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  • Rafat Mosalli MD

    Abnormal Gestation

  • ObjectivesWhat is Normal gestation?Newborn classification according to age and Weight.How to assess for Gestational age?Causes of abnormal gestationComplications of abnormal Gestation. - LGA & SGA -Premature & Post mature

  • DefinitionsFull Term : 37- 42W GAPrematurity : < 37 W GAPost term : > 42W GALarge for gestational age (LGA): BWT >2 SD from the mean of GA(>90 percentile)Small for gestational age( SGA): BWT
  • Low birth weight (LBW): Bwt
  • LBW could be both!- An infant of birth weight 1.8 kg born at 36 weeks is classified as preterm and LBW

  • Gestational age assessmentLMPUltrasoundBalllard score :-Physical and neuromuscular maturity-correlate the cumulative score with a gestational age (usually lies within 2weeks)

  • Large for gestational age (LGA)Bwt > 90% for their ageCauses:-Familial-IDDM-Others

  • LGA(IDM) :Complications-Prematurity - GIT-Birth injuries - Prenatal death -CNS - Congenital anomalies-Respiratory -CVS-Metabolic-Hematologic-Renal

  • Fetal growth has been divided into three phases.1-cellular hyperplasia2- hyperplasy & hypertrophy

    3- hypertrophy

    cell size.fat depositionfetal weight as much as 200 G.r. per week.

  • Normal Intrauterine Growth Pattern95% of fetal weight gain occurs during the last 20 weeks of gestationLate insult will affect weight the most

  • Intrauterine Growth Retardation (IUGR)Is deviation from expected fetal growth patterna fetus is unable to grow to its genetically determined potential size to a degree that may affect the health of the fetus.

  • A late pregnancy insult such as placental insufficiency would affect cell size. Asymmetrical

  • symmetricalAn early insultdue to :chemicalviralaneuploidyCell sizeCell num.Proportionate reduction in head & body

  • Symmetric Vs Asymmetric IUGRSymmetric IUGR Entire body is proportionally small.

    Asymmetric IUGRA fetus who is undernourished (Head sparing effect)

  • IUGR vs SGASGA :A fetus that has failed to achieve a expected weight by a specific gestational age(Bwt
  • IUGR vs SGA5070% of fetuses with a BWT
  • Small for gestational age (SGA) Causes : Fetal MaternalPlacental and Uterine Abnormalities impaired nutrient delivery

  • Fetal impaired fetal uptake

    Genetics

    Congenital anomalies/ Infections

    Multiple gestation

  • MaternalInfectionPre- eclampsia, Diabetes, HypoxemiaDrug misuse / SMOKINGChronic medical illnessimpaired nutrient uptake

  • Uterine &Placental impaired nutrient delivery Short cervix,Incompetent cervix Placenta Previa ,Abruptio Placentae

  • Others Premature rupture of membrane

    Hydramnios

    Iatrogenic

    Trauma/

  • Which is common?Vascular disease (HTN, DM, etc) 35%Chromosomal and congenital anomalies 10%Normal variation 10%Congenital infections 5%Drug misuse 5%Placenta and cord defect 2%Uterine defects 1%Others : Low socioeconomic status, unknown

  • Problems of SGA

  • SGA: associated problems Intrauterine deathAsphyxiaMeconium aspirationPersistent pulmonary hypertensionPolycythemia/hyperviscosityHypothermiaHypo-er glycemiaAcute renal failureGastrointestinal perforationImmunodeficiencyNeonatal death(1%)

  • IUGR : long term problems!Depend on the causes &Type?The asymmetrically GR is more likely to catch up after birthImpaired neurodevelopment, CP type 2 diabetes hypertension.

  • Prematurity< 37W GA

  • Prematurity

    Incidence: 6-8 % all birthCauses: Idiopathic Maternal fetal

  • Prematurity complicationsAffect every system !

    Short term

    Long term

  • Neurologic &OphthalmologicImmature temperature regulation hypothermiaAsphyxiaIVHPVLCP and neurodevelopment delay

    ROP

  • Respiratory and CVSRDSApnea of prematurityBPDpneumoniaHypotensionPDA

  • GIT and NutritionFeeding difficulty

    NEC

  • Renal and MetabolicImmature kidneysElectrolyte dist.AcidosisHypo-er glycemiaHypocalcemiaOsteopenia of prematurity

  • Hematologic &ImmunologyAnemia of prematurity

    Jaundice

    Infection

  • Post maturity> 42 weeks GAC/PComplications:MAS and related complicationsHypoxic ischemic encephalopathy(HIE sequences)MetabolicPolycythemia

  • We Talked aboutWhat is Normal gestation?Newborn classification according to age and Weight.How to assess for Gestational age?Causes of abnormal gestationComplications of abnormal Gestation. - LGA & SGA -Premature & Post mature

    ****It aids in predicting the neonatal complications of largness or smallness for GA also detection of abnormal fetal gth patternFirmness of pinna,size of breast tissue,opacity of the skin,laungo hair******demonstrates a normal caliber rectum, a small caliber sigmoid, and descending colon with an abrupt caliber transition at the splenic flexure *****is directing most of its energy to maintaining growth of vital organs, such as the brain and heart, at the expense of the liver, muscle and fat. This type of growth restriction is usually the result of placental insufficiency.

    The commonly used threshold is the tenth centile for abdominal circumference and estimated birthweightDeviation from the predicted weight at term may result in an infant with IUGR but may NOT result in an infant who is SGA

    **********neonatal mortality rate of a SGA infant born at 38 weeks 1% compared 0.2% in those with AGAA significant association between fetal growth restriction and cerebral palsy.In a 9-11 year follow up study learning deficit in almost half of GRF IUGR:- a fetus is unable to grow to its genetically determined potential size to a degree that may affect the health of the fetus.

    *******stage4*****pnumoniaThe AP film shows bilateral patchy opacity, more marked on the right. No effusions are seen *