(精选)【高血压英文课件精品课件】 Ultrasound in the management of IUGR教学课件.pptVIP

Blood flow study sequence Umbilical artery, raised PI Umbilical artery, absent diastolic flow Middle cerebral, reduced resistance Umbilical artery, reversed diastolic flow Ductus venosus, reversed diastolic flow Umbilical vein, pulsatile flow Blood flow studies in placental insufficiency a] Uteroplacental Effects on PI Uterine artery increase Arcuate artery increase b] Feto-placental Umbilical artery increase Umbilical vein Umbilical artery flow the PI falls throughout gestation after 16/40 there is always end-diastolic flow no notching Redistribution During Fetal Hypoxemia Blood flow studies in placental insufficiency a] Fetal Effects on PI Middle cerebral decrease Internal carotid decrease Thoracic aorta increase Abdominal aorta increase Renal artery increase Ductus arteriosus Cerebral vessels end-diastolic frequencies are virtually always present in the internal carotid and other cerebral arteries the PI falls steeply after 32 weeks, suggesting centralization of flow occurs in normal pregnancy toward term Uterine artery flow in IUGR high impedance persistent dicrotic notch ? failure of modification of muscular spiral arteries to achieve a low-resistance uteroplacental circulation Uterine artery flow rapid fall in the PI between the 13th and 20th weeks of gestation then more gentle fall to term notch in early diastole which disappears by week 24 due to invasion of uteroplacental vessels by trophoblast Sonographic evaluation Amniotic fluid assessment Amniotic fluid index normal range 5-25cm moderate oligomenorrhoea 5-8cm Deepest pool depth 1cm or 2cm Sonographic evaluation Biophysical profile Amniotic fluid volume Deepest pool depth 2cm Fetal movements Fetal breathing movements Fetal tone Cardiotocography Clinical assessment of IUGR Search for underlying condition karyotype ultrasound search for structural abnormalities TORCH titres renal function tests Prevention Treatment of IUGR Treatment of IUGR Treatment of underlying condition stop smoki