[61] Intrauterine Growth Restriction Flashcards
What is IUGR?
Refers to poor growth of fetus while in the mothers womb during pregnancy
What are the major categories of IUGR?
- Symmetrical
- Asymmetrical
What kind of IUGR is more common?
Asymmetrical
What % of cases of IUGR are asymmetrical?
70%
What happens in asymmetrical IUGR?
There is a restriction of weight followed by length, but the head continues to grow at normal or near-normal rates, called head sparing
What does a lack of subcutaneous fat lead to in asymmetrical IUGR?
A thin and small body out of proportion with the liver
When does asymmetrical IUGR occur?
When the embryo/fetus has grown normally in the first 2 trimesters, but encounters difficulties in the third
What is asymmetrical IUGR most commonly caused by?
Extrinsic factors that affect the fetus at later gestational ages
What does symmetrical IUGR indicate?
The fetus has developed slowly throughout the duration of the pregnancy, and thus was affected from a very early stage
Is the head circumference of the newborn with symmetrical IUGR in proportion to the rest of the body?
Yes
Is permanent neurological sequelae more common in symmetrical or asymmetrical IUGR?
Symmetrical
Why are permanent neurological sequelae more common in symmetrical IUGR?
Because most neurones have developed by 18 weeks gestation
Give 4 examples of causes of symmetrical IUGR
- Early intrauterine infection
- Chromosomal abnormalities
- Anaemia
- Maternal substance abuse
What are the categories of causes of IUGR?
- Maternal
- Uteroplacental
- Fetal
What are the maternal causes of IUGR?
- Pre-pregnancy weight and nutritional status
- Poor weight gain during pregnancy
- Poor nutrition
- Anaemia
- Alcohol, smoking, or drug-use
- Pre-gestational diabetes or gestational diabetes
- Pulmonary, renal, or cardiovascular disease
- Hypertension
- Coeliac disease
What are the uteroplacental causes of IUGR?
- Pre-eclampsia
- Multiple gestation
- Uterine malformations
- Placental insufficiency
What are the fetal causes of IUGR?
- Chromosomal abnormalities
- Vertically transmitted infections
What is the main symptom of IUGR?
A small for gestational age baby, specifically being below the 10th percentile
What are the other clinical features of IUGR?
- Dry, peeling skin
- Overly-thin umbilical cord
- Hypoxia
- Hypoglycaemia
What investigations may be useful in IUGR?
- Estimating babies size
- Ultrasound
- Doppler flow
- Weight checks
- Fetal monitoring
- Amniocentesis
How is the babies size estimated in IUGR?
Measurement from fundus to pubic bone
How might estimating the babies size be useful in IUGR?
Can help initially identify IUGR
What is the importance of ultrasound in IUGR?
It is the main test for checking baby’s growth in the uterus
What are the management strategies for mothers whose fetus is diagnosed with IUGR based on?
Monitoring and delivery methods
Give an example of a monitoring method for a fetus with IUGR
Umbilical artery Doppler
What is recommended for women with spontaneous labour with a small for gestational age fetus?
Early admission
Why is early admission recommended for a mother in spontaneous labour with a small for gestational age fetus?
In order to instigate continuous fetal heart rate monitoring
What are the potential complications of IUGR?
- Polycythaemia
- Hypothermia
- Thrombocytopenia
- Leukopenia
- Hypocalcaemia
- Pulmonary haemorrhage
- Neurodevelopmental disorders
