Transcript BPP
27years
G1
GA : 28w 2d (by sono 8w :28w 3d )
Fondal height : 24 cm
BPD :24W 3D
AC : 22 W
FL : 21 W
AFI : NL
Severe IUGR
BPP: breath:0
AF:2
tone:2
Doppler : increased Umbilical artery RI
AC < 10% and EFW < 10% : SUSPECTED TO
IUGR
AC < 10% and EFW > 10% : at risk to IUGR
27years ,G1
) GA : 28w 2d (by sono 8w :28w 3d
C.C : fundal height 24
cm
بیمار مورد شناخته شده تاالسمی اینترمدیا که 10سال قبل اسپلنکتومیشده است
2هفته بعد از اسپلنکتومی دچار ترومبوفلبیت عروق کبدی می شود وتحت درمان با هپارین و وارفارین تا 1ماه پس از ترخیص قرار میگیرد
از 10سال قبل تا کنون آسپیرین مصرف می کند1سال پس از اسپلنکتومی کوله سیستکتومی می شود
از 10سال قبل تزریق خون نداشتهاز ابتدای بارداری تحت درمان با هپارین به صورت 5000واحد BDبودهاست
Gestational age
BPD ,HC,AC,FL
TCD
EFW
AFI
Doppler sonography
BPP
BPD : 24W
HC : 24W 2D
AC : 24W 1D
FL :23W 3D
EFW : 539 g
AFI : 10cm
Umbilical artery : reversed EDV
Ductus venosus : NL
BPP : 10/10
symmetric IUGR
Associated conditions:
- Genetic
- Congenital anomalies
- Intrauterine infections
- Substance abuse
- Cigarette smoking
- Therapeutic irradiation
Anomaly scan
Karyotyping identification : severe early
onset IUGR , Symmetrical IUGR
,polyhydramnious ,stractural anomaly .
Echocardiography
Serology :CMV ,RUBELLA , VARICELLA
IUGR
yes
TORCH stigmata work-up?
no
yes
Dysmorphic features work-up?
no
yes
Maternal/placental explanation work-up?
no
yes
Maternal drug use tox screen
no
Unknown cause
Growth curve (biometry)
Doppler
BPP
NST
Normal doppler & AFI : fortnightly
umbilical artery end diastolic flow is present :
weekly Doppler
BPP twice weekly
Absent or reversed end diastolic flow in the
umbilical artery :
hospital admission
daily BPP and Doppler
FGR < 5 %
Severe oligohydramnious
Absent / reverse EDV
Equivocal BPP ( 6/10 )
Sonography after than 18
days
BPP : 26w 5d
HC : 25w 6d
AC : 24w 6d
FL : 24w 2d
EFW : 615 g
AFI : 10 cm
Umbilical artery reversed EDV
DV : flow a wave decreased
GA : 30w 2d
C/S
Female : 630 gr
Fetal acidemia
Spontaneous late deceleration
Absent /reverse umbilical artery EDV
40y , G3L2(c/s)
GA : 35w 1d but by sono 8 weeks : 33w 1d
FH : 30 cm
PMH : no problem
OBH : neg
US :
BPD : 28w 3d
HC : 28w 3d
AC : 25w
FL : 26w
HL : 24w 5d
EFW : 746g
AFI : 5 cm
doppler: NL
SGA 24+0 and 35+6 weeks before delivery :
antenatal corticosteroids.
Magnesium : under 30 week.
smoking cessation.
Antithrombotic therapy appears to be a
promising therapy for preventing SGA in
high risk women.However there is
insufficient evidence, especially concerning
serious adverse effects, to recommend
its use.
BPD : 29W 3D
AC : 26w
FL : 26W 5D
EFW : 767 g
AFI : 2 cm
BPP : 8/10
DOPPLER : NL
BPD : 28w 3d
HC : 28w 3d
AC : 25w (191 mm)
FL : 26w
HL : 24w 5d
EFW : 746g
AFI : 5 cm
BPD : 29W 3D
HC : 28w 5d
AC : 26w (200 mm)
FL : 26W 5D
EFW : 767 g
AFI : 2 cm
During 16 days : growth arrest .
GA 35w 3d : C/S
BW : 825 gr
29y , G2ab1
GA : 30w 4d (by sono 13w : 30w 6d )
FH=26 cm
PMH : NEG
DH: heparin
Sono: GA : 29 w 6 d
BPD=27W 4D
HC : 27W 6D
AC : 25W 4D
FL : 25W 4D
EFW: 765 g
AFI : 67 mm
BPP : 10/10
DOPPLER : NL
Sono ( GA : 30w 4d)
AFI < 5 cm
BPP=6/8 (breath=0)
RI MCA/ RI UMA=0.67/0.79
Hospitalization
Sono ( GA : 31 w 6d )
AFI < 5 cm
Doppler : absent EDV in umbilical artery
BPP=10/10
After than 15 days
AFI =severe oligohydramnious
EFW= 997 gr
BPP=8/8
در سن حاملگی 32هفته و 5روز به صورت
اوژانسی به دلیل پره اکالمپسی شدید
ترمیناسیون
انجام شد
Abnormal DV(A/R a wave) or umbillical
vein(pulsetile) with every GA .
Umbilical artery reverse EDV until 30-32
weeks
Umbilical artery absent EDV until 32-34
weeks
Umbilical artery high RI until 36- 37 weeks
Constitutional IUGR : 37-38 weeks
Maternal comorbidity
arrest of growth
Oligohydramnious
A/R EDV umbilical artery
MCA PI < 5%
BPP < 4
Recurrent deceleration FHR
First pregnancy AGA : 9%
First pregnancy SGA : 29%
First and second pregnancy SGA : 44%
cessation of smoking and alcohol intake
balanced energy/protein supplementation
Avoiding a short or long interpregnancy
interval
Low risk : fundal height (exception large myoma
,BMI > 35)
High risk : ultrasonography
Biochemical : low PAPP-A , high AFP
Uterine artery doppler
Maternal age > 35 yrs
Nulliparity
BMI <20
BMI 25-29.9
Smoker 1-10 per day
Pregnancy interval < 6 mo
Pregnancy interval >30 mo
Paternal SGA
Maternal age > 40 yrs
Daily vigorous exercise
Previous SGA baby
Smoker >11 per day
Previous stillbirth
Maternal SGA
Preeclampsia
Maternal Medical disease
Heavy bleeding similar to mense
Echogenic bowel
Low maternal weight
Low PAPP-A
"Advise women at high risk of pre-eclampsia to
take 75 mg of aspirin* daily from 12 weeks until the
birth of the baby. Women at high risk are those
with any of the following:
• hypertensive disease during a previous pregnancy
• chronic kidney disease
• autoimmune disease such as systemic lupus
erythematosis or antiphospholipid syndrome
• type 1 or type 2 diabetes
• chronic hypertension.
Advise women with more than one moderate risk
factor for pre-eclampsia to take 75 mg of aspirin* daily
from 12 weeks until the birth of the baby. Factors
indicating moderate risk are:
• first pregnancy
• age 40 years or older
• pregnancy interval of more than 10 years
• body mass index (BMI) of 35 kg/m² or more at first
visit
• family history of pre-eclampsia
• multiple pregnancy.