If growth restriction is suspected, hospital admission may be required so that regular fetal surveillance can be undertaken. Fetal heart rate monitoring by cardiotocograph CTG may be performed. If the fetal condition is considered poor and continuation of the pregnancy is not considered safe, then delivery is considered. If delivery is recommended before 37 weeks gestation, your maternity care provider will consider maternal steroid injections and magnesium sulphate if less than 30 weeks to reduce the risk to the newborn of complications associated with prematurity.
A newborn baby that has had trouble growing in the uterus may need to be cared for in the Neonatal Critical Care Unit depending on their prematurity, birth weight and how well they adapt to life outside the uterus. Most fetuses that are shown to be large for gestational age on ultrasound are well nourished and healthy at birth. In some cases there is an underlying cause for the fetus to be large such as diabetes or a genetic syndrome.
Some babies are larger due to maternal diabetes during pregnancy and in particular if maternal blood glucose levels have been difficult to control. Larger babies born to mothers with diabetes are at increased risk of birth trauma including shoulder dystocia. When the fetus is suspected to be excessively large, induction of labour or caesarean section may be considered. When the mother has diabetes in pregnancy, their babies are also at risk of low blood sugar hypoglycaemia after birth as they no longer have access to the high sugar levels that they have become used to while in the uterus.
This may require monitoring and treatment in the special care nursery. Please note: we will endeavour to respond to your enquiry within five 5 business days. Follow us on. Quick Links Why is a fetal growth scan needed? What happens during a fetal growth scan? Why is a fetal growth scan needed? Common reasons to have a fetal growth scan in pregnancy include the following: Your abdomen measures smaller or larger than expected.
Previous pregnancy complications. Maternal diabetes or high blood pressure. The main fetal measurements taken for a growth scan include: Biparietal diameter BPD measures across the head Head Circumference HC — measures around the head Abdominal Circumference AC — measures around the abdomen Femur Length FL — measures the length of the thigh bone An estimate of fetal weight EFW can be calculated by combining the above measurements. An ultrasound scan to look for major fetal abnormalities is routinely performed earlier in pregnancy between 18 and 20 weeks gestation see the brochure Ultrasound—your 18 to 20 week scan Small for gestational age SGA Most fetuses that are shown to be small for gestational age are healthy but some may require further ultrasound assessment to ensure that they are growing adequately.
What is fetal growth restriction FGR? The mean maternal BMI was Gender-specific birth datasets could be ascertained in In total, we had boys and girls, representing respectively 10, and 10, scans. The immediate outcome of AS and pH were also different in boys and girls, although not statistically different due to the smaller preterm group Table 2. The term group is outlined separately in Additional file 2.
For each parameter, the 5th, 10th, 50th, 90th, and 95th centiles were constructed. Actual values for these centiles and grid curves are outlined in Additional file 4. This corresponds to a difference of three gestational days. Generally, prenatal AC measurements were significantly higher in boys than in girls, but less demonstrable across the total gestational period than for BPD and HC Fig.
For FL, there was no significant difference between boys and girls in their antenatal growth percentiles Fig. In this study, we have constructed antenatal growth and estimated fetal weight charts, with a strict and clearly defined selection protocol in a normal Caucasian population and separately for boys and girls.
For FL, there are no differences. These antenatal differences were confirmed at birth with boys being significantly heavier, longer, and having larger head circumferences as compared to girls. The 1- and 5-min AS and cord pH was lower in boys. The dating and weight estimation differences could potentially be taken into account in determining prenatal and immediate perinatal viability management in terms of timing the administration of maternal steroids for fetal lung maturation, decisions for delivery, and possible resuscitation.
Also, in the post-term period management in pregnancy, these gender differences could also potentially influence decisions including the timing of labor inductions, affecting an even larger population. Consequently, if second trimester dating of the pregnancy has been undertaken, girls are potentially put at risk of stillbirth in the post-term period by assuming the gestational maturity to be less than it is [ 27 ].
In one cross-sectional study, a difference has been shown between fetal head measurements for both boys and girls, although the curves were constructed with the older linear regression models [ 28 ].
They also confirmed the birth weight difference but did not report information on neonatal head circumference or other outcomes AS, cord pH.
Another unselected multi-ethnic combined cross-sectional and longitudinal population study also found differences in fetal head and abdomen measurements using statistical methods current at that time; however, no birth outcomes were available [ 29 ]. These results underline male vulnerability in the perinatal period. This concerned a multi-ethnic retrospective cohort from one center and birth data specified for both genders.
It is of course possible that neonatal outcomes are worse because immediate birth outcomes are worse. Whether this is an attribute of being male per se, or some effect of fetal size on delivery, cannot be explained from their results or ours. One hypothesis is that either the differences in biometry are relatively more important in the full-grown male fetus interacting with maternal pelvic limitations causing more labor dystocia for boys, and hence lower AS.
Alternatively, other fetal gender-specific factors can influence the birth process and compromising the immediate birth outcomes. Gender-specific body composition at birth has been reported, where the male infant has more fat mass and lean body mass than the female infant, especially in well-nourished mothers [ 31 ]. This phenomenon has been associated with gender-different intrauterine physical adaptations to an enhanced nutrient supply from the mother.
The male infant body composition has been more subject to maternal influences as higher pre-gestational BMI and excessive gestational weight gain [ 32 ].
Lastly, the lung maturation of the male fetus proceeds slower than in the female fetus, possibly contributing to a higher rate of low AS in the term grown fetus. In animal studies, lung fluid secretion is inhibited and the lung fluid absorption initiated by adrenalin infusions at birth [ 33 ].
And preterm asphyxiated male infants have lower adrenaline levels than female infants, again putting the boys at higher risk [ 34 ]. Whether in the term infant this will be similar is unknown. Our antenatal growth curves are unique in that all four fetal growth parameters BPD, HC, AC, and FL were measured in standardized circumstances in accordance with international guidelines [ 26 ]. GAMLSS can combine longitudinal data with a cross-sectional component and can construct centiles in a way that they are constrained and do not cross.
Further, in using the GAMLSS analysis statistics, one could, by synchronizing the statistical methods of the WHO, align the biometry measurements with the neonatal and pediatric charts [ 22 , 23 ]. With the available neonatal data, we could discriminate different growth curves for boys and girls for all four fetal growth parameters and hence the EFW. Since the introduction of ultrasound in antenatal care, many reports on fetal growth curves have been published [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ].
Recognizing pathological fetal growth depends on reliable, standardized growth curves [ 35 ]. Discrepancies between the curves have often been attributed to the differences in methodology and population selection [ 36 ]. A recent report reviewed fetal growth charts, demonstrating the wide variations of methodologies on how these charts have been constructed concluding that there were many grounds for bias in the growth curves that are currently used [ 37 ].
Standardization of the methodologies with a checklist was recommended to define a high-quality study [ 37 ]. When we compare our growth charts to the requirements, these would be compliant for the combination of a high-quality control score, longitudinal design, sample size, and the fact that all four parameters BPD, HC, AC, and FL were examined Additional file 6. All growth measurements were reviewed by certified staff members, judging all the scanned images as to whether they adhered to the protocol described.
We also incorporated a strict protocol on pregnancy dating. In Belgium, in routine obstetrical care, every pregnant woman will be offered a first, second, and third trimester ultrasound scan with fetal growth measurements. In many countries, the third trimester scan is not part of the routine care for low-risk pregnancies [ 38 ]. Furthermore, we were able to eliminate aberrant fetal growth and extreme maternal influences by excluding fetal anomalies level 1 and 2 indications and including only the mothers enrolled to a routine obstetric care scheme [ 40 ].
Finally, a population-based cohort was generated with a significant sample size over a period of 11 years. The description of a routine population could also be supported by our neonatal data. In our population selection, we further customized the charts for one maternal and one fetal factor. Other ethnicity-derived customized growth curves have arisen in response to the early reference charts from mainly Europe and the USA [ 18 , 19 ].
Ethnicity was reported to have a discriminative influence on fetal growth [ 24 , 41 ]. This highly qualitative study Additional file 6 represents a fascinating investigation of the physiology of fetal growth, concluding that optimal growth potential can be attained irrespective of the ethnicity in a selected population, which is in contradiction with the previous studies.
Unfortunately, it lacks information on fetal gender differences; not all measurements were longitudinal, and the derived charts are by their selective nature manifestly not representative of a general population, regardless of the ethnicity concerned.
Our current study adds these advantages. Girls and boys both have different neonatal growth curves, assuming there is a discriminative effect of the gender on their growth trajectories. In more than three quarters of our cohort, complete neonatal data was registered, including gender registration. Therefore, we focused on developing two separate fetal growth charts, both for boys and girls. Some limitations on constructing these charts have to be addressed.
The study was performed in a university teaching hospital, a large tertiary referral center, not necessarily reflecting a routine setting. This center, on the other hand, also has a regional remit for routine obstetric care for low-risk pregnancies, but the included cases were not selected on maternal morbidity nor on parental characteristics.
Some maternal characteristics e. But artificial conception was excluded for intracytoplasmic sperm injection, since this is a level 1 ultrasound indication.
Finally, it is expected that within this large time period, some women with subsequent pregnancies were included more than once for this cohort. Our fetal growth curves for the Caucasian population resemble predictive growth curves with the gender specified which can discern aberrant from normal fetal growth.
The longitudinal aspect and large cohort, covering the full trimesters, have not been reported before in the Caucasian population. The neonatal data gave us the opportunity to customize for the fetal gender.
There was a marked difference between fetal boys and girls in their growth trajectory for fetal head measurements and to a lesser extent the abdominal circumferences.
Also for the estimated fetal weight, there was a difference. This gender differentiation is important in antenatal and perinatal care. Prenatal ultrasound is used not only to define fetal growth, but also gestational age. Both growth and fetal age are important in defining the time point of fetal viability and the optimization of the timing of obstetrical interventions, e. Second trimester dating depends on fetal growth parameters and particular on the fetal head measurement.
Our results suggest a gender-specific approach in counseling future parents on important issues when fetal viability starts and when is the best time point to start obstetrical interventions. The gender differences are further demonstrated by the immediate birth outcomes for males: different anthropometry heavier, longer, and bigger heads , lower AS, and lower cord pH.
Therefore, one can argue on the clinical importance of the pH findings and perhaps also the AS in our study. In summary, we present fetal growth curves with the latest statistical tools in a large, routine pregnant population with state-of-the-art ultrasound technology.
Also, the immediate neonatal outcome demonstrated gender differences favoring the girls. This could give caretakers the opportunity to take into account a gender-tailored approach in life decision care both at the margins of viability and post-term.
Investigations of abdominal masses by pulsed ultrasound. Campbell S. Edit article. View revision history Report problem with Article. Citation, DOI and article data. Stanislavsky, A. Biparietal diameter. Reference article, Radiopaedia. URL of Article. Measurement technique The BPD should be measured on an axial plane that traverses the thalami, and cavum septum pellucidum.
The calipers should be placed at the: outer edge of the near calvarial wall inner edge of the far calvarial wall The cerebellar hemispheres should not be in the plane of the image.
Interpretation BPD has been shown to be accurate in predicting gestational age from 14 to 20 weeks 2. Quiz questions. Callen PW. Ultrasonography in Obstetrics and Gynecology. Elsevier Health Sciences.
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