., Laube, D., Ling, F., Smith, R., & American College of Obstetricians Gynecologists. (2014). Obstetrics and gynecology (7th ed.).
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Uterine fetal growth pattern
Reethiya, L., & Rokeshwar, H.D., Doctrina Perpetua: Guides on Obstetrics. (2015).
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Types of IUGR
Reethiya, L., & Rokeshwar, H.D., Doctrina Perpetua: Guides on Obstetrics. (2015).
Pondoral index: Ratio of BW to Length:
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Causes and risk factors of FGR
Beckmann, C., Herbert, W., Laube, D., Ling, F., Smith, R., & American College of Obstetricians Gynecologists. (2014). Obstetrics and gynecology (7th ed.).
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Evaluation• Assess gestational age on early routine
visit.• History to assess the risk factors.• Physical examination• Screening test – serial measurements of
fundal height.• Fundal height should increase approx.
1cm/week between 20 and 36 weeks• Significant discrepancy of > 2 cm may indicate
IUGR
Ultrasound
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Evaluation (Continued)• Investigation• CBC – Hb, WBC (possible infection)• TORCHES Screening• Look for dysmorphic features • Mother urine for substance/ meconium for substance• Blood sugar• Calcium • Bilirubin
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• Ultrasound• To assess fetal size and
growth.• Fetal biometry
measurements and compare with standardized table• Biparietal diameter• Head circumference• Abdominal circumference
(AC) – false negative < 10%• Femur length
Evaluation (Continued)
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•Direct studies• Invasive studies of the fetus.• Amniocentesis for fetal lung
maturity• Fetal karyotyping and viral
cultures and PCRs
Evaluation (Continued)
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Evaluation (Continued)• Doppler velocimetry• On fetal umbilical artery.• Measured by Systolic/ Diastolic ratio• Normal at term: 1.8 to 2.0
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Doppler velocimetry (continued)• IUGR secondary to uteroplacental insufficiency
• Show reversed end- dystolic flow
• May suggest impending fetal demise
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Complication• Fetal• Hypothermia• Hypoglycemia• Hypocalcemia
• Perinatal• Perinatal asphyxia• Hypothermia• Hypoglycemia• Polycythemia, hyperviscosity• meconium aspiration syndrome
• Neurodevelopment• Lower intelligent• Learning/behavior disorders• Neurologic handicap
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References• Beckmann, C., Herbert, W., Laube, D., Ling, F., Smith, R., & American College
of Obstetricians Gynecologists. (2014). Obstetrics and gynecology (7th ed.).• http://www.stanfordchildrens.org/en/topic/default?id=amniocentesis-90-
P02429• Callahan, T., & Caughey, A. (2007). Blueprints obstetrics & gynecology (4th
ed. / Tamara L. Callahan, Aaron B. Caughey. ed., Blueprints). Philadelphia ; London: Lippincott Williams & Wilkins.• Cunningham, F., & Williams, J. (2014). Williams obstetrics. (24th ed. /
[edited by] F. Gary Cunningham et al. ed.). New York ; London: McGraw-Hill Medical.
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References• Beckmann, C., Herbert, W., Laube, D., Ling, F., Smith, R., & American College
of Obstetricians Gynecologists. (2014). Obstetrics and gynecology (7th ed.).• https://ghr.nlm.nih.gov/condition/vacterl-association• https://www.uptodate.com/contents/placental-abruption-clinical-features-an
d-diagnosis?source=machineLearning&search=abruptio+placenta&selectedTitle=1~150§ionRank=1&anchor=H4#H4
• Cunningham, F., & Williams, J. (2014). Williams obstetrics. (24th ed. / [edited by] F. Gary Cunningham et al. ed.). New York ; London: McGraw-Hill Medical.
• https://www.uptodate.com/contents/oligohydramnios?source=search_result&search=oligohydramnios&selectedTitle=1~150
• Callahan, T., & Caughey, A. (2007). Blueprints obstetrics & gynecology (4th ed. / Tamara L. Callahan, Aaron B. Caughey. ed., Blueprints). Philadelphia ; London: Lippincott Williams & Wilkins.
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Thank You