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Fetal growth restriction
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Daniel L. Jackson, M. Y. Divon, Hung N. Winn
Third-trimester screening for FGR by serial fundal height and maternal weight–gain assessments should be routinely performed during prenatal care. Decreased fundal height may be associated with FGR (oligohydramnios, wrong dates, and fetal malposition should also be considered). The sensitivity of this test may be as high as 50% (26). The false-positive rate is, however, quite high at approximately 56% (27). Beazley and Kurjak (28) reported that 25% of such assessments performed beyond 36 weeks of gestation were inaccurate by >500g and that the error increased at the extremes of the birth weight range (when this information is most useful). Similar results were reported by Loeffler (29). Despite these inaccuracies, serial measurement of fundal height is nearly twice as sensitive as palpation for detection of FGR (30). Accuracy can be improved by using a standardized technique of measuring from the fundus to the symphysis along the fetal axis and plotting along a customized growth curve similar to that discussed previously for estimation of fetal weight (31).
DRCOG OSCE for Circuit B Answers
Published in Una F. Coales, DRCOG: Practice MCQs and OSCEs: How to Pass First Time three Complete MCQ Practice Exams (180 MCQs) Three Complete OSCE Practice Papers (60 Questions) Detailed Answers and Tips, 2020
On clinical examination, you would palpate the abdomen to assess the site and severity of any abdominal tenderness. You would measure the fundal height and correlate this with the gestation of pregnancy and check the presentation of the fetus. You would also auscultate for fetal heart sounds or use a sonicaid. You would perform a speculum examination to determine the origin of the bleed. You would examine the cervix to exclude cervical polyp, ectropion or erosion. You would not perform a digital vaginal examination.
Treatment of Anti-Phospholipid Antibody Mediated Fetal Loss: The Case for Corticosteroid Therapy
Published in E. Nigel Harris, Thomas Exner, Graham R. V. Hughes, Ronald A. Asherson, Phospholipid-Binding Antibodies, 2020
It is not our practice to admit the patient to hospital or to deliver by cesarean section; however, close outpatient supervision is essential. This should include assessment of growth by fundal height examination and regular ultrasound growth profiles. If facilities are available for Doppler flow studies or biophysical profiles, these should also be performed.
Evaluation of maternal plasma platelet activating factor acetylhydrolase activity and mRNA expression in pre-eclampsia: a case control study
Published in Journal of Obstetrics and Gynaecology, 2021
Preeti Gupta, Rachna Agarwal, Sruthi Bhaskaran, Seema Garg, Mohit Mehndiratta, Gita Radhakrishnan, Alpana Singh, Richa Agarwal, Divya Narang
Exclusion criteria for the study were anomalous foetuses, those with overt or gestational diabetes, multiple pregnancy, intrauterine foetal death, Rh isoimmunisation, chronic hypertension, smoking, any chronic disease, conceived after assisted reproduction technology. After obtaining informed written consent, a detailed history was taken and examination done. Details were entered in a preset proforma. Clinically suspected foetal growth restriction (symphysio-fundal height ≤4 weeks POG), if present, was noted. Relevant investigations, including the complete blood count, the coagulation profile, the liver function test, the kidney function test, the lipid profile, the 24 hours’ urine protein, the peripheral smear for haemolysis and the fundus examination were done. All of the subjects were classified into non-severe and severe PE, as described in the Taskforce Guidelines (ACOG 2013).
Symphysis-fundal height to identify large-for-gestational-age and macrosomia: a meta-analysis
Published in Journal of Obstetrics and Gynaecology, 2020
Similar to small-for-gestational-age (SGA) and low birth weight, large-for-gestational-age (LGA) and macrosomia have been suggested to be associated with mortality and morbidity rates of pregnant women and their neonates (Oral et al. 2001; Wassimi et al. 2011; Weissmann-Brenner et al. 2012; Mendez-Figueroa et al. 2017). Therefore, a simple, reliable and inexpensive tool to identify not only SGA and low birth weight but also LGA and macrosomia would be helpful to reduce both of these rates. Formerly published meta-analyses could draw the conclusion that chest and arm circumferences of neonates are effective for identifying low birth weight (Goto 2011a, 2011b), but anthropometries and ultrasonography of pregnant women are not beneficial in primarily screening for SGA and low birth weight (Goto 2015a, 2015b, 2016a, 2016b). Symphysis-fundal height (SFH) was also concluded not to be useful for the same purpose mainly in developing countries (Goto 2013; Robert Peter et al. 2015; Figueras et al. 2018; McCowan et al. 2018), but it is still expected to be beneficial for identifying LGA and macrosomia. The results of a recent meta-analysis were contradictory to this expectation, but it used only a PubMed (MEDLINE) literature search and did not include an assessment of study quality, especially by using the tool designed for this purpose (Goto 2017).
Estimation of fetal weight: a comparison of clinical and sonographic methods
Published in Journal of Obstetrics and Gynaecology, 2019
C. C. Mgbafulu, L. O. Ajah, O. U. J. Umeora, P. C. Ibekwe, P. O. Ezeonu, M. Orji
This was done in the antenatal ward using a flexible tape measure calibrated in centimetres. The parturient, having emptied her bladder, lied in a supine position. Using the tape, the fundal height was measured from the highest point on the uterine fundus to the midpoint of the upper border of the symphysis pubis. Measurement was made using the reverse-side of the tape up so as to forestall any bias. The AC was also measured at the level of the umbilicus using the same flexible tape with the reverse side up. A pelvic examination was done to ascertain the station of the fetal head. Estimated fetal weight was thereafter calculated using Johnson’s and Dare’s formula (Dare et al. 1990; Numprasert 2004).