Uterine size discrepancy Prof Madya Dr Shuhaila Ahmad Obstetrics & Gynaecology Department PPUKM

Scope of lecture Definition Causes Relevant investigation and management

Definition It is a condition whereby size of a gravid uterus is not equal to the gestational age ± 2 weeks Can be smaller or larger than date

Causes in first trimester mum fetus uterus adnexa

Mum Unsure of last menstrual period Why?

Fetus

Uterus

Adnexal mass

Causes in 2nd and 3rd trimester Almost similar causes to first trimester Differs in some aspect Mum Fetus liqour placenta Uterus & adnexae

Mum

Maternal obesity During inspection: may be observed as larger than date During palpation: the uterine size maybe equal to date but the measurement could be wrong Difficult to feel for fetal parts but fluid thrill test negative

Macrosomia Definition: Causes: >90th centile or 4.0kg in Malaysia Genetic background Diabetes mellitus Beckwith Wiedemann syndrome

Intrauterine growth restriction Defined as < 10th centile associated with reduced liqour Do not grow optimally in utero ‘wise old man look’ Wrinkled skin due to loss of subcutaneous fat and reduced muscle mass Shrunken face

Amniotic fluid circulation Amount changes with gestation The circulation keeps the amount balanced Disruption in this circulation causes marked change in amount

Liqour volume Polyhydramnios: Oligohydramnios AFI > 26 MVP > 8

Oligohydramnios Possible causes: Reduced urine output Leaking liqour

Polyhydramnios Possible causes: Reduced swallowing Too much production

Management Depends on the causes Must have good clinical skill especially in estimating fundal height, fetal weight etc Ultrasound scan plays a major role in determining possible causes First trimester scan Detailed scan Liqour assessment Doppler studies

Too much to digest???