FETAL GROWTH RESTRICTION Presenting a case of Mrs. Ratna Chakrobarty Gravida 2 Parity 1 (SGA in nulliparous 1.89), a Hindu patient of 26 years old (age ≥35 1.4, age >40 3.2), residing at Kadma (high altitude leading to chronic hypoxia is risk factor), coming from upper high socio economic class (socio economic status & malnutrition), a housewife was admitted in Tata Main Hospital on 12th October 2015 with… History of 9 months of amenorrhea, appreciating fetal movements well. For elective caesarean. History of present pregnancy: Patient conceived spontaneously (IVF singleton pregnancy is a risk factor). Patient doesn’t have any complaints at present. 1st trimester: Confirmation of pregnancy done at home with urine pregnancy test, Prepregnancy weight was 50 kg [with BMI 22.2 kg/m2 (rule out constitutionally small mother)], booked at Tata Main Hospital, started on folic acid supplements, ultrasound was done and told to be normal [1st trimester dating scan done (using CRL up to 13+6 weeks)], blood, sugar and urine investigations were done and told to be normal, no H/O fever with or without rash (to rule out TORCH infections, malaria), no H/O exposure to drug or radiation, no H/O bleeding per vaginum, no H/o excessive vomiting, 1st trimester aneuploidy screening was not done (PAPP-A <0.4), uneventful. 2nd trimester: Quickening at 5th month, oral supplements taken, anomaly scan done and told to normal (echogenic bowel-major risk factor), 2 doses of injection tetanus toxoid were given 1 month apart, antenatal visits at interval of 28 days, weight at the end of 7 completed months was 54 kg (poor or excessive weight gain), blood and sugar investigations were done and told to be normal, no H/O bleeding; pain abdomen; leaking per vaginum (to rule out chronic abruption, placenta previa & PPROM), uneventful. 3rd trimester: Patient was advised ultrasound in view of decreased symphysio fundal height during routine antenatal check up and found to have small for gestational age fetus with less liquor for gestational age on 1st October (35 weeks 3 days). Repeat ultrasound with umbilical artery and middle cerebral artery Doppler was done after 7 days and patient was advised admission. H/O fever 15 days back which was low grade, lasted for 1 day, and subsided after taking tab paracetamol. No history of pain abdomen, bleeding per vaginum, leaking per vaginum. No history of headache, blurring of vision, epigastric pain, decreased urine output. No history of blood transfusion. Obstetric history: Active married life: 7 years, Non consanguineous marriage. History of using barrier contraception after 1st baby (H/O using oral contraceptives just prior to conception?) Gravida2 Parity1 Abortion0 Living1 Past obstetric history: Gravida1: Uncomplicated antenatal period. Full term (gestational age), normal vaginal hospital delivery (mode of delivery) in 2010. Delivered Male baby of 2.1kg (previous SGA 3.9). Baby is 5 years old (interval <6 months or ≥60 months), alive, immunised and healthy. Postnatal period was uneventful (history of hypertension, diabetes, abruption, miscarriages, stillbirth should be ruled out). Menstrual history: She attained menarche at 14 years of age. Past menstrual period: Interval of 28 days (regular, any h/o prolonged cycles?), lasting for 4-5 days, regular, normal flow, painless. Last menstrual period: 26/01/15 (sure of dates?) Expected date of delivery according to Naegele’s formula: 2/11/15 (EDD cross matched with dating scan) Gestational age: 37 weeks 1 SGA, Dr. Prashant Pujara.
Case presentation of fetal growth restriction/ intrauterine growth restriction
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