204 - Fetal Growth Restriction Flashcards
Definition of IUGR
<10%ile
Etiologies of IUGR - Maternal
- pregestational DM
- SLE
- Renal disease
- HTN
- Cyanotic heart disease
- Substances (alcohol, tobacco 3.5x, cocaine, narcotics)
- APLS
- teratogens (cyclophosphamide, valproic, warfarin)
- malnutrition/calorie restricting <600-900kcal/d
Etiologies of IUGR - Fetal
- infections (malaria, CMV, rubella, toxo, VZV, syphilis)
- genetics: trisomy 18 (50%), trisomy 13 (50%), placental mosaicism, congenital heart disease, gastroschisis (25%)
- multiples: twins 25%, triplets/quads 60%. mono/mono via TTTS and unequal placental sharing
Etiologies of IUGR - Placental
- placental disorders: abruption, infarction, circumvallate shape, hemangioma, and chorioangioma. (NOT accreta or previa)
- cord abnormalities: velamentous or marginal cord insertion
Do inherited thrombophilias predispose to IUGR?
NO! only autoimmune mediated i.e. ALPS, SLE
infections cause what % of IuGR?
5-10%
Most common cause of infectious IUGR worldwide?
Malaria
Most common cause of IUGR
placental insufficiency
prevalence of 2 vessel cord and relation to IUGR
1%, mixed data
Risk of fetal death at <10%ile?
1.5%
Risk of fetal death at <5%ile?
2.5%
At what GA can you use fundal height as a screening for IUGR?
24-38wks
Sensitivity and specificity for detecting IUGR at 32-34wks?
Sensitivity: 65-85%
Specificity: 96%
How much are sonos off by?
95% up to 20% off
5% more than 20% off
What UA doppler findings are associated with increased fetal mortality?
Absent and elevated
Rate of perinatal death is reduced by what percent when umbilical artery Doppler velocimetry is added to standard antepartum testing in the setting of fetal growth restriction?
29%
Utility of ductus venosus flow?
Does NOT affect fetal/perinatal mortality
TRUFFLE (Trial of umbilical fetal flow in Europe) showed better neurodevelopmental outcomes at 2 yrs when delivered based on this as opposed to FHRT
Fundal height off by how many weeks is a positive screen?
3
risk of recurrent SGA in a subsequent pregnancy?
20% - can screen with growth sonos but nothing else
Food/drugs to help prevent SGA?
NONE proven (including diets and aspirin)
IUGR + structural anomalies: thing of?
Aneuploidy, offer invasive testing especially if in 2nd trimester
Antepartum testing for growth of IUGR fetus
- growth every 3-4 weeks (minimum 2wks)
- AFI/BPP/NST
When to deliver isolated growth restricted singleton?
38-39+6 weeks
When do deliver singleton with other risk factors (oligo, abnormal UA dopplers, maternal risk factors, or comorbidities)?
32-37+6 weeks
