Abnormal growth in utero Flashcards
Causes of Intrauterine Growth Restriction
Maternal causes malnutrition Smoking Drug abuse Alcoholism Cyanotic heart disease Type 1 DM SLE pulmonary insufficiency previous IUGR Maternal fetal any disease causing placental insufficiency Includes gestational HTN, chronic HTN, chronic renal insufficiency, gross, placental morphological abnormalies (infarction, hemangiomas) fetal causes TORCH infections toxoplasmosis Other eg syphilis Rubella CMV HSV Multiple gestation congenital anomalies
Types of IUGR
Symmetric type 1 occurs in early pregnancies
Inadequate growth of head and body
Head:abdomen ratio may be normal
Causes
congenital anomalies
TORCH infection
Asymmetric type 2 occurs in late pregnancy
brain is spared, therefore head:abdomen ratio increased
Usually associated with placental insufficiency
More favorable prognosis than type 1
Cx of IUGR
Prone to meconium aspiration, asphyxia, polycythemia, hypoglycaemia, and mental retardation
Greater risk of perinatal morbidity and mortality
Ix of IUGR
SFH measurements at every antepartum visit - if high risk or >2cm
USS
Dopplers analysis of umbilical cord blood flow.
Mx of IUGR
Modify controllable factors
Smoking
Alcohol
nutrition
treat maternal illness
bed rest in left lateral decubitus position
Serial BBP, and determine caused of IUGR
Delivery when extrauterine existence is less dangerous than continued intrauterine existence especially if GA >34 wk
abnormal function tests, absent growth, severe oligohydramnios
liberal use of C/S since IUGR fetes withstands labor poorly.
Causes of macrosomia
Maternal obesity GDM PmHx of macrosomic infant Prolonged gestation Multiparity
Cx of macrosomia
Increase risk of perinatal mortality
CPD and birth injuries - shoulder dystocia, fetal bone fracture. more common
Complications of DM in labor
Ix of macrosomia
Serial SFH further Ix if mother at high risk or SFH greater then 2cm ahead of GA USS predictors Polydyramnios T3 AC greater then 1.5cm/wk HC/AC ratio less then 10th percentile FL/AC ratio less then 20th percentile
Mx of macrosomia
Prophylactic C/S is a reasonable option where EFW greater 5000g in non-diabetic woman and EFW greater then 4500g in DM
no evidence that prophylactic C/S improves outcomes
Early induction of labor is not recommended for non-diabetic mothers
Risk and benefits of early induction (risk of C/S vs risk of dystocia) must be weighed in diabetic mother as current research is unclear
Define polyhydramnios
AFI greater then 25cm
USS: single deepest pocket greater 8cm
Causes of polyhydramnios
Idiopathic most common
Maternal - T1D
Maternal-fetal: Chorioangiomas, multiple gestation, fetal hydrops
Fetal: Chromosomal anomaly, Resp: cystic adenomatoid malformed lung, CNS:Anencephaly, hydrocephalus, meningocele, GI: tracheoesophageal fistula, duodenal atresia, facial clefts
Clinical features and complications of polydyramnios
Uterus large for dates
Difficulty palpating fetal parts and hearing FHR
Maternal Cx: pressure symptoms form over distended uterus e.g. dyspnea, oedema, hydronephrosis
Obstetrical Cx: Cord prophase, placental abruption, malpresentation, preterm labor, uterine dysfunction and PPH
Define Oligohydramnios
AFI less then 5 cm
USS of single deepest pocket less then 2cm
Causes of oligohydramnios
Idiopathic most common
Maternal:
Uteroplacenta insufficiency e.g. pre eclampsia,
nephropathy or
medication e.g. ACEi
Fetal:
Congeital UT anomalies e.g. renal agenesis, obstruction, posterior urethral valves,
Demise/chronic hypoxemia e.g. blood shunt away from kidneys to perfuse brain
IUGR
Ruptured membranes: prolonged amniotic fluid leak
Amniotic fluid normally decreases after 35 wk.
Clinical features and complications of oligohydramnios
uterus small for dates Fetal Cx: 15-25% have fetal anomalies amniotic fluid bands (T1) can lead to Potter's facies, limb deformities, abdominal wall defects Ob Cx: cord compression increased risk of adverse fetal outcomes Pulmonary hypolasia - late onset Marker for infants who may not tolerate labor well
