During the whole pregnancy, expectant mothers need to do several B-ultrasounds. It is not uncommon for B-ultrasounds to indicate that the fetus is less than the gestational week. There are two situations in which the fetus is smaller than the gestational age. One situation is that the fetus is indeed small and small for gestational age (SGA, Small forGestationAge), including fetal growth restriction (FGR, FetalGrowthRestriction), and the other is due to ovulation And delayed fertilization, the expected date of delivery needs to be adjusted. What is the difference between
SGA, FGR and IUGR?
When the fetus is less than the gestational week, there will be three terms: SGA, FGR and IUGR. There are still differences between the three.
SGA means that the birth weight is lower than the 10th percentile of the weight at the same gestational age or 2 standard deviations lower than its average weight. SGA can be divided into three situations.
1. Normal SGA: , that is, fetal structure and Doppler blood flow assessment were not abnormal, which means that this is a normal "small" child, except for the younger, everything else is normal. It's a bit like me. Anyone who has seen me knows that I am a short and powerful type, and Yao Ming is probably LGA (Large for Gestation Age, larger than gestational age). But Yao Ming and I are quite normal. It's just a big one and a small one. Both are pretty good.
2. Abnormal SGA: has a fetus with structural abnormalities or genetic diseases. The fetus is small and has problems.
3. FGR: refers to SGA that cannot reach its expected growth potential.
Therefore, SGA includes FGR. As for IUGR (IntrauterineGrowthRetardation), it is actually another term for FGR. Because the noun of IUGR contains a Retardation. Retardation is a relatively negative term. For example, Mental Retardation is intellectual disability, which can easily lead to misunderstandings and associations with intellectual disability. Therefore, some experts propose to change to a more neutral FGR (FetalGrowthRestriction). In fact, the two are the same thing. La. Now more and more people are using FGR, but some people still use IUGR habitually. How does
judge whether the fetus is less than the gestational week is delayed ovulation or FGR?
This requires a series of B-ultrasound to identify, especially the B-ultrasound during early pregnancy. Under normal circumstances, the fetus smaller than the gestational week caused by delayed ovulation and fertilization has the following characteristics: the usual menstrual cycle is relatively long , the time when the urine pregnancy test is positive is relatively late , and the time when the embryo and heartbeat are found by B-ultrasound Later at , a series of B-ultrasound examinations showed that the speed and trend of fetal growth and development were normal .
The characteristic that the fetus is smaller than the gestational week due to FGR is: in the early pregnancy, the embryo size is normal, consistent with the gestational week of menopause, but enters the second trimester, the growth rate of the fetus begins to slow down. The size of the fetus starts to be smaller than the menopausal gestational week. If the fetus is too small, less than the average 10% of the gestational week, it can be diagnosed as FGR.
For delayed ovulation and fertilization, how to adjust the due date?
Every time you do a B-ultrasound, there are generally two gestational weeks in the report, one is the fetal gestational week calculated based on the last menstruation, and the other is the actual gestational week of the fetus. These two numbers often differ. Under normal circumstances, this gap is basically the same throughout the pregnancy, either because the fetus is larger than the gestational week or smaller than the gestational week. But there will be another situation, that is, the fetus will be larger than the menopausal gestational week, and the fetus will be smaller than the gestational week, leaving everyone at a loss.
Regarding the situation that the fetus will be younger and younger, in general, there is no need to worry about and special treatment, because the growth and development of fetuses are notIt is a constant speed process . It may grow faster at the front and grow slowly at the back, or it may grow slowly at the front and grow faster at the back. In the middle and late pregnancy, the size of the fetus will basically be close to the menopausal gestational week.
For fetuses whose menopausal gestational week does not match the actual gestational week, the expected delivery date needs to be adjusted. The most reliable basis for correcting the expected date of delivery is to have a early pregnancy ultrasound examination . Before correcting the expected date of delivery, there must be at least two consecutive ultrasound examinations to confirm that the growth trend of the child whose gestational age is inconsistent with the last menstrual period is normal. There is a possibility of FGR.
If the difference between the expected delivery date calculated according to the last menstrual period and the expected delivery date calculated by ultrasound examination is no more than one week, there is generally no need to correct the expected delivery date, because the expected delivery date is originally a range, not the point of 40 weeks.
If there is no ultrasound in the first trimester, it is necessary to be relatively cautious when correcting the expected date of delivery. It is necessary to check whether the growth trend of the fetus is consistent with the results of at least 2-3 consecutive ultrasound examinations and make corresponding adjustments.
During the follow-up process, there may be inconsistencies between the actual gestational age of the fetus in each ultrasound examination and the gestational age calculated at the last menstrual period. For example, the first ultrasound examination indicated a gestational week difference of 8 days, and the second ultrasound examination indicated a gestational week difference of 12 days. How to correct this time? When correcting pregnancy and childbirth,
first focuses on the results of early pregnancy, and then uses the average of the number of days between inspections as the standard to appropriately adjust the pregnancy and childbirth. How to deal with
FGR? The causes of
leading to FGR include mother’s nutritional deficiencies, comorbidities and complications; fetal factors; placental factors and umbilical cord factors. However, in China, really does not account for the proportion of FGR caused by mother's nutritional deficiencies , unless it is in some African countries with severe famine. The therapeutic effect of
FGR is not very good. Unless it is caused by severe nutritional deficiency, it is useless to eat nutritious meals and intravenous nutritional injections. Low-molecular-weight heparin and low-dose aspirin only have a certain effect on a small number of FGR.
For FGR fetuses, the most important thing is to strengthen fetal monitoring, including electronic fetal heart rate monitoring, B-ultrasound biophysical score, especially fetal Doppler blood flow monitoring. If there is an abnormality, consider timely termination of pregnancy.
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