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Fetal Growth Restriction
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Juliana Gevaerd Martins, Alfred Abuhamad
Fetal growth restriction (FGR) is diagnosed with a sonographic estimated fetal weight (EFW) or abdominal circumference (AC) < 10th percentile for gestational age. Small for Gestational Age (SGA) should be used to describe a newborn whose birth-weight is below the 10th percentile.
Paper V
Published in Justin C Konje, Complete Revision Guide for MRCOG Part 3, 2020
Reference: The investigation and management of small-for-gestational age fetus. The Royal College of Obstetricians and Gynaecologists Green-top Guideline No. 31 February 2013. Minor revisions January 2014
Obstetrics: Questions
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
A primigravid patient is referred by her midwife to the antenatal assessment unit at 32 weeks’ gestation with reduced fetal movements and a symphyseal–fundal height of 26 cm. An ultrasound scan suggests a fetus small for gestational age (SGA). What are the causes of a fetus being small for gestational age (SGA)? (7 marks)Outline appropriate antenatal care for the rest of this pregnancy. (8 marks)Identify the potential short- and long-term sequelae of a SGA fetus. (5 marks)
Prepregnancy overweight and obesity as risk factors for birth defects: a cross-sectional study over a 30-year period
Published in Journal of Obstetrics and Gynaecology, 2022
Carolina Bicudo Borrelli, Sirlei Siani Morais, Mariane M. Barbieri, Thayane Leme, Jessica Fernanda Teixeira Prado, Fernanda G. Surita
Neonatal outcomes were worse in the BD group and it was expected since some BD can be very severe. Researchers found that foetuses with BD had higher chances of being born preterm and with low weight than foetuses without BD. Preterm birth is associated with oesophageal and intestinal atresia, for example. The complex association of genetic and epigenetic factors could cause BD and growth restriction, like a vascular compromise (Miquel-Verges et al. 2015). We found that in our BD group the prevalence of low birth weight was higher, consistent with published data(Montes-Núñez et al. 2011; Cosme et al. 2017; Luz et al. 2019). Newborns with congenital heart defects have twice the risk of being born small for gestational age and this is maybe due to the severity of the disease (Miquel-Verges et al. 2015; Luz et al. 2019). BD also shown an association with preterm birth (Montes-Núñez et al. 2011). Research has suggested that the introduction of the prenatal screening program led to a decrease in perinatal mortality in infants with BD (Bardi et al. 2021) but this is not accessible for a large part of the population so we need to focus on prevention, like modifiable risk factors.
Managing pregnancy in women with Sturge-Weber syndrome: case report and review of the literature
Published in Journal of Obstetrics and Gynaecology, 2022
Vignesh Durai, Haritha Sagili, Jayalakshmi Durairaj, Ramesh Ananthakrishnan, Pradeep P. Nair, Arun Keepanasseril, Anish Keepanasseril
A 22-year-old primigravida, diagnosed with SWS since 5 years of age, was admitted at 28 weeks of gestation with recurrent focal seizures. At admission, she had moderate pallor, PWS on the face (right side), and pyogenic granuloma over the scalp’s frontal area (right side). Her haemoglobin level was 9.4 gm/dL, and a deranged GTT (Fasting-95 mg/dL, 1st h-149 mg/dL and 2nd h-160 mg/dL). She discontinued Phenytoin and Valproate, on her own, at four months of pregnancy. After restarting on Phenytoin, she remained seizure-free but required a switch over to Levetiracetam (1 g BD) as she had developed bleeding from gum hyperplasia. Magnetic resonance imaging (MRI) brain was suggestive of SWS (Figure 1(a,b)). She was started on Iron tablets and diabetic diet with which her sugars were well controlled. Her body mass index was 23.4 kg/m2, with gestational weight gain for 9 kg. Her blood pressure with the normal limits and proteinuria was absent. Obstetric ultrasound at 32 weeks gestation diagnosed small for gestational age, with normal doppler. She was followed up with ultrasound surveillance with biometry and doppler sonography. Following the spontaneous onset of labour at 38 weeks, she delivered vaginally, a live male baby weighing 2.35 kg (5th centile of birth weight for gestational age based on Indian academy of Paediatrics growth chart). Puerperium was uneventful. On follow-up, mother is seizure free on antiseizure medications (levetiracetam 1 g BD and phenytoin 100 mg 1TID) and the baby is healthy without any malformations.
Umbilical cord diameter in the prediction of foetal growth restriction: a cross sectional study
Published in Journal of Obstetrics and Gynaecology, 2022
Mariam L. Mohamed, Magda M. Elbeily, Maisara M. Shalaby, Yara H. Khattab, Omima T. Taha
This study was conducted as a cross sectional study with a prospective design in the outpatient clinics of a tertiary hospital, after approval of our research ethics committee. We recruited patients at risk for FGR as (a) Maternal age >40 years, (b) Previous small for gestational age baby, (c) Smokers >11 cigarettes per day, (d) Previous stillbirth, (e) Chronic hypertension, (f) cocaine use, (g) daily vigorous exercise, (h) maternal SGA, (i) diabetes with vascular disease, (j) renal impairment, (k) antiphospholipid antibody syndrome, (l) paternal SGA, (m) heavy bleeding similar to menses in the first trimester, (n) preeclampsia, (o) echogenic bowel, (p) unexplained antepartum haemorrhage, (q) low maternal weight gain, (r) BMI < 20 or > 30, and (s) PAPP-A < 0.4 MoM (RCOG 2014), and with sure dates of the last menstrual period to calculate the gestational age. An early ultrasound was done to confirm the gestational age.