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Fetal Head Circumference

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1041. Pulmonary Hypoplasia

or 'Potter's facies' in oligohydramnios. Other congenital anomalies - eg, cardiac malformations. Diagnosis Suspect if oligohydramnios is present. Fetal ultrasonography - can be used to measure lung area to head circumference ratio; a ratio of <1 is associated with high rate of neonatal death. Doppler velocimetry has been used experimentally and can detect severe hypoplasia. [ ] Increased nuchal translucency is seen in almost half of fetuses who have a congenital diaphragmatic hernia. Management Suspect (...) the poorest prognosis due to severity of co-existent anomalies. Antenatal diagnosis using fetal ultrasound and MRI allows early diagnosis. Differential diagnoses include diaphragmatic hernia, cystic adenomatoid malformation of the lung, giant lobar emphysema, and situs inversus. Pulmonary agenesis may be compatible with normal life provided co-existent malformations are thoroughly investigated and managed. [ ] Epidemiology Primary isolated bilateral pulmonary hypoplasia is rare and familial occurrence

2008 Mentor

1042. Postmaturity (Prolonged Pregnancy) (Full text)

perinatal mortality. [ ] Where possible, first trimester ultrasound rather than last menstrual period (LMP) dating should be relied on to assess pregnancy duration. This should be determined using crown-rump measurement or head circumference if crown-rump length is above 84 mm. [ ] Risks associated with post-term pregnancy [ ] Fetal and neonatal risks Prolonged pregnancy is associated with an increase in perinatal morbidity and mortality. There is an increased risk of stillbirth and neonatal death (...) on research evidence, UK and European Guidelines. You may find the article more useful, or one of our other . In this article In This Article Post-term Pregnancy Prolonged Pregnancy In this article Prolonged pregnancy is defined as pregnancy which progresses beyond 42 weeks. [ ] Prolonged pregnancy is associated with fetal, neonatal and maternal complications. Risks increase after term and significantly so after 41 weeks of pregnancy. A policy of induction of labour appears to improve outcomes and reduce

2008 Mentor PubMed abstract

1043. Intrauterine Growth Restriction

, hypophosphatasia, fetal phenylketonuria. Placental factors - eg, placental dysfunction (including pre-eclampsia), placental abruption. Genetic factors: placental genes, maternal genes, fetal genes. Classification [ ] There are predominately three types of IUGR: asymmetrical IUGR (malnourished babies), symmetrical IUGR (hypoplastic SGA) and mixed IUGR. Symmetrical IUGR Cause of IUGR earlier in pregnancy. Antenatal scan: head circumference, abdominal circumference, biparietal diameter and fetal length all (...) when early IUGR is affected further by placental causes in late pregnancy. Affected neonates have clinical features of both symmetrical and asymmetrical IUGR at birth. Diagnosing a small for gestational age fetus and fetal growth restriction [ ] Fetal abdominal circumference (AC) or estimated fetal weight (EFW) <10th centile can be used to diagnose an SGA fetus. Use of a customised fetal weight reference may improve prediction of an SGA neonate and perinatal outcome. When using two measurements

2008 Mentor

1044. Neonatal Examination

and incorporate [ ] : A review of parental concerns and the baby's medical history. Family, maternal, antenatal and perinatal history. Fetal, neonatal and infant history, including any previously plotted birth weight and head circumference. Whether the baby has passed meconium and urine (and urinary stream in a boy). Other tests as recommended by the UK National Screening Committee. These should also be carried out or arranged at this time. The examination is best conducted in a well-lit, warm, private room (...) . Listen to the baby's cry and note its sound. Weigh the baby and plot this reading on its growth chart. Perform a systematic 'head to toes' examination This should be done carefully and in good light to detect abnormalities: Head : Shape, presence of fontanelle and whether normal, sunken or bulging. Measure and record head circumference on the growth chart. Assess facial appearance and eye position. Look for any asymmetry or abnormality of facial form. Eyes : Establish that they are of normal shape

2008 Mentor

1045. Dandy-Walker Syndrome

that there is no association with a Mendelian or chromosomal disorder then the recurrence risk is relatively low at between 1% and 5%. [ ] Presentation [ ] Symptoms often occur in early infancy with 80-90% of individuals becoming symptomatic in the first year of life. Most children have hydrocephalus with abnormally rapid increase in head circumference with bulging at the back of the skull. Development is often affected, particularly with delay in motor skills such as crawling and walking. Spastic paraplegia and seizures (...) syndrome ( P osterior fossa anomalies as Dandy-Walker malformation (DWM); H aemangioma; A rterial lesions of the head and neck; C ardiac abnormalities as aortic coarctation; E ye abnormalities and S ternal defect). [ ] A large number of associated problems may also be present, such as hydrocephalus (often develops postnatally), atresia of the foramen of Magendie and atresia of the foramen of Luschka. Epidemiology Incidence is approximately 1 in 25-35,000 live births. [ ] It occurs slightly more

2008 Mentor

1046. Centile Charts and Assessing Growth

of an infant or fetus. They may also be used in public health. For example, Clinical Commissioning Groups (CCGs) may show their index for coronary heart disease (CHD) or cancer as a centile to demonstrate how the local prevalence compares with the country as a whole. Because centile charts are usually used to assess a parameter over time, they are normally presented graphically. The parameter such as height, weight or head circumference is shown on the y axis and the age or gestation on the x axis (...) is normal or abnormal. They merely show how it compares with that measurement in other individuals. They are called centiles and not per centiles . If a parameter such as height is on the 9th centile, this means that for every 100 children of that age, 9 would be expected to be shorter and 91 taller. On the 25th centile, 25 would be shorter and 75 taller. Centile charts are very useful for plotting changing parameters such as assessing a child's height or weight over time, or head circumference

2008 Mentor

1047. Benign Congenital Hypotonia

and walking. ± Muscle contractures (not before the age of 8 years). Joint hyperlaxity. Recurrent episodes of myalgia when using muscles. A full history should be taken from the parents of any child with hypotonia, looking for evidence of: Oligohydramnios or polyhydramnios. Birth trauma. Family history of hypotonia (found in 46%). [ ] Perinatal asphyxia. Infection and/or drugs taken by the mother during pregnancy. Mother's description of fetal movements. Examination This should include: [ ] Head (...) circumference (central hypotonia more likely to have microcephaly). Developmental assessment. Evaluation of muscle tone. Reflexes. Resting postures in prone and supine. Pull-to-sit. Antigravity movements. Visual following/alertness. Infants with hypotonia of peripheral origin (eg, congenital muscular dystrophies, spinal muscular atrophy or congenital myasthenic syndrome) also often have joint contractures. Differential diagnosis [ ] Differentiation of central from peripheral origins of hypotonia should

2008 Mentor

1048. Antenatal Examinations

pregnancies. It may also be part of the screening for fetal anomalies when the nuchal translucency is measured. Accurate gestational age assessment helps optimal antenatal care by, for example, reducing the need for induction of labour at >41 weeks. Crown-rump length is the best surrogate measure of gestational age in the first trimester. Pregnant women who present at or beyond 14 weeks of gestation should be offered an ultrasound scan to estimate gestational age using head circumference or biparietal (...) diameter. If the crown-rump length is above 84 mm, the gestational age should also be estimated using head circumference or biparietal diameter. By the second or third trimester, multiple parameters may be used, including biparietal diameter, head and abdominal circumference and femur length. Frequency and number of antenatal assessments in uncomplicated pregnancies [ ] Nulliparous patients with uncomplicated pregnancies should be seen over a schedule of ten appointments. Parous women

2008 Mentor

1049. Growth and Failure to Thrive

of gestation is treated as a four-week-old baby. Growth charts based on gestational age rather than chronological age are available for infants from 26 weeks of gestational age but they are synthesised from a relatively small number of infants with variable problems and so they should be treated with caution. [ ] A premature baby should have reached 'normality' for head circumference at around 18 months, for weight at about 24 months and for height at above 40 months. Thereafter, normal charts may (...) , weight and head circumference on a chart. If possible, plot earlier readings too, as trends or falling through the centiles are much more important than isolated readings. Note pulse rate and respiratory rate. Possibly blood pressure and even arterial blood gases may be required. Blood gas analysis may prevent excessive diagnosis of renal tubular acidosis. [ ] Other physical signs may include: Oedema. Hepatomegaly. Rash or skin changes. Hair colour and texture abnormalities. Signs of vitamin

2008 Mentor

1050. Neurofibromatosis

circumference in an infant is increasing rapidly. Hydrocephalus is rare in NF1. MRI can evaluate the optic nerves or optic chiasma. It is indicated for optic nerve pallor, visual changes, proptosis, or precocious puberty. Consider MRI scans of the head if headaches increase in frequency or intensity over time. Brain tumours are more common in NF2 than in NF1. MRI can also be useful to evaluate mediastinal masses, spinal cord tumours, deep plexiform neurofibromas, abdominal and pelvic lesions (...) , hemihypertrophy, and long-bone modelling defects. Check head circumference in the first three years, as rapid increase may indicate tumour or hydrocephalus. Examine the heart, looking for murmurs. Check blood pressure at every visit and take prompt action if there is hypertension. Any unexplained murmur should be referred for a cardiology opinion and echocardiography. Ask about the child's neurodevelopment, to note any learning disabilities and take early action. Older adults should be offered the opportunity

2008 Mentor

1051. Obstetric Ultrasound

to see if this is persisting. Transvaginal scanning is preferred over transabdominal for this indication. To confirm that fetal growth is appropriate. Procedure Assess growth by the measurement methods below: Bi-parietal diameter (most accurate for dating up to 20 weeks). Head circumference. Femur length. Abdominal circumference. Look at the head shape and internal structures: Cavum septum pellucidum. Cerebellum. Ventricular size at atrium (<10 mm). Minimum standards: Spine: longitudinal (...) [ ] . This is essential for intervention of post-maturity, and for accurate serum screening for . Determine viability - to confirm the presence of a heartbeat and exclude and . Determine fetal number and, in , the chorionicity/amnionicity [ ] . Detect gross fetal abnormalities. Procedure Measurement of crown-rump length accurately measures gestational age if performed before 13 weeks. After 13 weeks, the fetus becomes increasingly flexed so results are inaccurate. Alternatives that can be used after this include bi

2008 Mentor

1052. Alcohol consumption in pregnancy. How much is safe? (Full text)

ml alcohol a day had significantly smaller head circumferences than the babies of non-drinkers in some gestational age groups. Maternal serum gamma-glutamyltransferase levels predicted abnormal fetal outcome in the 3 women in whom they were raised. There is no safe level of alcohol consumption in pregnancy and even moderate 'social' drinking is associated with abnormal fetal outcome.

1982 Archives of Disease in Childhood PubMed abstract

1053. Pregnancy in phenylketonuria: dietary treatment aimed at normalising maternal plasma phenylalanine concentration. (Full text)

Pregnancy in phenylketonuria: dietary treatment aimed at normalising maternal plasma phenylalanine concentration. The transport characteristics of the placenta, which favour higher phenylalanine concentrations in the fetus than in the mother, and regression data of head circumference at birth against phenylalanine concentration at conception in maternal phenylketonuria (PKU), suggest that treatment of maternal PKU should ideally aim to maintain plasma phenylalanine concentration within (...) at delivery. Normal weight gain and fetal growth were maintained throughout the pregnancy. A normal baby was born at term with a head circumference of 35.5 cm; at 1 year of age no abnormality is detectable. These results show that with careful monitoring and compliance it is possible, and may be advisable, to maintain plasma phenylalanine concentration within the normal range in the management of PKU pregnancy.

1991 Archives of Disease in Childhood PubMed abstract

1054. Improving Brain Development in Medically Healthy Premature Infants

, Layout table for eligibility information Ages Eligible for Study: 28 Weeks to 33 Weeks (Child) Sexes Eligible for Study: All Accepts Healthy Volunteers: Yes Criteria Inclusion Criteria for Preterm Infants Born at Brigham and Women's Hospital (BWH), Boston Family residence in the greater Boston area Gestational age at birth of 28 to 33 weeks assessed by mother's dates, the Ballard assessment, and prenatal ultrasound as available Birthweight, height, and head circumference appropriate (10th to 90th (...) care in preventing brain damage. Condition or disease Intervention/treatment Phase Premature Birth Behavioral: Newborn Individualized Developmental Care Assessment Program Not Applicable Detailed Description: From 28 to 33 weeks' gestation, significant neurological reorganization takes place, initiating fetal behavioral individuality and capacity for extrauterine survival. Infants born at this transitional stage exhibit unexpectedly significant brain dysfunction as they develop and age

2003 Clinical Trials

1055. Hydroxyurea to Prevent Organ Damage in Children With Sickle Cell Anemia

confirmed centrally by electrophoresis (screening may begin at 7 months of age) Exclusion Criteria: Chronic transfusion therapy Cancer Less than 5th percentile (10th percentile for the pilot study) height, weight, or head circumference for age Severe developmental delay (e.g., cerebral palsy or other mental retardation, Grade III/IV intraventricular hemorrhage) Stroke with neurological deficit Surgical splenectomy Participating in other clinical intervention trials Probable or known diagnosis (...) that hydroxyurea is effective in decreasing the frequency of painful crises, hospitalizations for crises, acute chest syndrome, and blood transfusions by 50%. The recently completed phase II study of hydroxyurea in children (PED HUG) demonstrated that children have a response to hydroxyurea similar to that seen in adults in terms of increasing fetal hemoglobin levels and total hemoglobin, and decreasing complications associated with sickle cell anemia. In addition, this study demonstrated that the drug does

2000 Clinical Trials

1056. Randomised controlled comparative study of methyldopa and oxprenolol in treatment of hypertension in pregnancy. (Full text)

receiving oxprenolol than in those receiving methyldopa. The eventual fetal outcome for all patients treated with methyldopa was the same as that for those treated with oxprenolol; birth weight, placental weight, head circumference, and Apgar score were not significantly different and there were no stillbirths in either group.

1983 British medical journal (Clinical research ed.) Controlled trial quality: uncertain PubMed abstract

1057. Is serum free estriol measurement essential in the management of hypertensive disorders during pregnancy? (Abstract)

circumference ratio (H/A c.r.). A second group (group 2), composed of 152 patients, was managed using another protocol (protocol B) which included the NST, OCT and ultrasound measurement of the fetal head-to-abdomen circumference ratio (H/A). We found a good correlation between the serial normal tests and the outcome of pregnancies. We obtained good results in patients with abnormal NST-OCT and meconium-stained amniotic fluid and in patients with repeated abnormal NST-OCT with clear amniotic fluid due (...) Is serum free estriol measurement essential in the management of hypertensive disorders during pregnancy? A prospective study of antepartum fetal evaluation of 306 randomized hypertensive pregnancies was carried out. One hundred and fifty-four patients (group 1) were managed in accordance with a protocol (protocol A) which included non-stress test (NST), oxytocin challenge test (OCT), serum unconjugated (free) estriol measurements (E3), and ultrasound measurement of the fetal head-to-abdomen

1984 European journal of obstetrics, gynecology, and reproductive biology Controlled trial quality: uncertain

1058. A prospective controlled trial of metoprolol-hydralazine treatment in hypertension during pregnancy. (Abstract)

, because of maternal or fetal complications, was somewhat more frequent in the control group. Nine women in the treatment group and 5 in the control group developed albuminuria. Three infants in the drug-treated group died perinatally, and one in the control group. The outcome for the newborns was similar in both groups concerning birth weight, head circumference and Apgar score and in the frequencies of respiratory distress, bradycardia and hypoglycemia. The better blood pressure control achieved

1985 Acta Obstetricia et Gynecologica Scandinavica

1059. First trimester chorionic villus sampling versus mid-trimester genetic amniocentesis--preliminary results of a controlled prospective trial. (Abstract)

., therapeutic abortion for cytogenetic abnormalities) did not influence the observed risk of pregnancy loss. Overall perinatal mortality rates were also similar in both groups. No significant differences were identified for a number of pregnancy outcome parameters including 5 min Apgar score, birth weight, body length, head circumference, gestational age at delivery, preterm delivery, fetal growth retardation, congenital malformations, and neonatal complications. Preliminary results of this controlled

1988 Prenatal diagnosis

1060. A comparison of no medication versus methyldopa or labetalol in chronic hypertension during pregnancy. (Abstract)

and diastolic blood pressures at 14 to 26 weeks' gestation. However, there were no differences among the three groups regarding the incidences of either superimposed preeclampsia (15.6%, 18.4%, and 16.3%, respectively), abruptio placentae (2.2%, 1.1%, and 2.3%, respectively), or preterm delivery (10%, 12.5%, and 11.6%, respectively). In addition, there were no differences among the groups regarding gestational age at delivery, birth weight, incidence of fetal growth retardation, or neonatal head (...) function tests and serial assessment of fetal status. There were no differences among the three groups in mean systolic or diastolic blood pressures, mean gestational age, or initial laboratory findings at time of entry. Patients treated with medications had significantly lower (p less than 0.0001) systolic and diastolic blood pressures throughout gestation compared with the no-medication group. Among the control group there was a spontaneously significant lowering (p less than 0.0001) of both systolic

1990 American journal of obstetrics and gynecology Controlled trial quality: uncertain

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