Uterine Size > Dates
Roya Sohaey, MD
DIFFERENTIAL DIAGNOSIS
Common
Macrosomia
Polyhydramnios
Multiple Gestations
Less Common
Leiomyoma
Rare but Important
Ovarian/Paraovarian Mass
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Fundal height (FH) vs. menstrual age (MA)
FH = clinical measurement from pubic symphysis to top of uterus
FH in cm = MA in wks
FH most accurate at 18-32 wks
Ultrasound more accurate than FH
Helpful Clues for Common Diagnoses
Macrosomia
Estimated fetal weight > 90th percentile
↑ Abdominal circumference (AC) is hallmark feature
Associations
Polyhydramnios
Diabetes
Beckwith-Wiedemann syndrome
Polyhydramnios
2/3 idiopathic
1/3 with maternal or fetal cause
Maternal diabetes
Fetal gastrointestinal obstruction
Abnormal fetal swallowing
Abnormal fetal movement
Hydrops
Multiple Gestations
Determine chorionicity and amnionicity
Best in 1st trimester
Helpful Clues for Less Common Diagnoses
Leiomyoma
Fibroids grow in first 20 wks of pregnancy
Variable appearance
Diffusely hypoechoic (most common)
Complex, cystic from degeneration
Calcified in older patients
Complications with retroplacental myoma
Abruption
Preterm labor
Intrauterine growth restriction
Helpful Clues for Rare Diagnoses
Ovarian/Paraovarian Mass
Common
Hemorrhagic corpus luteum
Teratoma
Ovarian hyperstimulation
Less common
Paraovarian cyst
Theca lutein cysts (associated with gestational trophoblastic neoplasia)
Ovarian neoplasm
Management
Surgery if mass is suspicious
Optimal time is 14-18 wks
Emergent surgery for torsion
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