SMALL FOR DATE UTERUS
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Woman at 33wks. Her height of fundus is 30cm. What will you do next?
I will confirm that she has a small for date uterus by ensuring the measurement is accurate and that the date is accurate.
How will you ensure that the date is accurate?
By checking her USG result done at <24wks gestation
What if she did not have any ultrasound done at <24wks, how will you ensure the date is accurate?
By verifying that her LMP was not the date she missed her period, and if she kept a menstrual calender, and if her menses were regular prior to the menses, or if she did use hormonal contraception prior to her LMP, or any early pregnancy bleeding. Also date of quickening and of any early pelvic exam could help
Okay, you are now sure the measurements are accurate and the date is certain, what will you do next?
I will find out if the small uterus is due to small baby or small liqour, by from ultrasound biometry and amniotic fluid measurements. If fetal biometry are <10th percentile, then the diagnosis of SGA baby is made.
On the ultrasound, the EFW, HC, AC, FL are all < 3rd percentile and so you made a diagnosis of SGA. What will you do next?
I will find out if the baby is small constitutionally or small because of growth restriction.
How will you differentiate a constitutional SGA from IUGR?
Initially from associated features on ultrasound, then on repeat ultrasound in 2weeks
What associated features will you find on ultrasound that may tell you the fetus is suffering from FGR rather than being constitutionally small
Low biophysical profile, abnormal doppler studies, oligohydramnios
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