Articles
Register for 8th World Congress on Ultrasound in Obstetrics & Gynecology
Fetal Growth Restriction – Long Term Implications: Round
Table Discussion
Terry
J. DuBose, M.S., RDMS, Chair, Ultrasound section of
OBGYN.net
November 4, 1998, Edinburgh, Scotland
The questions around relative fetal growth are central to obstetrical case management, and neonatal well being, and it now appears that fetal growth may actually affect the life span of the resulting adult. This was a very interesting series of lectures.
Chair S. Uzan:
In this Round Table the Chair chose to save the Overview lecture to the end of the session. This review will follow that order.
R. Geirsson
US dating – how accurate?
This lecture covered the problems with the current methods of using the last menstrual period (LMP) for dating pregnancies and the resulting uncertainties. To be brief, Geirsson concluded that we should "Forget about the LMP". He commented that we should use the 280-day age as estimated by sonography instead of the LMP. This reviewer completely agrees with this conclusion. However, I also believe that we must devise a method (terminology) for communicating this age to the parents other than "gestational" age because they are often curious as to the more certain date of conception as well as the estimated birth date. The use of the 280 day age can lead to serious misunderstandings (see put URL for LMP short story here).
J. Gardosi:
Antenatal determinants of fetal growth
Gardosi discussed the very complex subject of what effects relative fetal growth, and therefore the resulting neonatal wellbeing. Among the issues that must be considered other than the fetal gestational considerations are the parental issues of size, socioeconomics, life-style, infection, and others. Of these, the placental insufficiency appears to have the largest effect on fetal growth. Gardosi stated that accurate dating, individualized adjustments for parental factors, and issues of pathology must be considered in making estimates about relative fetal growth.
K. Harrington
Abnormal placentation and fetal cardiovascular response
This is very interesting research looking at the maternal and fetal perfusion and the effects on fetal wellbeing, as well as possibly providing much needed indications of fetal stress well before the fetal develops serious hypoxia. This involves simple Doppler measurements of the bilateral maternal uterine arteries as well as fetal circulation. The subject is very complex, much too complex for this brief review. Stuart Campbell emphasized this research in the "Presidential Lecture" yesterday evening. For more detail the reader is directed to the real-audio interview with Kevin Harrington
Y. Ben-Shlomo stood in for H.-G. Blaas:
Fetal growth restriction causes of adult diseases
This lecture discussed historical research in to birth weights and concluded that fetal wellbeing and birth weights have a significant effect on the chronic diseases of adult life. In deed, they showed that women birthing large, healthy babies have one-half the risk of dying prematurely of heart disease than do people who bear small babies. Similar effects of the neonatal birth weights were found to affect the child’s long-term life prospects. Maternal nutrition is very important to the child’s prognosis of developing chronic diseases, particularly heart disease, as an adult. Ben-Shlomo concluded that IUGR predicts poor adult health, and that an improved understanding of classifications of IUGR and SGA fetuses will help define the health prospects of the resulting adult.
This research will have very important effects on the social costs of poor maternal/prenatal health care because of the apparent very long term and very expensive cost of health care for the entire population throughout life. This reviewer wishes every public official and legislator of every nation could hear this Round Table of lectures. This is the REAL way to reduce the cost of health care.
Visit our ISUOG Audio page for audio interviews with some of the foremost experts in the field of Ultrasound
