1: Neonatology - IUGR Flashcards

1
Q

Define IUGR

A

Failure of growth in-utero that may or may-not cause SGA

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2
Q

Define SGA

A

Weight below 10th-centile for gestational age

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3
Q

What are the two types of IUGR

A

1, Symmetrical

2. Asymmetrical

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4
Q

What causes asymmetrical IUGR

A
  • Due to external factors, most commonly placental insufficiency. Occurs late in gestation.
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5
Q

What causes symmetrical IUGR

A
  • Due to internal factors (Chromosomal abnormalities)
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6
Q

What are two maternal causes of IUGR

A
  • Substance abuse

- Teratogenic medications

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7
Q

What is the main utter-placental cause of IUGR

A

Placental insufficiency

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8
Q

What is placental insufficiency

A

Disruption in maternal-foetal circulation impairing substances exchange causing foetal compromise

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9
Q

What are 5 causes of placental insufficiency

A
  • DM
  • HTN
  • Smoking
  • Antiphospholipid syndrome
  • SLE
  • Pre-eclampsia
  • Rhesus incompatibility
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10
Q

What are 3 foetal causes of IUGR

A

Chromosomal abnormality
TORCH
Cyanotic heat defects

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11
Q

What is 70% of IUGR

A

Asymmetrical

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12
Q

How will symmetrical growth IUGR present

A

Proportional decrease in head and abdominal circumference

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13
Q

When does symmetrical IUGR usually occur

A

Abnormalities in brain development

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14
Q

What is a more common complication of symmetrical IUGR and why

A

Abnormalities in brain development - due to occurring in first trimester

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15
Q

How does asymmetrical IUGR present

A

Maintained head circumference, small abdominal circumference

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16
Q

Explain pathophysiology of asymmetrical IUGR

A

Placental dysfunction decreases nutrients and oxygen delivered. Foetus therefore preferentially shunts oxygen and nutrients to vital organs, including the brain. Foetus then switches to glycolysis, which causes metabolic acidosis and foetal multi-organ failure

17
Q

What are features of IUGR on growth restriction

A

Below 10th gentile

May have oligohydramnios

18
Q

In asymmetrical IUGR, what will be seen on doppler US

A

Reduced umbilical blood flow

19
Q

What is a risk with IUGR

A

Baby born low birth weight - which increases risk of sudden infant death syndrome

20
Q

What is small for gestational-age

A

Weight below 10th centile of that for gestational age

21
Q

What is symmetrical SGA

A

All growth parameters are symmetrically small

22
Q

What causes symmetrical SGA

A

Chromosomal aberrations

Constitutionally small

23
Q

What is asymmetrical SGA

A

Weight is proportional smaller compared to head circumference and length

24
Q

What is the main cause of asymmetrical SGA

A

Pre-eclampsia

25
Q

What does SGA increase risk of

A
Perinatal asphyxia 
Hypoglycaemia 
Necrotising enterocolitis 
Meconium aspiration 
Polycythaemia 
TORCH infections
26
Q

Why does SGA increase risk of hypoglycaemia

A

Less glycogen stores

27
Q

Why does SGA increase risk of polycythaemia

A

Chronic in-utero hypoxia

28
Q

What is LGA

A

Babies weight >90th centile that for gestational age

29
Q

What are 4 causes of LGA

A

Constitutional
Maternal DM
Beckwith-weidemann syndrome
Hydrops foetalis

30
Q

What is the presentation of beckwith-widemann syndrome

A

Hypoglycaemia
Crease near ears
Organomegaly
Macroglossia

31
Q

What are the risks of LGA

A

Syndrome of over-growth that presents with

  • Perinatal asphyxia
  • Shoulder dystocia
  • Clavicle fracture
  • Nerve palsies
  • Hypoglycaemia