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decision of delivery
Dr. Rasha Salem
trainee
Introduction
Termination of Pregnancy before
spontaneous labor in non routine
patients
represents
a
major
challenge to clinician.
we should weigh between:
Introduction
Theme are 3 clinical situations in which
it would be useful to have an objective
assessment of fetal lung maturity:
1.Preterm patient at high risk for imminent
delivery secondary to premature labor.
2.Women whom early delivery is mandated
by maternal and/or fetal indication: e.g. sever
PIH, IUGR, chronic HTN and diabetes.
3.Patient
with
previous
C.S
with
uncomplicated pregnancy but unsure of her
dates.
Introduction
Assessment
Introduction
Amniocentesis represents a gold standard
for evaluation of FLM (L/S ratio<2 &
presence of PG).
Amniocentesis is an invasive technique with
a complication rate of up to 15% in the third
trimester of pregnancy (Sabbagha, 1979).
Maternal complications include infection,
bleeding, Rh iso immunization.
Fetal Complications include fetal injury &
fetal demise.
Introduction
Its
more
dangerous
or
contraindicated in obese patients,
oligohydramnios & anteriorly located
placenta.
Repeat amniocentesis if the analysis
yields premature results is another
cause of desperate to both doctor &
mother.
Then what to do
Ultrasound:
(very
charming
alternative to amniocentesis):
1. Easy to do.
2. Non invasive.
3. Safely repeatable.
Lung Maturity
Sonographic indices of fetal lung
maturity:
Placental maturity.
Free floating particles in amniotic fluid.
Fetal lung echogenicity.
Fetal intestinal indices.
Fetal epiphyseal ossification center.
Ongoing research:
1. Cerebellar echogenicity.
2. Thalamic echogenicity.
Placental Maturity
Grannum, 1979 reported that:
Since the placenta is fetal organ, It
should mature in a fashion similar to
that of fetal lung.
He classified placental maturation
into 4 grades: 0, I, II, III.
All grade III placenta has L /S
ratio<2.
He assigned the placenta according
to the highest grade.
Placental grading
Placental grading
Placental grading
Placental grading
Modified placental grading (Kazzi
et al, 1985):
Immature placenta: Grade 0,I or
II , according to Grannumms
classification.
Intermediate placenta: Partly
Grade III.
Mature placenta: Totally grade III.
= 1 borderline
> 1 mature
Sonographic indices of
fetal lung maturity
Mature placenta: Totally grade III.
Amniotic fluid FFP: >5.1 mm.
Colon Grade III: (echogenecity = liver ).
Fetal EOC if :
PHE present.
DFE 1mm larger than PTE.
Liver /lung echogenecity: >1
Thank you