GESTATIONAL TROPHOBLASTIC TUMORS (GTT) GESTATIONAL TROPHOBLASTIC Disease (GTD)
IUGR - India’s Premier Educational Institution JK.pdf · • uterine artery • normal flow •...
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Transcript of IUGR - India’s Premier Educational Institution JK.pdf · • uterine artery • normal flow •...
IUGR
• Defenition
• SGA
• Cause
• Placental insufficiency
• UA
• MCA
• FETAL CVS
• S/D=PSV/EDV
• RI= PSV‐EDV/PSV
• PI=PSV‐EDV/MEAN
• VASCULAE IMPEDANCE/VASCULAR RESISTANCE
• UTERINE ARTERY
• NORMAL FLOW
• FUNCTION
• TROPHOBLASTIC INVASION
• EARLY DETECTION OF
• PREECLAMPSIA PI/UTERINE NOTCHING 2ND
TRIMESTER
• IUGR‐‐‐RI
• UNCLEAR MESSAGES
UMBLICAL ARTERY
• AREAS
• END DIASTOLIC FLOW
• FETAL BREATHING
• DIASTOLIC VELOCITY
MCA
• BRAIN SPARING EFFECT = PI
• LOW ,HIGH
• PSV =IUGR
• ANEMIA,HYPOXIA ‐‐‐‐PATHOPHYSIOLOGY
MEASUREMENT OF MCA/PSV
• AXIAL SECTION ‐‐‐SPHENOID BONE
• CIRCLE OF WILLIS‐‐‐‐ANGLE 0
• ENLARGE MCA
• INTERROGATE MCA
• MEASURE PSV
• REPEAT 3‐5 TIMES
• REPEATED WAVEFORMS SHOULD BE SIMILAR
• LOW MCA PI• Brain growth post uterine contractions
• Heart rate
• Severe anemia
• Post transfusion
• Therapeutic amniocentesis
• Hypoximia/acidemia
HIGH MCA PI
• UTERINE CONTRACTION
• HEART RATE
• OLIGOHYDRAMNOIS
• FETAL HEAD COMPRESSION
• SUSTAINED HYPOXEMIA /ACIDEMIA
• HYDRANENCEPHALY
• INDOMETHACIN ADMINISTRATION
• DESCENDING AORTA
• SPLENIC ARTERY
• SMA
• ADRENAL ARTERY
• RENAL ARTERY
• SUPERIOR CEREBELLAR ARTERY
FETAL VENOUS SYSTEM
FETAL CARDIAC SYSTEMATRIO/VENTRICULAR VALVES
• E=• A=• NORMAL=A>E• MID= A=E• LATE= A<E• IUGR E/A
• MR/TR
AORTIC/PULMONARY VALVES
• PEAK VELOCITY ‐‐‐
• IUGR—
• PLACENTAL RESISTANCE
• RT‐‐‐‐LT VENTRICLE SHIFT
• NST/UA –NORMAL=NO FETAL ACIDOSIS /HYPOXIA=STAGE 1
• NST‐‐‐NOR , UA‐‐‐ABNORMAL‐‐‐5% HYPOXIA/= STAGE 2
• BOTH ABNORMAL =50% HYPOXIA=STAGE 3
• STAGE 1
• Abnormal UA PI
• Abnormal MCA PI
• STAGE 2
• UA—ABSENT
• MCA PSV‐‐‐
• DV PI abnormal
• Umblical vein pulsation
• STAGE 3
• DV PI ‐‐‐‐REVERSE
• UV—REVERSED FLOW