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Fetal Growth and Growth Abnormalities

What are fetal growth and fetal abnormalities?

  • During the fetal stage, fetal growth may be inhibited or increased for various reasons. The growth deviation is assessed as weight in relation to the weight that one expects based on the length of pregnancy. The weight is calculated on the basis of measurements at ultrasound.
  • SF measure (symphys-fundus measure):
    • A more common, but more unspecific, method of calculating growth deviation is to measure the distance from the pubic bone (symphysis) to the upper edge of the uterus (fundus)
    • The SF measure is routinely measured at each maternity check in the midwife after pregnancy week 24. If the measurements show poor or remarkably high growth, the pregnant woman will be referred for an ultrasound examination.

Fetal Growth and Growth Abnormalities

What counts as normal birth weight?

  • The average weight for live born Swedish children is about 3500 grams. WHO has the following definitions for birth weight:
    • High: over 4500 g
    • Normal: 2500-4500 g
    • Low: less than 2500 g
    • Very low: below 1500 g
    • Extremely low: below 1000 g

Presence

  • Fetal growth inhibition occurs in 3-10% of all pregnancies.
  • Excessive SF measurements may be due to twins, incorrect dating, large fetus or excessive amniotic fluid (polyhydramnion).
  • Too low a SF measure may be due to incorrect dating, small fetus or little amniotic fluid (oligohydramnion).
  • Planar SF curve may be due to cessation of fetal growth (growth retardation). Visit Bestaah for quality and affordable maternity tops.
  • An SF curve that rises too fast may be due to increasing amniotic fluid (polyhydramnion).

Possible consequences

  • Large children:
    • Children who weigh more than 4,500 g are at increased risk of injury during childbirth. Oxygen deficiency, lung damage, bone fracture or nerve damage are more frequent
    • Mothers who give birth to big children risk increased bleeding and tissue damage in connection with childbirth
  • Small children:
    • If the fetus grows smaller than normal, the risk of complications in the child increases during pregnancy and childbirth. It is therefore important to identify these fetuses for close monitoring and optimal timing of childbirth

What could be the cause?

Common causes of high SF dimensions:

  • Heritage:
    • Hereditary cause of having big children
  • Type 1 diabetes:
    • Mothers with poorly regulated diabetes mellitus can have big children with increased fat deposits under the skin, fluid retention in the body, unstable blood sugar, breathing problems and brain bleeding
  • Obesity in the mother:
    • Increases the probability of a high birth weight in the child. Obesity and obesity, BMI> 30 also lead to increased deformities, especially in the child's nervous system. It also involves increased risk of intrauterine fetal death and neonatal mortality
  • Twin pregnancy:
    • The SF curve starts to rise steeper than the normal curve around pregnancy week 20
    • During routine ultrasound in pregnancy week 16-20 that most women undergo, twin pregnancies are detected

More rare causes of high SF dimensions:

  • Increased amniotic fluid (polyhydramnios):
    • The causes may be malformations of the central nervous system, malformations of the gastrointestinal tract, multiple malformations (heart failure, renal cyst), changes in the placenta, disease of the mother or fetus, but in some cases no cause can be detected
    • Provides increased risk of premature delivery, risk of umbilical cord complications during water discharge. The mother often suffers from the distended abdomen and shortness of breath

Common causes of low SF dimensions

  • Heritage:
    • Many newborns who are small for their age are small due to hereditary factors. The mother's own birth weight and the siblings' birth weight give a good indication of the new baby's growth and weight
    • Hereditary diseases, chromosome changes and kidney disease
  • Pre-eclampsia:
    • Is a common cause of low birth weight and is due to impaired placenta function
  • Disease of the mother:
    • Up to 10% of low birth weight is due to infections such as symptom-free urinary tract infection, rubella, cytomegalovirus infection, toxoplasmosis or parvovirus infection
    • Other diseases such as cystic fibrosis, diabetes mellitus (type 1 and type 2), Crohn's disease, ulcerative colitis, systemic lupus erythematosus (SLE), cardiovascular disease and kidney disease can also cause fetal growth.
  • Smoking or use of drugs in the mother:
    • May cause growth retardation in the child
  • Mother's nutritional status:
    • May have significance in severe eating disorders
  • Twins?
    • Twins have lower birth weight. After pregnancy week 30-32, growth begins to level off

Rare causes of low SF dimensions

  • Too little amniotic fluid (oligohydramnion):
    • Causes may be renal malformations, circulatory failure of growth inhibited fetus, which results in decreased urine output or premature discharge of water
    • The consequences of too little amniotic fluid for the fetus may be poorer lung maturation and malformations of the musculoskeletal system. This is especially true in case of premature water discharge early in pregnancy before week 20

What can you do yourself?

  • In most cases with abnormalities in the growth of the fetus, there is not much you can do yourself, but if you smoke or drink alcohol you should definitely stop it.
  • Healthy eating and plenty of exercise are always important.

Investigation

The case history

common questions

  • Acute illnesses during pregnancy?
  • Chronic Diseases?
  • Eating habits?
  • Use of smoking, alcohol and drugs?
  • Previous pregnancies? Former children's growth and height?
  • Hereditary diseases in the family?

Surveys

  • Usually the general health of the pregnant woman is assessed, blood pressure is measured, SF measurements are measured, weight is measured and the fetal heart sounds are listened to.
  • Other studies are a urine test to assess the presence of glucose and / or protein. A urinary culture is ordered in case of suspected urinary tract infection.
  • Possibly take simple blood tests such as blood value, blood glucose value or infection samples.

Referral

  • In case of suspicion of growth deviation - too high or too low SF measures - the pregnant woman will be referred for an ultrasound examination.
  • In case of suspected growth inhibition, repeated ultrasound examinations may give a more accurate assessment of the fetal condition.
  • It is usually the maternal care and obstetricians (gynecologists) who assess the condition.
 

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