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  • Bavaharan: Criteria & FGR Management

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    This document discusses criteria and management of fetal growth restriction (FGR). It defines small for gestational age (SGA) as near normal perinatal outcome, while FGR is pathological with abnormal fetoplacental circulation and poor perinatal outcome. Early-onset FGR (<32 weeks) is associated with severe placental insufficiency and chronic fetal hypoxia, while late-onset FGR (>32 weeks) has milder placental disease and lacks natural history. Management is based on fetal adaptability and response, with increased surveillance and potential delivery depending on gestational age and signs of deterioration.

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    This document discusses criteria and management of fetal growth restriction (FGR). It defines small for gestational age (SGA) as near normal perinatal outcome, while FGR is pathological with abnormal fetoplacental circulation and poor perinatal outcome. Early-onset FGR (<32 weeks) is associated with severe placental insufficiency and chronic fetal hypoxia, while late-onset FGR (>32 weeks) has milder placental disease and lacks natural history. Management is based on fetal adaptability and response, with increased surveillance and potential delivery depending on gestational age and signs of deterioration.

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    © All Rights Reserved
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    10 views12 pages

    Bavaharan: Criteria & FGR Management

    Uploaded by

    SM SCANS
    This document discusses criteria and management of fetal growth restriction (FGR). It defines small for gestational age (SGA) as near normal perinatal outcome, while FGR is pathological with abnormal fetoplacental circulation and poor perinatal outcome. Early-onset FGR (<32 weeks) is associated with severe placental insufficiency and chronic fetal hypoxia, while late-onset FGR (>32 weeks) has milder placental disease and lacks natural history. Management is based on fetal adaptability and response, with increased surveillance and potential delivery depending on gestational age and signs of deterioration.

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    BAVAHARAN

    CRITERIA & FGR MANAGEMENT


    CRITERIAS
    SMALL FETUSES — ULTRASOUND EFW < 10TH CENTILE.
    AC <10TH CENTILE CAN ALSO BE USED AS
    CRITERIA

    SGA FGR
    SGA - NEAR NORMAL PERINATAL OUTCOME FGR -PATHOLOGICAL - ABNORMAL FETOPLACENTAL CIRCULATION - POOR
    F A L PERINATAL OUTCOME
    K O R M G IC
    IR S BN OL O O
    A EUR E
    N COM
    U T EARLY ONSET
    O LATE ONSET
    <32WEEKS >32WEEKS
    GOOD POOR
    FETAL ADAPTATION FETAL ADAPTATION
    SEVERE SMALLNESS IMMATURE / GOOD TOLERANCE TO HYPOXIA MATURE / POOR TOLERANCE TO HYPOXIA
    <3RD CENTILE EFW OR AC SEVERE PLACENTAL DISEASE MILD PLACENTAL DISEASE
    WITH NORMAL DOPPLER HIGH ASSOCIATION WITH PE LOW ASSOCIATION WITH PE
    10TH - 50TH CENTILE EFW

    UMBILICAL ARTERY - NORMAL UTERINE ARTERY - ABNORMAL


    CPR - ABNORMAL

    SURVEILLANCE
    NEEDED
    CPR IS THE
    LATE ONSET FGR - NEED NOT HAVE REDUCED WEIGHT OF SURVEILLANCE TOOL
    <1OTH CENTILE
    EARLY ONSET FGR
    EARLY-ONSET FGR
    ASSOCIATED WITH GOOD FETAL
    ADAPTABILITY

    SEVERE PLACENTAL INSUFFICIENCY CHRONIC FETAL HYPOXIA.


    UMBIL
    ICAL A
    RTERY
    IS ABNOR DECO PROG
    MAL MPE RESS
    NSAT
    E TO
    ACID D HYPO
    OSIS XIA &

    MANAGEMENT BASED ON FETAL


    ADAPTABILITY & RESPONSE
    LATE ONSET FGR LACKS NATURAL HISTORY DETORIATION CASCADE OCCURS FAST

    THE DEGREE OF PLACENTAL DISEASE IS MILD UA DOPPLER IS NORMAL

    ABNORMAL CPR VALUES


    ADVANCED SIGNS OF FETAL DETERIORATION WITH CHANGES IN THE DV ARE VIRTUALLY NEVER OBSERVED

    SURVEILLANCE
    NEEDED
    PLAN DELIVERY IF SIGNS
    OF DETORIATION OCCURS
    STAGES
    STAGE 1
    <37 WEEKS >37WEEKS

    WEEKLY DELIVER BY
    FOLLOW UP LABOUR
    INDUCTION
    TEXT

    STAGE 2

    <34 WEEKS >34 WEEKS

    TWICE WEEKLY DELIVER BY LSCS


    FOLLOW UP
    TEXT

    STAGE 3

    <30 WEEKS >30 WEEKS

    DAILY DELIVER BY LSCS


    FOLLOW UP
    STAGE 4

    <27 WEEKS >27 WEEKS

    DAILY DELIVER BY LSCS


    FOLLOW UP
    ISOLATED OLIGO
    ▸ Mild oligo with no comorbid conditions - till 37 - deliver

    ▸ However pregnancies which were remote from term should be managed


    conservatively and should be kept under regular follow up with frequent
    assessment of AFI

    ▸ Moderate to severe oligohydramnios may be delivered at 35 completed weeks


    after administration of antenatal steroids.
    GESTATIONAL DIABETES MELLITUS WITH FGR & POLYDRAMNIOS - NO STRUCTURAL FETAL ANOMALIES

    ▸ Chance of IUD is high

    ▸ Deliver if more than 32 weeks - irrespective of doppler findings

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