Diagnostic ultrasound ( PDFDrive )

1456 PART IV Obstetric and Fetal Sonography
Fetal and Placental Risk Factors Associated
With Fetal Growth Restriction
FETAL FACTORS
Chromosomal Abnormalities
Trisomy 13, 18, 21
Monosomy (45,XO)
Deletions
Uniparental disomy
Conined placental mosaicism
Congenital Malformations
Absence of fetal pancreas
Anencephaly
Diaphragmatic hernia
Omphalocele
Gastroschisis
Renal agenesis/dysplasia
Multiple malformations
Multiple Gestations
Monochorionic twins
One fetus with malformations
Twin-to-twin transfusion
Discordant twins
Triplets
PLACENTAL FACTORS
Abnormal trophoblastic invasion
Multiple placental infarctions (chronic abruption)
Umbilical-placental vascular anomalies
Abnormal cord insertion (velamentous cord insertion)
Placenta previa
Circumvallate placenta
Chorioangiomata
With permission from Lin C. Current concepts of fetal growth
restriction: part I. Causes, classiication, and pathophysiology. Obstet
Gynecol. 1998;92(6):1044-1055. 135
oxygenation or nutrition to the fetus, antenatal surveillance can
improve the outcome for these fetuses. Surveillance of such a
fetus includes serial ultrasounds to monitor fetal growth, perform
biophysical proiles (BPPs), and measure Doppler parameters.
Nonstress tests (NSTs) are also used to monitor fetal well-being.
he nature and frequency of monitoring tests depends on the
apparent severity of fetal compromise. 10,11
Biophysical Proile
he BPP, introduced in the 1980s, is a noninvasive test of fetal
well-being based on four ultrasound parameters and the NST.
he four ultrasound parameters are (1) fetal movement, (2) fetal
tone, (3) fetal breathing movements, and (4) amniotic luid volume
(Table 42.13, Fig. 42.11, Videos 42.2 and 42.3). Each parameter
receives 2 points if the fetus meets criteria and 0 points if it does
not. hus a perfect score for the ultrasound portion of the BPP
is 8 out of 8, with 2 points given for each of the four parameters.
145,146 he parameters were chosen to assess both the acute
and the chronic state of the fetus, with acute parameters being
fetal tone, movement, and breathing movements, and amniotic
Maternal Risk Factors Associated With Fetal
Growth Restriction
GENETIC/CONSTITUTIONAL
NUTRITION/STARVATION
Inlammatory bowel disease
Ileojejunal bypass
Chronic pancreatitis
Low prepregnancy weight
Poor pregnancy weight gain, second and third trimesters
HYPOXIC
Severe lung disease
Cyanotic heart disease
Sickle cell anemia
VASCULAR
Chronic hypertension
Preeclampsia
Collagen vascular disease
Type 1 diabetes mellitus
RENAL
Glomerulonephritis
Lipoid nephritis
Arteriolar nephrosclerosis
Renal transplantation
ANTIPHOSPHOLIPID ANTIBODIES
ENVIRONMENT AND DRUGS
High altitude
Emotional stress
Physical stress
Cigarette smoking
Alcohol abuse
Substance abuse (heroin, cocaine)
Therapeutic drugs
Antimetabolites
Anticonvulsants
Anticoagulants
POOR OBSTETRIC HISTORY
Previous stillbirths
Recurrent aborters
Previous birth of growth-restricted fetus
Previous preterm births
With permission from Lin C. Current concepts of fetal growth
restriction: part I. Causes, classiication, and pathophysiology. Obstet
Gynecol. 1998;92(6):1044-1055. 135
luid volume being a chronic marker of fetal well-being. 145 Studies
have shown that the BPP is reliable and reproducible, and that
scores of 8 out of 8 are associated with a low rate of stillbirths
and low rate of fetal asphyxia within 1 week of testing. 11,145,147-150
Lower scores, those below 6 out of 8, are associated with increased
risk for fetal asphyxia, low cord pH, cerebral palsy, and stillbirth.
he lower the score is, the higher the risk of perinatal compromise
will be. 11,145,148
he BPP exam is performed within 30 minutes. If a fetus
does not meet criteria for a parameter within the 30-minute
time period, that parameter is given a score of 0. he BPP score