Medicina fetal Barcelona
Medicina fetal Barcelona

DATING BY LMP AND BIOMETRIES

LMP (Last Menstrual Period)

First TM 1 (CRL<=84mm)

Second TM 2 (BDP<= 70mm)

Third TM 3 (BPD>70mm)

Estimate fetal weight

DBP, PC, PA, LF (Hadlock FL)

PA, LF (Hadlock FL)

Growth centile in II TM

Gender:

Unique percentile III TM

Gender:

Multiple percentile III TM

Gender larger twin:
Gender smaller twin:

Preeclampsia 1T

Epidemiologic data

Biometric data

First Trimester Data

Congenital Diaphragmatic Hernia Calculator

Left side Hernia

o/e LHR (%)

Longest diameter method

Right Lung to Head Ratio

Tracing method

Right Lung to Head Ratio

Lung Doppler (z-scores)

Intrapulmonary Doppler

Prediction of survival

LHR and liver herniation

Prediction of survival in left CDH

Intrapulmonary Doppler

Lung Doppler in Prediction of survival

Only for left CHD cases with LHR<26% and liver herniation treated with FETO

Right side hernia

o/e LHR (%)

Longest diameter method

Left Lung to Head Ratio

Tracing method

Left Lung to Head Ratio

Lung Doppler (z-scores)

Intrapulmonary Doppler

Prediction of survival

Anemia

Cerebral Doppler

CALCULATE VOLUME TO TRANSFUSE

Doppler

Umbilical artery

Middle cerebral artery

Cerebroplacental ratio

Uterine arteries

Ductus venosus

Aortic isthmus

TEI index



EFW (G):



Percentile:

Gender:



Percentile:

UA Diastolic flow



Percentile:





CPR (Percentile:1)

Mean Ut. A (Percentile:64)

Ao Isthmus Diastolic Flow:

Percentile:

D.V. Atrial Flow:

Fetal Growth restriction:

Stage 2

Recommended management:

Follow-up in 1 week

Recommendations:

  • Control every two weeks
  • Amniotic fluid (maximum vertical pocket) + estimated fetal weight or abdominal circumference + peak systolic velocity middle cerebral artery

DIAGNOSTIC ALGORITHM




Twins gender

TWIN 1


TWIN 2


Twin-twin transfusion syndromePSV-MCA values not entered, the risk for TAPS can not be assessed.


STAGING

Quintero RA et al. J Perinatol. 1999 Dec;19 (8 Pt1): 550-5.

TWIN 1

MVP-AF (mm):

Bladder:





TWIN 2

MVP-AF (mm):

Bladder:






RISK OF IUFD WITHIN ONE WEEK AFTER LASER

Eixarch E et al. Prenat Diagn. 2013 Nov;33(11):1033-8.

Gestational age:

Estimated fetal weight discordance (%):

TWIN 1


TWIN 2


Selective IUGRPSV-MCA values not entered, the risk for TAPS can not be assessed.


TYPE OF IUGR

Diastolic flow in Umbilical artery of small fetus:

Recomendations:

POOR PROGNOSIS CRITERIA

Gestational age:

Estimated fetal weight discordance (%):






Recomendations:

Dating

1. Robinson HP. A critical evaluation of sonar ‘crown-rump length’ measurements. BJOG 1975;82:702-710. Revised BUMS sept 2008.

2. Mul T. A comparative analysis of second-trimester ultrasound dating formulas in pregnancies conceived with artificial reproductive techniques. UOG 1996; 8:397-402.

3. Mongelli M. Third trimester ultrasound dating algorithms derived from pregnancies conceived with artificial reproductive techniques. UOG 2005; 26:129-131.

Fetal Growth

1. Hadlock FP. Estimation of fetal weight with the use of head, body and femur measurements a prospective study. Am J Obstet Gynecol 1985;151(3):333.

2. Hadlock FP. Sonographic estimation of fetal weight. The value of femur length in addition to head and abdomen measurements. Radiology, 1984 Feb; 150(2):535.

Growth centile in II TM

1. Pedersen N, Figueras F, Tabor A. Obstetrics and Gynecology 2008; 112(4):765-71.

Unique percentile in III TM

1. Figueras F. Customized birthweight for a Spanish Population. EJOGRM 2008; 136(1):20-4.

Multiple percentile in III TM

1. Kuno A. Comparision of fetal growth in singleton, twin and triplet pregnancies. Hum Reprod 1999.

2. Corbes de referència de pes, perímetro craneal i longitud en nèixer de nounats d'embarassos únics, bessons i trigèmins a Catalunya. Departament de Salut. Generalitat de Catalunya 2000.

Normal Doppler Values

1. Arduini D J Perinat Med 1990; 18:165.

2. Baschat AA UOG 2003; 21:124.

3. Mari G N Engl J Med 2000; 342:9.

4. Hecher K UOG 1994; 4:381.

5. Rizzo G UOG 1996; 7:401.

Biometrías óseas

CC: Snijders RL, UOG 1994.

Extremidades: Chitty, LS BJOG 2002.