高血压英文ppt精品课件ultrasound in the management of

Ultrasound in the management of IUGR Dr Philippa Ramsay MBBS FRANZCOG DDU COGU POW Campus Centre RPA Medical Centre Sydney Adventist Hospital St Leonards Intra-uterine growth restriction vs Small for gestational age Low birth weight (LBW): 37 completed weeks gestation Intra-uterine growth restriction vs Small for gestational age Intra-uterine growth restriction 7A fetus with pathologically impaired growth of varying degrees Small for gestational age 7A fetus who is below the tenth centile for gestational age for weight, length 178:1121-1125 Causes of late fetal death l Cord and placental complications 10-20% l Maternal hypertensive disease 5-25% l Maternal medical complications 5-10% l Congenital malformations 5-10% l Intrauterine infections 5-15% l Erythroblastosis 3-15% l unexplained 50% Pitkin RM et al. Fetal death: diagnosis and management. Am J Obstet Gynecol 1987;157:583-589 Risk of neonatal death from IUGR Causes of IUGR -1 Maternal disease 7Chronic hypertension 7Renal disease 7Cardiac disease Maternal 133-281 Risk groups 766% of IUGR infants are associated with these risk factors 7Perinatal mortality is higher among members of these groups REF: Galbraith RS et al. The clinical prediction of intrauterine growth restriction. Am J Obstet Gynecol 1979;133-281 Detecting the IUGR fetus a Tests of fetal size 7Mothers weight 7Mothers fundal height 7Fetal biometry on ultrasound Fundal height 7Serial measurements of fundal height plateau 7Measurements 1500g: 2SD +/- 14.8% for babies 2cm 7Fetal movements 7Fetal breathing movements 7Fetal tone 7Cardiotocography Clinical assessment of IUGR Search for underlying condition 7karyotype 7ultrasound search for structural abnormalities 7TORCH titres 7renal function tests Prevention 91:129-138 Flow velocity waveforms of the ductus venosus with low pulsatility (top) and high pulsatility (bottom), which is caused by a decrease of early diastolic forward flow (D) and in particular by very low velocities during atrial contraction Pathologic Venous Doppler Late sign of CV decompensation Reflects decreased ability to handle venous return Increase in RAP causes a-wave Accentuated A-wave may be: Transmitted to DV Transmitted to UV Precedes FHR decels & fetal death Present in 79/211 (37%) of preterm IUGR Highly predictive of pH 29wks. in minority (37%) of cases “too little, too late” ? “a test in search of a purpose” No evidence that its use improves outcome Await TRUFFLE study results , O&G,2007Ghidini Thank-you Mammalian Dive Reflex Transitions at birth cardiac function and the circulator