Investigation and management of the small for gestational age fetus

Bullough, Sian; Navaratnam, Kate; Sharp, Andrew

doi:10.1016/j.ogrm.2020.11.002

Cited by 10 publications

(15 citation statements)

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“…However, understanding the health of the placenta, the interface between the mother and the fetus that facilitates the transport of oxygen and nutrients from the mother to the fetus, informs the clinician of fetal health. Placental insufficiency is associated with the reduced transfer of oxygen and nutrients, preventing the fetus from reaching its genetic growth potential [ 1 ] and resulting in fetal growth restriction (FGR). Concerningly, FGR not only predisposes an infant to preterm delivery and a greater risk of both morbidity or death at or around the time of birth, but also predisposes surviving neonates to coronary artery disease, obesity, diabetes, and hypertension in later life, a phenomenon known as developmental programming.…”

Section: Introductionmentioning

confidence: 99%

“…Current clinical management of FGR, therefore, includes sonographic serial assessment of fetal size, amniotic fluid, and fetal movements, as well as the measurement of fetal and maternal uterine artery and fetal arterial/venous vascular resistance and waveforms, derived from Doppler ultrasound to indicate the severity of the placental insufficiency. [ 1 , 12 ] However, these parameters only assess the fetal circulatory response to placental oxygen and nutrient supply and are unable to directly assess fetal oxygenation. Thus, fetal blood oxygenation status is not a parameter that is currently used to detect and characterize FGR in humans.…”

Section: Introductionmentioning

confidence: 99%

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Placental MRI Predicts Fetal Oxygenation and Growth Rates in Sheep and Human Pregnancy

et al. 2022

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Magnetic resonance imaging (MRI) assessment of fetal blood oxygen saturation (SO 2 ) can transform the clinical management of high-risk pregnancies affected by fetal growth restriction (FGR). Here, a novel MRI method assesses the feasibility of identifying normally grown and FGR fetuses in sheep and is then applied to humans. MRI scans are performed in pregnant ewes at 110 and 140 days (term = 150d) gestation and in pregnant women at 28 +3 ± 2 +5 weeks to measure feto-placental SO 2 . Birth weight is collected and, in sheep, fetal blood SO 2 is measured with a blood gas analyzer (BGA). Fetal arterial SO 2 measured by BGA predicts fetal birth weight in sheep and distinguishes between fetuses that are normally grown, small for gestational age, and FGR. MRI feto-placental SO 2 in late gestation is related to fetal blood SO 2 measured by BGA and body weight. In sheep, MRI feto-placental SO 2 in mid-gestation is related to fetal SO 2 later in gestation. MRI feto-placental SO 2 distinguishes between normally grown and FGR fetuses, as well as distinguishing FGR fetuses with and without normal Doppler in humans. Thus, a multi-compartment placental MRI model detects low placental SO 2 and distinguishes between small hypoxemic fetuses and normally grown fetuses.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Placental MRI Predicts Fetal Oxygenation and Growth Rates in Sheep and Human Pregnancy

et al. 2022

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“…As expected, this is smaller than the prevalence of 13.5% reported in Buea and the 11% national prevalence [ 28 ], which considered deliveries irrespective of gestational age. The prevalence in this study corresponds more to the proportion of babies who might have experienced intra-uterine growth restriction or, better still, were just small for their gestational age babies at term [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Adverse maternofoetal outcomes associated with ionised calcaemia, total calcaemia, albuminaemia, and calcium supplementation in pregnancy: Analysis from a resource-limited setting

et al. 2022

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Introduction Disorders of total calcium (tCa) in pregnancy have been associated with adverse maternofoetal outcomes. However, studies evaluating this from the viewpoint of ionised calcaemia are practically inexistent. This study estimates the prevalence of some adverse maternal and foetal outcomes and the potential effect of ionised calcium (iCa), tCa, albumin and calcium supplementation on some maternofoetal outcomes. Methods A cross-sectional study was conducted among 1074 pregnant women in late pregnancy from four health facilities in the Nkongsamba Health District. Data were collected by interview, analysis of maternal blood samples and measurement of maternal and foetal parameters. Total calcaemia and albuminaemia were measured by atomic absorption spectrophotometry, while iCa and pH were measured using ion-selective potentiometry. Associations were measured using the odds ratio in simple and multiple logistic regression. Results The prevalence of low birth weight, macrosomia, and hypertension in pregnancy was 6.27 [4.97–7.89]%, 4.78 [3.65–7.89]%, 10.24 [8.57–12.20]%, respectively. Following multiple logistic regression, women with iCa levels ≤ 1.31mmol/L had significantly increased odds of hypertension in pregnancy (AOR = 2.47 [1.63–3.74], p-value = 0.000), having babies with low birth weight (AOR = 2.02[1.33–3.61], p-value = 0.002), low birth length (AOR = 2.00 [1.34–2.99], p-value = 0.001), low brachial circumference (AOR = 1.41[1.10–1.81], p-value = 0.007), first minute Apgar score < 7 (AOR = 3.08[1.70–5.59], p-value = 0.000) and fifth minute Apgar score < 7 (AOR = 2.86[1.32–6.16], p-value = 0.007). Ionised calcaemia had no significant association with maternal body mass index immediately after birth and the head circumference of the baby. Total calcaemia was found to have no significant association with any of the selected outcomes, while women with total albuminaemia ≤ 30mg/L had significantly higher odds of having babies with low birth weight (AOR = 3.40[1.96–5.91], p-value = 0.000), and Apgar scores < 7 at the first (AOR = 2.07[1.16–3.70], p-value = 0.013). Calcium supplementation showed no significant association with any of the selected outcomes except for the first (OR = 0.42[0.24–0.72], p-value = 0.002) and fifth minute Apgar score (OR = 0.25[0.12–0.50], p-value = 0.000). Conclusion The prevalence of low birth weight, macrosomia, and hypertension in pregnancy was 6.27 [4.97–7.89]%, 4.78 [3.65–7.89]%, 10.24 [8.57–12.20]%, respectively. Maternal iCa levels ≤ 1.31mmol/L significantly increase the odds of having babies with low birth weight, low birth length, low brachial circumference at birth, low Apgar scores at the first and fifth minutes and maternal hypertension in pregnancy. Low maternal albuminaemia is significantly associated with low birth weight, and Apgar score < 7 at the first minute. None f the selected maternofoetal outcomes directly depend on total calcaemia, given that none of the associations was statistically significant. Even though iCa levels remain relatively normal in normal pregnancies, it remains the strongest predictor of foetal outcomes. Calcium supplementation significantly improves the Apgar scores at the first and fifth minute. Routine pregnancy follow-up should include evaluating maternal calcaemic states, particularly the ionised fraction, to detect the low-normal concentrations likely to impact maternal and foetal outcomes. Normal iCa levels for pregnant women need revisiting.

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“…Maternal risk factors included previous caesarean section, 7 BMI ≥30 kg/m, 2,8–11 diabetes, 12,13 pre‐eclampsia or cardiac comorbidities 14 that would limit the second stage of labour. Fetal risk factors included large for gestational age, 15 intrauterine growth restriction, 16 twin pregnancy 17,18 and malpresentation 19–22 …”

Section: Methodsmentioning

confidence: 99%

“…Maternal risk factors included previous caesarean section, 7 BMI ≥30 kg/m, 2,8-11 diabetes, 12,13 pre-eclampsia or cardiac comorbidities 14 that would limit the second stage of labour. Fetal risk factors included large for gestational age, 15 intrauterine growth restriction, 16 twin pregnancy 17,18 and malpresentation. [19][20][21][22] The sample was one of convenience, determined by the response rate achieved during the period of data collection, with the aim of achieving a sample of over 100.…”

Section: They Were Also Asked What Advice They Received On What To Eatmentioning

confidence: 99%

Single‐centre survey of women reflecting on recent experiences and preferences of oral intake during labour

McDermott

Pelecanos

Krepska

et al. 2022

Aust NZ J Obst Gynaeco

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Background: Consensus-based recommendations guiding oral intake during labour are lacking. Aims:We surveyed women at a tertiary women's hospital about preferences for and experiences of oral intake during labour, gastrointestinal symptoms during labour and recalled advice about oral intake. Materials and methods:Women who experienced labour completed a postpartum survey with responses as free text, yes-no questions and five-point Likert scales. We identified demographic data and risk factors for surgical or anaesthetic intervention at delivery from medical records. We summarised free text comments using conventional content analysis.Results: One hundred and forty-nine women completed the survey (47% response rate). Their mean (SD) age was 31 (four) years, birthing at median gestation of 39 weeks (interquartile range: 38-40). One hundred and twenty-two (83%) and 44 (30%) women strongly agreed or agreed they felt like drinking and eating respectively during labour. Ninety women (61%) reported nausea and 47 women (32%) reported vomiting in labour. Forty-one women (28%) did not receive advice on oral intake during labour. Maternal risk factors for surgical intervention were identified in 72 (48%) women and fetal risk factors in 27 (18%) women. Thirty-one women (21%) delivered by emergency caesarean section. Conclusion:Pregnant women received variable advice regarding oral intake during labour, from variable sources. Most women felt like drinking but not eating during labour. Guidelines on oral intake in labour may be beneficial to women, balancing the preferences of women with risks of surgical intervention.

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Investigation and management of the small for gestational age fetus

Cited by 10 publications

References 1 publication

Placental MRI Predicts Fetal Oxygenation and Growth Rates in Sheep and Human Pregnancy

Placental MRI Predicts Fetal Oxygenation and Growth Rates in Sheep and Human Pregnancy

Adverse maternofoetal outcomes associated with ionised calcaemia, total calcaemia, albuminaemia, and calcium supplementation in pregnancy: Analysis from a resource-limited setting

Single‐centre survey of women reflecting on recent experiences and preferences of oral intake during labour

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