exam 2 - intrauterine growth restriction

Question 1

A 22 yo G1 P0 at 34 weeks comes to you for a routine prenatal appointment. She states she feels well. She reports good fetal movement and denies: rupture of membranes, vaginal bleeding, or abdominal pain.
You note her fundal height is 30 cm.

Answer 1

You note her fundal height is 30 cm.
Ultrasound demonstrates symmetric intrauterine growth restriction. You order TORCH titers. Results are positive for cytomegalovirus. You counsel the patient about the diagnosis and refer her to a maternal-fetal medicine specialist.

Question 2

intrauterine growth restriction (IUGR) and fetal biometry

Answer 2

-Definition: estimated fetal weight at or below 10th percentile for GA as measured by ultrasound
-Suspect in patients with discrepancy of fundal height and gestational age
-For example, a patient at 32 weeks with a fundal height of 29 cm should have an ultrasound exam performed to rule out IUGR
-Fetal biometry is performed to determine estimated fetal weight (EFW)
-It includes measurement of:
-Head circumference
-Biparietal diameter
-Abdominal circumference
-Femur length
-These measurements then are used to calculate EFW
-The diagnosis of IUGR is also based on Doppler measurement of blood flow through umbilical vessels

Question 3

etiology of IUGR

Answer 3

-Underlying maternal conditions
-HTN
-Renal, endocrine, autoimmune, infectious diseases
-Substance use
-Genetic conditions
-Placental abnormalities
-Umbilical cord abnormalities

Question 4

maternal risk factors for IUGR

Answer 4

-!Hypertensive disorders of pregnancy
-!Renal insufficiency
-!Cocaine or amphetamine use
-!Infectious diseases (toxoplasmosis, rubella, cytomegalovirus, herpes, syphilis)
-dont need to know below
Pregestational diabetes mellitus
Cyanotic cardiac disease

Question 5

fetal risk factors for IUGR

Answer 5

-twin or higher order multiple gestation
-teratogen exposure
-genetic disorders
-placental and umbilical cord disorders
-twin to twin transfusion syndrome in monochorionic gestations

Question 6

intrauterine growth restriction

asymetric vs symmetric

Answer 6

-Most involve decrease in uteroplacental blood flow; may also involve conditions of placenta, uterus, fetus, or patient (see above)
->
-May be “head-sparing” or asymmetric
-more commonly assoc with HTN DISORDER
->
-may be symmetric
-more commonly assoc with INFECTION (torch)

Question 7

symmetrical and asymmetrical intrauterine growth restriction

Question 8

symmetric IUGR

Answer 8

-Associated with the following maternal infections during pregnancy:
-Toxoplasmosis
-Rubella
-Cytomegalovirus
-Herpes

Question 9

sequelae of IUGR

Answer 9

-passage of meconium and meconium aspiration
-sequelae of prematurity:
-Necrotizing enterocolitis
-Retinopathy of prematurity
-Long term pulmonary disease
-Decreased Apgar scores
-Hypoxic brain injury

Question 10

management of IUGR

Answer 10

-serial US to monitor fetal growth and amniotic fluid index
-r/o TORCH infections -> obtain TORCH titers
-doppler velocimetry of cord vessels -> reversed end-diastolic flow is assoc with increased risk of fetal mortality
-biophysical profiles q 2-4wks
-Indication for delivery depends on:
-Underlying etiology of IUGR
-Estimated gestational age
-Results of f/u studies
-However, delivery is indicated after 38 weeks, and, in certain cases, as early as 32 weeks

Question 11

by what gestational age should fetuses with IUGR be delivered

Answer 11

-30
-32
-34
-36
-38!!!!!!!!! (max)