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Re: Prior cesarean, SGA, need your help....From: Terry J. DuBose (tjdubose@chrp.uams.edu)Thu Jul 31 17:46:09 1997
If I am reading the data correctly the following is what has transpired, correct? Sono @ no date (Feb.21?)= 15 weeks = EDC: 8/16/97 Sono @ 7/14/97 = 35.4 = EDC: 8/15/97 Sono @ 7/15/97 = Head35/abd33 = EDC: 8/19/97 (by head) There appears to have been appropiate growth, judging from the limited data set, between the sono at 15 weeks and the 35.4 week exam, and only for days less growth than expected by head measurements. The body is about 2 weeks behind the head. Our large population research on age range analysis indicates that normal fetal parameter variation can be upto +/-10% of the mean age. So at 35 weeks, the body might be as much as 3.5 weeks behind before going outside -2SD. At this late date, I guess I don’t understand the problem, unless it is that she came under your care so late in gestation. If in the next exam(s) the body size/age becomes progressively less than the head size/age, then that’s a problem. But if it stays at about 2 weeks behind, then I would consider it SGA rather than IUGR. Just my 2 pence worth. I would like to know exactly which parameters you use to estimate “head” and “body” sizes, and how those are calcualted? Peace, Terry J. DuBose, M.S., RDMS; Assistant Professor Director, Diagnostic Medical Sonography Program University of Arkansas for Medical Sciences, Fellow, AIUM; Secretary, SDMS tjdubose@chrp.uams.edu http://www.uams.edu/chrp/dmshome.htm http://www.io.com/~dubose/ http://www.obgyn.net/CORRESP/DUBOSE.HTM HTTP://www.obgyn.net/women/advisors/tdubose.htm VOICE: 501-686-6510 FAX: 501-686-5613 Now is the time for all good folks to come to the aid of the Earth. SNIP>> 27 y/o G4P1A2 started prenatal care with this office at 31 wks gestation. Prior doctor did ultrasound at 15 wks supporting due date of 8/16/97. Patient has prior cesarean section with an LUT incision. Patient refusing TOL. Ultrasound was ordered 7/14/97 due to size less than dates. EFW at 35 3/7wks by U/S was 1900g (~10%). Repeat U/S by me on 7/15/97 (I did not have the report until later that day) was 2200g (greater than 10%) but head was 35 wks and body was 33 wks. AFI was 20. At that point I decided to get weekly NST's which have been reassuring. I had her at the hospital today at 37 4/7 wks. Strip was reactive. No contractions. My plan was to tap and deliver if mature... L/S was 1.2 and PG was 0.0. Questions: 1) Should I have just sectioned her? 2) Now that I documented immature lungs, what should I do?
-- ---------------------------------- Geffrey H. Klein, MD ---------------------------------- gklein@bcm.tmc.edu ---------------------------------- http://members.aol.com/gklein01/geff.html List-owner OB-GYN-L co-moderator sci.med.obgyn Advisory Board Chairman OBGYN.net >>
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