USS FEATURES OF IUGR AND MACROSOMIA.

IUGR
Various conventional and Doppler ultrasonographic criteria have been proposed for diagnosing IUGR. Proposed conventional criteria include estimated fetal weight below the tenth percentile for gestational age. Elevated ratio of femur length to abdominal circumference Elevated ratio of head circumference to abdominal circumference

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of FL/AC after 20wks GA of 0.21-0.24 is considered appropriate for GA. FL/AC less than 0.21 is considered as macrosomia. FL/AC greater than 0.24 is considered as asynmetrical IUGR.

Doppler criteria include elevated ratio of systolic: diastolic blood flow velocity in the umbilical artery or in the uterine artery. No single criterion however, has a sufficiently high positive predictive value for IUGR to permit a confident exclusion of IUGR Diagnosis or exclusion of IUGR can best be achieved by the combined use of three parameters: estimated fetal weight, amniotic fluid volume and maternal B.P

Intrauterine growth retarded fetus with absent enddiastolic flow in the fetal umbilical artery.

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etimated fetal birth weight, oligohydraminous and high maternal B.P are pointers towards IUGR. After extrinsic causes of IUGR,like smoking, alcoholism in the mother, DM and HBP have been excluded ; USS should attempt to exclude intrinsic causes. Intrinsic causes includes aneuploidy Particular attention should be paid to the fetal hands and tone

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fingers or strangely postured hands in a small fetus should immediately elicit a concern for trisomy. isolated fetal anomalies can cause IUGR. Anything that disrupts the fetal abdomen leads to apparent IUGR because the abdominal circumference is altered Examples are gastrochisis and omphalocele.

Fetal macrosomia.
Defined as estimated fetal birth weight greater than 4000gm. Various methods have been developed to achieve accurate weight estimates of the average-sized fetus. Unfortunately, there is no one excellent way of precisely predicting macrosomia. The problem lies in the fact that the best ultrasound estimation of weight can be as much 10% discrepant of the actual weight.

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causes like diabetes in the mother,and familial tendencies must be bore in mind.Some genetic causes includes Beckwith-Wiedemann syndrome usually is a sporadic abnormality. It is seen with macroglossia and occasionally umbilical hernia, which may appear on ultrasound as a small omphalocele.

Marshall-Smith syndrome is a sporadic disease in which markedly accelerated skeletal maturation results in a long, relatively thin newborn.An overestimation of weight is made because the head and femur are so much larger than anticipated. Sotos' syndrome is associated with profound macrocephaly and mild dilation of the cerebral ventricles, but there is no consistent pattern of brain malformation. The hands and feet are also very large for gestational age.

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physician should be aware of these syndromes and search for the associated anomalies. Above all, the physician should always look at the parents when assessing a fetus with macrocephaly or isolated large hands or feet. Often, large size is simply an expression of familial propensity.