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

2. Scope of lecture Definition Causes
Relevant investigation and management

3. 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

4. Causes in first trimester
mum
fetus
uterus
adnexa

5. Mum
Unsure of last menstrual period
Why?

6. Fetus

7. Uterus

8. Adnexal mass

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

10. Mum

11. 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

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

13. 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

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

15. Liqour volume Polyhydramnios: Oligohydramnios AFI > 26 MVP > 8

16. Oligohydramnios
Possible causes:
Reduced urine output
Leaking liqour

17. Polyhydramnios
Possible causes:
Reduced swallowing
Too much production

18. 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

19. Too much to digest???