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Re: IUGR caseFrom: ATFSOCCER@aol.comSat Oct 4 22:43:59 1997
In a message dated 97-10-04 12:21:35 EDT, you write: << 27 YO G4 P0 with LMP = 18 Feb 1997 now at 32w 5/7 and US at 11 weeks in concordance with the gestational age has now an US average GA of 24w and EFW 530 g with oligohydramnios and an IIIrd maturation degree placenta. Normal BP and usual lab tests, group A II Rh+ Fetal movement normal, reactive FHR. The US fetal morphology was difficult to perform (2 sessions till now) because of the oligohydramnios, but any way even the fetal kidneys weren't seen properly, the both renal arteries were seen and an urinary bladder of 15 mm diameter was identified. No major abnormalities of limbs, head structure, nuchal region, thoracal and lombar spine with normal aspect, heart with 4 chambers, ombilical cord with normal structure; the stomach was not identified. Velocimetry findings were: Omblical 0.81 Cerebral 0.86 with CPR 1.05 Uterine arteries with diastolic notch 0.98 (write) and 0.84 (left) The most intriguing fact is that at 15 weeks after LMP, the US measurement showed 9 weeks ! The patient received Gravibinon every 3 days since then. The question is what to do ? Wait and see what happends ? Is it possible that this is a second pregnancy ? Are there refferences of a "slow" growth in pregnancy ? Thank you very much for your input.
>> Based on the placental maturation and lack of bleeding to suggest a loss I would think that this is the original pregnacy and not a second. Assuming that she is 33 weeks I would seriously be thinking about getting her delivered in a level 3 hospital ASAP. The oligohydramnios and marked growth retardation which seems to be symmetric suggest we are going to get a "bad" baby out of this. In spite of the normal US findings I would be very suspicious for some type of karyotype abnormality or chronic in utero infection such as TORCH or AIDs Syphyllis or chronic drug use. The unfortunate part is that mom is very likely to end up with a stat section for fetal distress and end up with no baby anyway. An umbilical vein sampling for the above maybe helpful in avoiding a section??? Andy Folley MD FACOG Toledo OH
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