22. INTRA-UTERINE GROWTH RESTRICTION (IUGR)

Question 1

Growth restricted fetuses are at risk of:

Answer 1

Stillbirth
Birth asphyxia – Hypoxic Ischaemic Encephalopathy
Meconium aspiration syndrome
Iatrogenic preterm delivery
Neonatal complications -
Hypothermia due to reduced subcutaneous fat, Hypoglycaemia as a result of depleted glycogen stores , Polycythaemia due to chronic hypoxia
Impaired neurodevelopment
Neurological damage manifesting as cerebral palsy, seizures or minimal brain dysfunction
Metabolic syndrome in adulthood (Barker hypothesis

Question 2

What is birth asphyxia?

Answer 2

Failure to initiate or sustain breathing after delivery often resulting in hypoxemia, hypercapnia and metabolic acidosis mainly due to placental insufficiency of obstructed labour.

Question 3

What is placental insufficiency?

Answer 3

Condition in which the placenta is unable to supply sufficient oxygen and nutrients to the foetus.

Question 4

What is hypoxic ischemic encephalopathy?

Answer 4

stroke around birth, leading to long term neurological complications such as cerebral palsy.

Question 5

Define symmetrical IUGR

Answer 5

Occurs in the first trimester of pregnancy often due to infection (TORCH) or genetics. The fetus is proportional small and at risk of postnatal physical and mental retardation due to impaired organogenesis.

Question 6

Define asymmetrical IUGR

Answer 6

Late in pregnancy.
Commonly due to placental insufficiency.
Disproportional reduction (brain sparing)

Question 7

What are the causes of polyhydramnios?

Answer 7

Maternal factors: Diabetes Mellitus, Multiple pregnancy.
Foetal factors: Congenital anomalies, fetal anaemia, torch infections.
Idiopathic.

Question 8

Etiological factors of IUGR

Answer 8

MF: Cardiorespiratory disease, hypertensive disorders, Diabetes, Anaemia
FF: Congenital infections, chromosome abnormalities
PF: Placental insufficiency (Pre-eclampsia) Twin-to-twin transfusion syndrome, placenta previa, Infarction,

Question 9

What is twin-to-twin transfusion syndrome?

Answer 9

Occurs in monochorionic twin pregnancy.
Twins share a placenta.
One twin becomes undernourished.

Question 10

What are the risk factors of IUGR that can be ruled out on hx?

Answer 10

1. Markers of poor nutrition (LSES)
2. Smoking (10 or more cigarettes) and recreational drugs.
3. Previous IUGR baby
4. Hx of hypertension
5. Multiple pregnancies

Question 11

Clinical findings of IUGR

Answer 11

SSOI
Small Hard Head
SFH < GA
Oligohydramnios
Irritable Uterus

Question 12

Why is irritable uterus a clinical finding of IUGR?

Answer 12

Frequent non-labour uterine contractions: Inadequate blood flow leading to ischemia and the reflexive response