الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
One of the most challenging areas currently facing obstetricians is the detection and management of pregnancies in which the growth of the fetus is poor. There is little doubt that these fetuses experience not only increased rates of perinatal morbidity and mortality but also higher levels of morbidity extending into adult life. As many as 40 per cent of so-called unexplained stillbirths are small for gestational age (SGA), leading to the suggestion that early detection and timely delivery may well prevent many fetal deaths. Fetal growth restriction (FGR) is not synonymous with SGA. Some, but not all, growth restricted fetuses/infants are SGA while 50–70% of SGA fetuses are constitutionally small, with fetal growth appropriate for maternal size and ethnicity. SGA is defined here as a fetus who measures less than the 10th percentile for gestational age, whether it is because he is growth-restricted (IUGR) or just constitutionally small. The best definition of intrauterine growth restriction (IUGR) is failure of a fetus to reach its genetic growth potential. Thus the umbilical artery Doppler study appears to assist clinicians in distinguishing constitutionally small infants from those with FGR Growth-restricted fetuses or small fetuses with low 5-minutes Apgars score have a higher risk of stillbirth and mortality than appropriately grown fetuses of a similar gestation. They are more at risk of hypothermia, hypoglycemia, pulmonary hemorrhage, infection; encephalopathy and necrotizing enter colitis compared with normally grown babies of a similar gestation. The problems of the small fetus do not end at birth or soon after birth but continue well into childhood and adulthood, the affected fetuses predispose to develop cardiovascular, metabolic, and endocrine disease years later.
These antenatal testing modalities aim to detect fetal compromise by evaluating fetal manifestations of altered oxygenation and metabolic status. Doppler ultrasonography and biophysical profile scoring (BPS) are the principal surveillance tools in pregnancies complicated by placental vascular insufficiency and fetal growth restriction (IUGR), but fetal deterioration appears to be independently reflected in these two testing modalities: their combined use is likely to be complementary. In the SGA fetus detected after 30 weeks of gestation with normal umbilical artery Doppler, a senior obstetrician should be involved in determining the timing and mode of birth of these pregnancies. Delivery should be offered at 37 weeks of gestation especially when there was abnormal cerebrovascular Doppler indicies (<5th centil).
150 pregnant women diagnosed had late onset small for gestational age (SGA) fetuses throughout the third trimester scan (30-34w). Fetal outcome was determined by neonatal weight, Agar score and NICU admission. This study had described the longitudinal changes in uteroplacental and fetal brain hemodynamics focusing on late-onset SGA fetuses and whether there was significant difference in the outcome between cases had normal or abnormal Doppler. In this study, fetoplacental Doppler indices remain virtually unchanged from diagnosis to delivery in these fetuses, and consequently the proportion of cases progressing to abnormal Doppler velocimetry in the UA- PI and mean UtA- PI was negligible, while MCA-PI and CPR-PI demonstrated a clear and progressive decrease in values from 34 week of follow up to delivery in comparisons to normal values. The study group divided into two subgroups:- Group I:-Delivered before 37 weeks, Group II:-Delivered after 37 weeks to detect if there was significant difference in the mode of delivery and fetal outcome between cases had normal or abnormal Doppler (MCA-PI and CPR-PI) according to gestational age. In concerning the mode of delivery CS was higher in group I 53.8% due to pre term labor in 7 cases (33.3%), per eclampsia in 7 cases (33.3%), abruption placenta in 8 cases (38.1% and in group II 43.2% due to abnormal MCA, CPR Doppler and / or BPP<6 in 15 cases (31.25%), elective CS in 23 cases (47.9%) and failed induction or fetal distress in 10 cases (20.8%).
In our study fetal outcome was determined by neonatal weight (Kg) >
10th centile (1.96 ±0.21 in group I and 1.98 ±0.13in group II), 5-min APGAR score > 7 was in 9 case (23.1%) in group I and 21 cases (18.9%) in group II and NICU admission was in 12 case (30.8%) in group I and in 24 case (21.6%) in group II.
Our results regarding neonatal outcome in group I delivered < 37 weeks, APGAR score at 5 minute and NICU in between cases had abnormal MCA-PI and CPR-PI Doppler was significant 100% , 75% respectively while in group II delivered >37 was insignificant 14.3%, 12.5% respectively.