ULTRASOUND Messages for January, 2001: Re: Second trimester SGA

Re: Second trimester SGA

From: Terry J DuBose

tjdubose@juno.com

Sun Jan 14 07:50:08 2001

This is a difficult case... and will probably be a very good learning experience, as difficult cases often are. Thank you for asking questions about it here and for sharing this case with us. The suggestions for investigation that we have seen here so far all seem valid... RH incompatibility, chromosomal problems, placental insufficiency, and infection all come to mind. Of course, following the pregnancy will be informative.

I am curious about the specific fetal measurements. Since there is IUGR (approximately -3.0 standard deviations below the mean age), does it appear to be symmetrical or asymmetrical? How does the abdominal circumference (AC) compare to the transverse head circumference? With infection I would expect to see visceromegaly with enlargement of the liver and/or spleen which can result in an increased AC, or a normal appearing AC even though there is IUGR.

You mentioned a notching in the umbilical arterial flow; you might also look at the veinous side of the cord. I do not have a lot of experience with this, but there have been reports that "... Research has found that umbilical venous pulsations are a generic sign of fetal congestive heart failure and in combination with fetal non-immune hydrops is a dismal sign. Others point out that `Fetuses may have umbilical venous pulsations with absent end-diastolic velocities in the umbilical artery, or with growth retardation, multiple anomalies, chromosomal abnormalities, urethral atresia, or cardiac hypertrophy, among other conditions.' This complex topic maternal/fetal/placental Doppler study is deserving of more research. " Tulzer G, Gudmundsson S, Wood DC, et al; "Doppler in non-immune hydrops fetalis"; Ultrasound in Obstet Gynecol, 1994; 4:249-283. Indik JH, Chen V and Reed KL; "Association of umbilical venous and inferior vena cava blood flow velocities"; Obstet Gynecol, 1991; 77:551-557. Reed KL; "Opinion: the role of venous Doppler in fetuses with non-immune hydrops"; Ultrasound in Obstet Gynecol, 1994; 4:268-269. DuBose, TJ; FETAL SONOGRAPHY; W. B. Saunders Co. 1996; p 364-369.

I fear that there are no simple answers to these kinds of cases... however sonography and the ability of global communications affords us a wonderful opportunity to learn. Thanks again, and we will be anxious to hear more as the case progresses.

Peace, Terry J DuBose, M.S., RDMS Chair, Editorial Advisory Board, Ultrasound@OBGYN.net University of Arkansas for Medical Sciences Little Rock, USA

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On Sat, 13 Jan 2001 11:30:18 -0600 tychang@ms1.mmh.org.tw writes: -------------------------------- > Dear netters,

-- -------------------------------- > > I saw a fetus last Friday. Second trimester SGA. The mother was sure > about her > LMP and the gestational age was confirmed ealier by a dating scan at > another > hospital. The gestational age was 21+ weeks, but the fetal size was > equivalent > to 18-weeks. The anatomical screening was normal, and no chromosomal > markers > were found except mild dolichocephaly. The placental morphology was > normal. > There was only a small and unilateral notch on the uterine artery > Doppler > waveform, with normal PI. Liquor volume was around 3rd percentile. > No PPROM. > > Placental insufficiency? > > The mother had a previous IUFD around 28 weeks because of hydrops > fetalis. The > previous fetus was also growth retarded. An FBS before fetal death > revealed > severe fetal anemia. No infection or anomaly was identified. This is > all the > information I have for the previous pregnancy. > > Well, my friends. First, what will you do next? Second, what will > you recommand > to scan for fetal anemia? > > Tung-yao Chang, MD > Dept. of obstetric and Gynecology, > Mackay Memorial Hospital, > Taipei, Taiwan. >

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