Re: Second trimester SGA
From: art fougner, md (evsono@pipeline.com)
Sun Jan 14 17:55:59 2001
hemoglobin electrophoresis? so many choices, so little data.
art
At Sun, 14 Jan 2001, Terry J DuBose wrote:
>
>Dr. Tung-yao Chang:
>
>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
>
>--------------------------------
>
>--------------------------------
>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.
>>
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
