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Radiology

Fetal Growth Restriction

Built from Obstetric Imaging

The first 25 slides of Fetal Growth Restriction
The first 25 slides, exactly as they appear. The full deck has 135 content slides.

What’s inside

12 sections · 135 slides

  1. 01

    Overview

    • What this deck covers

    1 slide

  2. 02

    The basic idea

    Growth potential, and what it means to fall short of it

    • A fetus that never reaches its own potential
    • Small for gestational age is a number, not a diagnosis
    • Why it matters before birth
    • Why it matters after birth

    4 slides

  3. 03

    How normal growth is supplied

    Building the placental supply line, and what it delivers

    • Preparation starts before the embryo implants
    • The route blood takes to reach the placenta
    • The supply line, step by step
    • Spiral artery remodelling turns a hose into a river
    • 10x
    • What actually crosses to the fetus
    • Where that blood goes inside the fetus
    • The placenta takes its own cut first
    • Three compartments have to mature in step

    9 slides

  4. 04

    How common it is

    Ten percent by definition -- and why the true figure is slippery

    • How often does it happen?
    • What pushes the numbers up or down
    • Twins and preterm babies are hit hardest

    3 slides

  5. 05

    Why it happens

    Maternal, placental and fetal causes -- and how often each matters

    • Three places the problem can sit
    • Maternal causes -- the supply side
    • Smoking, drugs and alcohol
    • It tends to happen again
    • Placental insufficiency, the commonest mechanism
    • How placental failure becomes small size
    • Placental structure and placental genetics
    • Confined placental mosaicism and chromosome 16
    • Fetal causes -- infection
    • Fetal causes -- whole chromosomes
    • Fetal causes -- single genes and methylation
    • When the bones give the clue
    • How to read the risk factor table
    • Risk Factors for Fetal Growth Restriction
    • Risk Factors for Fetal Growth Restriction (continued)
    • Risk Factors for Fetal Growth Restriction (continued)
    • Risk Factors for Fetal Growth Restriction (continued)
    • Risk Factors for Fetal Growth Restriction (continued)
    • Risk Factors for Fetal Growth Restriction (continued)

    19 slides

  6. 06

    Making the diagnosis

    Dates first, then measurements, then which definition you follow

    • Clinical screening: history and fundal height
    • Everything rests on knowing the dates
    • Why the last menstrual period is not enough
    • When ACOG says to revise the due date
    • Reading the redating rules
    • What the growth scan measures
    • Abdominal circumference and weight percentile charts
    • What to notice on a serial growth chart
    • The trouble with one-size-fits-all charts
    • Why Hadlock is still the recommended formula
    • Early onset versus late onset
    • Severity predicts the outcome
    • The old symmetric versus asymmetric split
    • The United States definition
    • The international definition: early onset
    • The international definition: late onset
    • Two definitions, two different trade-offs
    • What to do once FGR is diagnosed
    • Checking the amniotic fluid

    19 slides

  7. 07

    Doppler

    Four vessels, and the story they tell as the placenta fails

    • What Doppler is actually measuring
    • Four vessels, four questions
    • How a Doppler waveform gives its indices
    • Numbers and yes-or-no signs
    • Uterine artery Doppler: what should happen
    • Normal uterine artery flow in pregnancy
    • When the uterine artery transition fails
    • Uterine artery notching
    • Umbilical artery Doppler: what it looks at
    • Normal umbilical artery flow
    • What happens when the placenta develops badly
    • The umbilical artery deteriorates in order
    • Rising umbilical artery resistance
    • Absent end-diastolic flow in the umbilical artery
    • Reversed end-diastolic flow in the umbilical artery
    • Which index should you use?
    • What abnormal umbilical Doppler means clinically
    • Why the test is weaker in late-onset disease
    • Middle cerebral artery: the fetus protects its brain
    • How to record the middle cerebral artery properly
    • Normal middle cerebral artery flow
    • Brain sparing in the middle cerebral artery
    • The physiology behind brain sparing
    • Cerebroplacental ratio: redistribution in one number
    • What the PORTO trial showed about CPR
    • Should cerebroplacental ratio be used to screen?
    • Where cerebroplacental ratio actually sits today
    • Ductus venosus: the fetal express lane
    • Normal ductus venosus flow
    • When the fetal heart starts to struggle
    • Reversed a-wave in the ductus venosus
    • What an abnormal a-wave warns you about
    • The TRUFFLE study
    • The caveat on ductus venosus

    34 slides

  8. 08

    Differential diagnosis

    Before you call it growth restriction, rule out the mimics

    • Is it really growth restriction?
    • Low fluid: think about ruptured membranes too
    • How Doppler helps the differential

    3 slides

  9. 09

    Management before birth

    No cure, so the whole question becomes when to deliver

    • There is no treatment that makes the fetus grow
    • What does help
    • Aspirin: for pre-eclampsia, not for FGR alone
    • So what is management actually for?
    • The monitoring toolkit
    • The guidelines do not agree
    • Common ground between the guidelines
    • The non-stress test
    • Computerised cardiotocography
    • How often to test
    • Why reversed flow means admission
    • The biophysical profile
    • Why the biophysical profile works
    • What a biophysical profile score predicts
    • The argument about BPP in growth restriction
    • Deciding when to deliver
    • Doppler changes outcomes, but guidelines differ
    • How to read the delivery timing table
    • Delivery Timing Recommendation Differences Between the Society of Maternal-Fetal Medicine and the International Society of Ultrasound in Obstetrics and Gynecology
    • Delivery Timing Recommendation Differences Between the Society of Maternal-Fetal Medicine and the International Society of Ultrasound in Obstetrics and Gynecology (continued)
    • Notes on that table

    21 slides

  10. 10

    After birth

    What growth restriction leaves behind, in the first days and for life

    • What decides the newborn's outcome
    • Immediate metabolic problems
    • Brain and nervous system
    • Other organ systems
    • Infection and long-term disease
    • The Barker hypothesis

    6 slides

  11. 11

    What to take away

    The points the referring clinician needs, and the classic signs

    • For the referring physician: dating and diagnosis
    • For the referring physician: testing
    • For the referring physician: management
    • Classic signs
    • Key points

    5 slides

  12. 12

    References

    The chapter's own reference list

    • References
    • References (continued)
    • References (continued)
    • References (continued)
    • References (continued)
    • References (continued)
    • References (continued)
    • References (continued)
    • References (continued)
    • Suggested reading
    • Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition

    11 slides