Prediction of Adverse Perinatal Outcome in Growth Restricted Fetuses with Antenatal Doppler Study.

Anita, S (2007) Prediction of Adverse Perinatal Outcome in Growth Restricted Fetuses with Antenatal Doppler Study. Masters thesis, Madras Medical College, Chennai.


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Ante Partum Fetal Surveillance Is The Corner Stone Of Preventive Obstetric Management Aimed At Reducing Maternal And Perinatal Mortality And Morbidity. Ante Partum Detection Of Fetus At Risk Of Death Or Compromise In Utero Remains The Major Challenge In Modern Obstetrics. Specific And Accurate Methods For Detection Of Fetus At Risk Can Result In Early Appropriate Intervention And Hence Reduce Fetal Loss. Antenatal Test Of Fetal Well Being Depends Indirectly On Changes In Fetal Physiology, An Aspect Of Fetus, Which Until Recently, Has Been Relatively Inaccessible To Study By The Paucity Of Techniques To Measure The Placental Function - The Critical Organ Through Which The Transfer Of Nutrients Occur. New Technologies Have Now Become Available In The Clinical Assessment Of Placental Function. Doppler Measurement Of The Pulsatile Blood Velocity In Umbilical Artery Gives Direct Information On Feto-Placental Circulation And Hence Identifies Placental Circulatory Failure. Diagnostic Ultrasound Is The Main Stay In The Evaluation And Management Of Obstetric Patients. Fetal Growth And Development Rely On Normal Uteroplacental And Fetoplacental Circulation To Supply Oxygen And Nutrients From The Maternal Circulation. Doppler Sonography Offers A Unique Tool For The Noninvasive Evaluation Of Physiological Hemodynamic Fetoplacental Blood Flow Information. There Are Specific Abnormalities In Doppler Parameters In Asymmetric Intrauterine Growth Retardation. Fetal Growth Restriction (FGR), Otherwise Known As Intrauterine Growth Restriction Is Defined As A Pathologic Decrease In The Rate Of Fetal Growth. Here The Fetus Does Not Achieve Its Inherent Growth Potential, Thereby Increasing Perinatal Morbidity And Mortality. Small For Gestational Age (SGA) Is Conceptually Not The Same Entity As FGR. It Is Defined As Fetus Which Has Failed To Achieve Specific And Arbitrary Anthropometric Measurements Or Weight Threshold By A Specific Gestational Age, Whereas In FGR, The Infant Has Not Achieved Its Genetic Growth Potential In Utero (Rajan. R. 2001). All FGR Fetuses Don't Suffer From In Utero Compromise In Terms Of Hypoxia Or Acidemia. Fetal Growth Restriction Only Means That The Fetus Has Not Grown Appropriately For The Corresponding Gestational Age, And Does Not Necessarily Mean It Is A Situation Of Uteroplacental Respiratory Insufficiency Causing Fetal Hypoxia Or Acidemia. But Many IUGR Fetuses Could Sooner Or Later Become Hypoxemic, Hypoxic And Acidotic As A Progressive Event Of The Pathophysiology. Diagnosis Of IUGR Is Based On B-Mode Ultrasound. Estimation Of Fetal Weight In Utero Using Multiple Ultrasound Parameters Remains The Mainstay In Screening For FGR. Use Of Various Fetal Morphometric Ratios And/Or Measurements Of Other Fetal Parameters May Provide Additional Useful Information. Serial Evaluation To Assess Interval Growth May Be Necessary To Clarify The Diagnosis. Doppler Velocimetry Has Poor Sensitivity In Detecting IUGR, Whereas It Is Helpful In Assessing The Hemodyanmic State. Doppler Indices Change If The Fetus Is Compromised Due To Hypoxemia. Doppler Flow Velocimetry, Particularly Of The Middle Cerebral And Umbilical Arteries Is An Earlier Predictor Of Hypoxemia, When Compared To BPP Or NST. Ductus Venosus Flow Study Is An Accurate Predictor For Acidemia. The Relationship Between The Size Of Fetal Abdominal Circumference And Fetal Head Is Used To Characterize The Pattern Of FGR As Being Either Symmetric Or Asymmetric. Symmetric IUGR Refers To A Growth Pattern In Which The Growth Of Both The Fetal Abdomen And Head Are Decreased Proportionally. Asymmetric IUGR Refers To The Growth-Retarded Fetus In Which A Disproportionate Decrease In The Size Of Fetal Abdomen With Respect To The Fetal Head Is Seen. Symmetric IUGR May Result From An Early Insult Such As Genetic Or Infective Pathology That Impairs Fetal Cellular Hyperplasia And Therefore Causes A Proportionate Decrease In Size Of All Fetal Organs. By Contrast, Asymmetric IUGR May Be Caused By A Later Insult That Impairs Cellular Hypertrophy, Causes A Disproportionate Decrease In The Size Of Fetal Abdomen In Relation To That Of The Fetal Head. Progressive Uteroplacental Insufficiency May Be Associated With This Asymmetric Growth Pattern. Nearly 70% Of Patients With IUGR May Be Classified As Having An Asymmetrical Growth Pattern. These Cases May Be At Greater Risk For Perinatal Hypoxia And Neonatal Hypoglycemia. However, Their Long-Term Prognosis With Appropriate Management Is Good. Symmetric IUGR Results From An Early Insult And Is Characterized By A Long Period Of Subnormal Growth. These Infants Usually Do Not Have Perinatal Hypoxia, But They Are At Risk Of Long-Term Neurodevelopmental Dysfunction, Resulting From A Deficit In The Total Number Of Brain Cells.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Prediction Adverse Perinatal Outcome ; Growth Restricted Fetuses ; Antenatal Doppler Study.
Subjects: MEDICAL > Radio Diagnosis
Depositing User: Subramani R
Date Deposited: 30 Jun 2017 07:28
Last Modified: 30 Jun 2017 07:28

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