{"id":2615,"date":"2020-08-13T16:24:52","date_gmt":"2020-08-13T16:24:52","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=214"},"modified":"2021-05-09T20:44:00","modified_gmt":"2021-05-09T20:44:00","slug":"31-fetal-growth-abnormalities","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/overview\/31-fetal-growth-abnormalities\/","title":{"rendered":"31. Fetal Growth Abnormalities"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/66mqz6awq5k\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 6:00<\/p>\n<input type='hidden' bg_collapse_expand='69e9b5a5339fa3087093113' value='69e9b5a5339fa3087093113'><input type='hidden' id='bg-show-more-text-69e9b5a5339fa3087093113' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b5a5339fa3087093113' value='Hide Transcript'><button id='bg-showmore-action-69e9b5a5339fa3087093113' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b5a5339fa3087093113' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number 31 fetal<br \/>\n00:03<br \/>\ngrowth abnormalities once upon a time<br \/>\n00:05<br \/>\nthere was a medical student named<br \/>\n00:07<br \/>\nGoldilocks and she encountered three<br \/>\n00:09<br \/>\npregnancies during her labor and<br \/>\n00:10<br \/>\ndelivery rotation one pregnancy was big<br \/>\n00:13<br \/>\none pregnancy was small and the third<br \/>\n00:15<br \/>\npregnancy was just right in this video<br \/>\n00:18<br \/>\nwe will discuss definitions significance<br \/>\n00:20<br \/>\nand management issues for fetal growth<br \/>\n00:22<br \/>\nabnormalities the objectives of this<br \/>\n00:24<br \/>\nvideo are to define macrosomia and fetal<br \/>\n00:26<br \/>\ngrowth restriction to describe the<br \/>\n00:28<br \/>\nideologies of abnormal growth list<br \/>\n00:31<br \/>\nmethods of detection for fetal growth<br \/>\n00:33<br \/>\nabnormalities describe the management of<br \/>\n00:36<br \/>\nfetal growth abnormalities and lastly<br \/>\n00:38<br \/>\nlist the associated morbidity and<br \/>\n00:40<br \/>\nmortality of fetal growth abnormalities<br \/>\n00:42<br \/>\nlet&#8217;s start with the pregnancy that was<br \/>\n00:44<br \/>\nbig we will discuss the definition<br \/>\n00:46<br \/>\nsignificance and management issues with<br \/>\n00:48<br \/>\nfetal macrosomia fetal macrosomia is<br \/>\n00:51<br \/>\ndefined as a very large fetus typically<br \/>\n00:53<br \/>\nbetween 4,000 and 4,500 grams the<br \/>\n00:56<br \/>\nmorbidity sharply increases when the<br \/>\n00:58<br \/>\nfetus is greater than 4,500 grams there<br \/>\n01:01<br \/>\nare maternal and fetal causes of fetal<br \/>\n01:03<br \/>\nmacrosomia maternal factors include a<br \/>\n01:05<br \/>\nhistory or macro stomach pregnancy<br \/>\n01:07<br \/>\npregnancy weight gain parity and glucose<br \/>\n01:11<br \/>\nintolerance during pregnancy women with<br \/>\n01:13<br \/>\ngestational diabetes pre gestational<br \/>\n01:15<br \/>\ndiabetes and even woman who failed their<br \/>\n01:17<br \/>\none-hour glucose tolerance test with the<br \/>\n01:19<br \/>\nnormal three-hour glucose tolerance test<br \/>\n01:20<br \/>\nor at increased risk for fetal<br \/>\n01:22<br \/>\nmacrosomia there are fewer fetal factors<br \/>\n01:25<br \/>\nthat are causes for fetal macrosomia but<br \/>\n01:27<br \/>\nthese include being a male fetus and<br \/>\n01:28<br \/>\nhaving beckwith Wiedemann syndrome<br \/>\n01:31<br \/>\nmoving on to significance there are<br \/>\n01:33<br \/>\nmaternal and fetal risk for the fetal<br \/>\n01:35<br \/>\nmacrosomia maternal risks include<br \/>\n01:37<br \/>\npostpartum hemorrhage vaginal laceration<br \/>\n01:39<br \/>\nand fetal risks include shoulder<br \/>\n01:41<br \/>\ndystocia clavicular fracture lower Apgar<br \/>\n01:44<br \/>\nscores and longer-term risk of being<br \/>\n01:46<br \/>\noverweight or obese later in life the<br \/>\n01:49<br \/>\ndiagnosis of macrosomia can be<br \/>\n01:51<br \/>\nchallenging many clinicians measure the<br \/>\n01:53<br \/>\nfundal height above the maternal<br \/>\n01:54<br \/>\nsymphysis pubis this measurement is<br \/>\n01:56<br \/>\ncommonly performed however is a poor<br \/>\n01:58<br \/>\npredictor of fetal macrosomia and should<br \/>\n02:00<br \/>\nbe used in combination with clinical<br \/>\n02:02<br \/>\npalpation of estimated fetal weight<br \/>\n02:04<br \/>\nultrasound derived estimated fetal<br \/>\n02:06<br \/>\nweights are associated with significant<br \/>\n02:08<br \/>\nerror when the fetus is macro stomach<br \/>\n02:10<br \/>\nand the true value of ultrasounds is in<br \/>\n02:12<br \/>\nout macrosomia once the diagnosis of<br \/>\n02:15<br \/>\nfetal macrosomia is made the management<br \/>\n02:17<br \/>\ndoes not include induction of labor for<br \/>\n02:20<br \/>\nthis does not decrease maternal or<br \/>\n02:22<br \/>\nneonatal morbidity and actually<br \/>\n02:24<br \/>\nincreases the c-section risk the<br \/>\n02:26<br \/>\nAmerican College of Obstetricians and<br \/>\n02:27<br \/>\nGynecologists recommends a primary<br \/>\n02:29<br \/>\ncesarean section if an estimate of fetal<br \/>\n02:32<br \/>\nweight is greater than 5,000 grams for a<br \/>\n02:34<br \/>\npatient without diabetes or 4,500 grams<br \/>\n02:37<br \/>\nfor a patient with diabetes let&#8217;s now<br \/>\n02:39<br \/>\nmove to fetal growth restriction which<br \/>\n02:41<br \/>\ndescribes infants whose weights are<br \/>\n02:43<br \/>\nlower than expected the definition of<br \/>\n02:45<br \/>\nintrauterine growth restriction or IUGR<br \/>\n02:47<br \/>\nis when the fetus is less than the 10th<br \/>\n02:49<br \/>\npercentile remember that this means that<br \/>\n02:51<br \/>\nthe prevalence of IUGR is approximately<br \/>\n02:54<br \/>\n9% therefore the change in percentile<br \/>\n02:56<br \/>\nover time may be the more important<br \/>\n02:58<br \/>\nmeasurement the significance of the<br \/>\n03:01<br \/>\ndiagnosis is that the goal is to try to<br \/>\n03:03<br \/>\nidentify infants who are at risks of<br \/>\n03:04<br \/>\nshort-term and long-term morbidity or<br \/>\n03:06<br \/>\nmortality the short-term risk so that<br \/>\n03:09<br \/>\nsmall fetuses potentially lack adequate<br \/>\n03:11<br \/>\nreserve to either continue intrauterine<br \/>\n03:13<br \/>\nexistence or potentially may lack<br \/>\n03:15<br \/>\nreserve to undergo the stress of labor<br \/>\n03:17<br \/>\nthe long-term risk so that alterations<br \/>\n03:20<br \/>\nand fetal growth may have lifelong<br \/>\n03:21<br \/>\nimplications it may predict health risks<br \/>\n03:24<br \/>\nsuch as a cardiovascular disease insulin<br \/>\n03:26<br \/>\nresistance and adult obesity in general<br \/>\n03:29<br \/>\nthe smaller the fetus the greater the<br \/>\n03:31<br \/>\nrisk of morbidity and mortality it&#8217;s<br \/>\n03:33<br \/>\nimportant to discuss early onset IUGR<br \/>\n03:36<br \/>\nversus late onset IUGR early in<br \/>\n03:39<br \/>\npregnancy fetal growth is primarily<br \/>\n03:41<br \/>\nthrough cellular hyperplasia thus early<br \/>\n03:43<br \/>\nonset IUGR can lead to irreversible<br \/>\n03:46<br \/>\ndecreases of organ size and possible<br \/>\n03:48<br \/>\nfunction later in the pregnancy fetal<br \/>\n03:52<br \/>\ngrowth is primarily secondary to<br \/>\n03:53<br \/>\ncellular hypertrophy so IUGR at this<br \/>\n03:56<br \/>\npoint is more amenable to restoration of<br \/>\n03:58<br \/>\nfetal size with adequate nutrition<br \/>\n04:00<br \/>\nmaternal factors associated with early<br \/>\n04:02<br \/>\nonset IUGR include maternal infections<br \/>\n04:05<br \/>\nsuch as rubella varicella or CMV smoking<br \/>\n04:09<br \/>\nmultiple pregnancies and chronic<br \/>\n04:11<br \/>\nmaternal disease late onset IUGR on the<br \/>\n04:14<br \/>\nother hand is usually secondary to<br \/>\n04:16<br \/>\nuterus until insufficiency the diagnosis<br \/>\n04:19<br \/>\nof IUGR is similar to the diagnosis of<br \/>\n04:21<br \/>\nmacrosomia in that fundal height and<br \/>\n04:23<br \/>\nclinical palpation of an estimated fetal<br \/>\n04:25<br \/>\nweight<br \/>\n04:26<br \/>\nhelpful clinicians suspect IUGR<br \/>\n04:28<br \/>\nultrasound can be utilized to estimate<br \/>\n04:31<br \/>\nthe fetal weight in addition Doppler<br \/>\n04:32<br \/>\nvelocity of fetal vessels is very<br \/>\n04:34<br \/>\nimportant in the management of IUGR the<br \/>\n04:37<br \/>\nuterine artery systolic to diastolic<br \/>\n04:39<br \/>\nratio evaluates the fetal placental<br \/>\n04:41<br \/>\ncirculation as placental resistance<br \/>\n04:43<br \/>\nincreases diastolic flow decreases<br \/>\n04:46<br \/>\ntherefore there is an increase in the<br \/>\n04:48<br \/>\nsystolic and diastolic ratio absent or<br \/>\n04:52<br \/>\nreversed end diastolic flow predicts a<br \/>\n04:54<br \/>\nworse perinatal outcome and is usually<br \/>\n04:56<br \/>\nan indication for delivery the middle<br \/>\n04:59<br \/>\ncerebral artery or MCA dopplers reflects<br \/>\n05:02<br \/>\nfetal adaptation this is because the<br \/>\n05:05<br \/>\nfetus always tries to spare the fetal<br \/>\n05:07<br \/>\nbrain circulation when there is<br \/>\n05:08<br \/>\ndecreased placental perfusion there is<br \/>\n05:10<br \/>\nincreased mca doppler flow moving now to<br \/>\n05:14<br \/>\nmanagement the goal is to deliver the<br \/>\n05:16<br \/>\nhealthiest possible infant at the<br \/>\n05:17<br \/>\noptimal time fetal surveillance is<br \/>\n05:20<br \/>\nimportant with continued management of<br \/>\n05:21<br \/>\nthe pregnancy based on the results of<br \/>\n05:23<br \/>\nfetal testing the gestational age of the<br \/>\n05:25<br \/>\nfetus and the known risks associated<br \/>\n05:27<br \/>\nwith prematurity all need to be factored<br \/>\n05:29<br \/>\ninto the decisions regarding the timing<br \/>\n05:31<br \/>\nof delivery and delivery should<br \/>\n05:33<br \/>\noptimally be performed when the risk of<br \/>\n05:34<br \/>\nfetal death is greater than the risk of<br \/>\n05:36<br \/>\nneonatal death this concludes the aapko<br \/>\n05:39<br \/>\nvideo on fetal growth abnormalities we<br \/>\n05:41<br \/>\nhave discussed the definitions<br \/>\n05:42<br \/>\nsignificance and management of fetal<br \/>\n05:44<br \/>\nmacrosomia and IUGR<br \/>\n05:59<br \/>\nyou<\/p>\n<p><\/div>\n<hr>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 6:00<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":46,"menu_order":31,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2615","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/2615","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=2615"}],"version-history":[{"count":1,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/2615\/revisions"}],"predecessor-version":[{"id":2837,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/2615\/revisions\/2837"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=2615"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}