Selected Clinical Presentations
Miriam Katz, Israel Meizner, Vaclav Insler in Fetal Well-Being, 2019
Her past medical history was unremarkable. Routine antenatal follow up did not show any pathology, except that the patient had been uncooperative and visited the clinic only sporadically. She was last seen 2 weeks previously. The uterus corresponded to full-term pregnancy, the fetus was in vertex presentation, and the NST was reactive. Since the gestational age was estimated to be 41 weeks, the patient was advised to return after 72 h for repeated fetal monitoring, however, she failed to show up. On admission, external examination revealed a term uterus with fundal height of 37 cm. The fetus was in vertex presentation. On vaginal examination the cervix was found to be 50% effaced and dilated 1.5 cm. The fetal head was at station −3. On amnioscopy, the membranes were found to be intact and the amniotic fluid heavily stained with meconium. On external monitoring slight uterine activity was seen. The FHR was 162 bpm with lack of baseline variability. Repetitive decelerations following even the mildest uterine contractions were observed (Figure 6.5).
Paper III
Justin C Konje in Complete Revision Guide for MRCOG Part 3, 2020
You are an ST5 in the clinic and have been asked to see a patient who has just returned from an ultrasound scan. This is a 29-year-old primigravida, who is now 34 weeks pregnant. She booked for antenatal care at 11 weeks of gestation. This was an unplanned pregnancy. Her BMI at booking was 34 kg/M2. All the investigations performed at boking came back as normal. She is blood group O Rhesus D positive. She had a combined biochemical and NT screening at 13 weeks, and this was low risk. At 26 weeks, she had an oral glucose tolerance test which was normal (fasting 4.8 mmol/l and 2 hours 6.0 mmol/L). At 20 weeks, she had a detailed ultrasound scan which was normal. Her care so far has been with the midwife. When she saw the midwife last week, the fundal height measured 38 cm. The midwife, therefore, referred her to the hospital for an ultrasound scan and a follow-up in the clinic. The baby’s movements are normal.
Fetal growth restriction
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
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).
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).
Association of vitamin D deficiency and vitamin D receptor (VDR) gene single-nucleotide polymorphism (rs7975232) with risk of preeclampsia
Published in Gynecological Endocrinology, 2023
Asma Aziz, Mohsin Shah, Sami Siraj, Waheed Iqbal, Amin Jan, Imran Khan, Sajjad Ahmed, Salvatore Giovanni Vitale, Stefano Angioni
Women suffering from chronic diseases like hypertension, cardiac pathologies, bad obstetrical history, or any fetal anomalies and those who do not want to participate in the study were excluded from the study. The term bad obstetrical history was defined as female who experience any loss in her pregnancy either abortion, still birth, early neonatal death, or demise of the fetus due to any other cause related to pregnancy. Subjects were examined for height, weight, pulse, edema, fundal height (height of the uterus), fetal heart sounds, and SBP and DBP. Obstetrical ultrasound of each patient was also done to exclude any fetal anomalies. Subjects taking VD supplements were excluded from the study. The subjects were also investigated for hemoglobin, blood grouping, and urinary proteins.
Related Knowledge Centers
- Oligohydramnios
- Uterus
- Gestational Age
- Pregnancy
- Gestational Diabetes
- Small For Gestational Age
- Intrauterine Growth Restriction
- Twin
- Multiple Birth
- Polyhydramnios