Fetal growth restriction: Suspicion, diagnosis and management by ultrasound and color doppler
Kuldeep Singh
IFUMB, India
: J Nurs Patient Care
Abstract
A small for dates fetus is broadly any fetus with an estimated fetal weight below the tenth percentile. What is most important is to define and classify and segregate whether it is a constitutionally small for gestational age fetus which is normal in terms of perinatal outcome or a fetus with true fetal growth restriction which is going to show signs on ultrasound and color Doppler and also reflect a poor perinatal outcome. This differentiation is done by meticulous search for signs on 2D ultrasound with charting of growth potential and Doppler ultrasound showing changes in cerebroplacental ratio and uterine arteries and umbilical artery. Once this is done we need to reclassify them as early or late onset fetal growth restriction. Further management strategies and decision of when and where to deliver are determined by changes in Doppler showing progressive fetal deterioration. Which vessels to be insonated, what to infer, optimal time intervals to repeat the scan and when to deliver so as to minimize fetal injury and demise and to avoid risks of iatrogenic preterm delivery is the aim of this study. Reference: 1. Turan OM, et al., (2008). Progression of Doppler abnormalities in intrauterine growth restriction. Ultrasound Obstet Gynecol. 32:160-167. 2. Batalle D, Eixarch E, Figueras F, Muñoz-Moreno E, Bargallo N, Illa M, Acosta-Rojas R, Amat-Roldan I, Gratacos E (2012). “Altered small-world topology of structural brain networks in infants with intrauterine growth restriction and its association with later neurodevelopmental outcome”. Neuroimage. 60 (2): 1352–66. 3. Vergani P, et al., (2002). Prognostic value of uterine artery Doppler velocimetry in growth-restricted fetuses delivered near term. Am J Obstet Gynecol.187:932-936. 4. Ghosh GS, Gudmundsson S. (2009). Uterine and umbilical artery Doppler are comparable in predicting perinatal outcome of growth-restricted fetuses. BJOG.116:424-430. 5. Oros D et al., (2011) Longitudinal changes in uterine, umbilical and fetal cerebral Doppler indices in late-onset small-for-gestational age fetuses. Ultrasound Obstet Gynecol. 37:191-195.
Biography
Kuldeep Singh is practicing in South Delhi and is known for his skills in Ultrasound in Ob, Gyn and Infertility. He has authored 16 books on Ultrasound in Obs, Gyn and Infertility. His books have been translated into Spanish, Chinese and Portugese. He was awarded the IMAGING SCIENCE AWARD in the AICOG in Delhi. He is presently the President of the Delhi Chapter of IFUMB. With teaching as his passion he is presently running Ultrasound Teaching Modules in Basic and Advanced Ultrasound in Obstetrics, Gynecology and Infertility. sdrkuldeep@gmail.com singhdrkuldeep@rediffmail.com
