Pakkialakshmi, G (2013) Comparative study of placental volume in normal pregnancy and intra uterine growth restriction. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Fetal growth restriction continues to be one of the major complications of pregnancy affecting 5-10% of all gestation .It is associated with increased morbidity and mortality in perinatal period and in infancy .More over the adverse consequences of fetal growth restriction extend beyond early years into later life .The concept of developmental programming pioneered by Prof. David Barker & others has stimulated tremendous research into the origin of a spectrum of cardiovascular and metabolic disorders in adults .But the exact causes of fetal growth restriction in utero still remains unclear. Antenatal fetal surveillance plays a major role in identifying fetuses at risk of IUGR to offer them close monitoring to prevent the perinatal mortality & morbidity & long term consequences. Deficiency in growth implies failure of the fetus to realise its genetically endowed growth potential .Determining the growth potential of an individual fetus however remains difficult. Many studies have produced normative gestational age specific birth weight standards that have been used to define retrospectively suboptimal fetal growth. Before the introduction of ultrasound, prospective measurement of fetal growth during pregnancy has been limited to measuring uterine size and guessing fetal size by palpation. Over the last few decades, ultra sonogram & Doppler has come into play a major role in evaluation of fetal growth in utero. AIM OF THE STUDY: 1 To estimate the placental volume using 2 dimensional ultrasound. 2. To estimate the placental volume immediately following delivery. 3. To compare the placental volume measured before delivery by ultrasound with that of measured after delivery. 4. To compare the placental volume in IUGR and NORMAL pregnancy. 5. To correlate the adverse perinatal outcome with placental volume in IUGR pregnancy. MATERIALS AND METHODS: This prospective analytical study was conducted at The Institute of obstetrics and gynaecology, Egmore, Chennai coming under the Madras medical college, Chennai from 2011 to 2012. Ethical committee clearance was obtained to undergo the study. The patients referred as IUGR beyond 34 wks up to term were carefully analysed. The inclusion criteria used were, 1. with singleton pregnancy, 2. well known gestational age, 3. without any maternal medical complications, 4. with first trimester ultrasound for confirming the gestational age and second trimester ultrasound to rule out fetal anomaly and serial ultrasound to see the interval growth. These patients were screened with clinical method of measuring fundal height. If it was lagging behind 4 weeks for their gestational age, then they were subjected to ultrasound and fetal biometry and estimated fetal weight were measured. Estimated fetal weight of < 10th percentile for their gestational age with ultrasound were selected for the study after getting informed consent. Exclusion criteria: Patients with multiple pregnancy, abnormal placentation, fetal malformation were excluded. Patients with severe oligohydromnios in which there was difficulty in localising the placenta were excluded from this study. And also in patients in whom there was difficulty in localizing as well as measuring the placenta due to fundal or lateral wall insertion were excluded. Detailed history was taken & patients with hypertension, diabetes, other medical disorders were excluded to avoid errors in monitoring the perinatal outcome. The results were compared with that of normal pregnancy. The average placental volume in normal pregnancy was 595.25 cm3. The average placental volume in IUGR pregnancy was 450 cm3. This shows a significant difference in placental volume between these group. On statistical analysis, this showed significant difference. p=0.001** (highly significant; Levenes T-Test). CONCLUSION: Healthy baby and healthy mother are the goal of obstetrical management. The diagnosis of Uteroplacental insufficiency , the major cause of IUGR,identifies the group of fetuses who are at incresed risk for perinatal complications. Ultrasonography plays a major role in early diagnosis of IUGR. Doppler ultrasonogram helps in identifying fetuses already in hypoxia and acidemia so that early interventions could be done to reduce perinatal complications. But it needs costly equipment and trained personale which limits its usefulness in developing country like India. Placental volume has positive correlation with birthweight of the baby and perinatal complications. Estimation of placental volume by simple 2 dimensional ultrasound could be a better alternative method of antenatal fetal surveillance in IUGR where doppler ultrasound is not available.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Comparative study ; placental volume ; Normal pregnancy ; intra uterine growth Restriction. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 25 Nov 2017 07:57 |
| Last Modified: | 28 Nov 2017 02:27 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4063 |
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