FGR

Question 1

Defintion of FGR

Answer 1

Failure of fetus to achieve its genetic growth potential

Question 2

SGA vs FGR

Answer 2

SGA means small for gestational age. SGA does not always mean that the baby is growth restricted. also not all FGR cases are SGA

Question 3

Causes of FGR

Answer 3

Reduced fetal growth potential
Reduced fetal growth support

Question 4

Reduced fetal growth potential

Answer 4

Aneuploidies (trisomy 18)
Single gene defect (Seckel Syn)
Structural abnormality (renal agenesis)
Intrauterine infections (CMV, Toxoplasmosis)

Question 5

Reduced Fetal Growth Support

Answer 5

Maternal:
Malnutrition
Hypoxic
Drugs

Placental
Reduced uteroplacental perfusion (sickle cell/ multi gest)
Reduced feto-placental perfusion (TTTS or single umbilical artery)

Question 6

Symmetrical FGR

Answer 6

associated with chromosomal/ genetic defect

Question 7

Asymmetrical FGR

Answer 7

associated with uteroplacental insufficiency which leads to a decrease in oxygen transfer to uterus and impaired excretion of CO2 by placenta

Question 8

How does Asymmetrical FGR develop

Answer 8

Decrease in pO2 and increase in pCO2 induces chemoreceptor response in carotid bodies which causes
VasoDILATION in brain, myocardium and adrenal glands
AND
VasoCONSTRICTION in kidneys,liver, splanchic vessels, limbs and subcutaneous tissue
SOOO Asym FGR
Decrease in abdominal girth
Impaired urine production=Oligohydramnios
Decrease in thyroxine , insulin , glucose etc
Increase in corticosteroids and catecholamines

Question 9

Changes in Asymmetrical FGR (or signs in baby)

Answer 9

Decreased abdominal girth
Impaired urine production
Oligohydramnios
Decrease in glucose, insulin, thyroxine
Increase in corticosteroids and catecholamines

Question 10

Chronic FGR can lead to

Answer 10

Fetal Acidemia which may lead to IUFD if fetus is not removed from toxic environment

Question 11

During labour there is increase risk of ____ due to compromise of _____ due to _____

Answer 11

risk of ASPHYXIA due to compromise of UTEROPLACENTAL CIRCULATION die to CONTRACTIONS

Question 12

Management

Answer 12

1.Detection of SGA via accurate Gest. Age and recognition of fetal smallness via U/S
2.Early U/s for crown-rump length
3.U/S at regular intervals to measure biparietal diameter, head and abdominal circumference for pregnancies at risk of FGR

Question 13

Pregnancies at risk of FGR

Answer 13

1. Multiple gestation
2. Hx of FGR
3. Heavy smokers
4. Drug Users
   5.Underlying Med Disorders
   HTN,DM, Cyanotic Heart Disease, Antiphospholipid syndrome
5. Preg w/ symphysis fundal height is less than expected

Question 14

If SGA is diagnosed,

Answer 14

Fetal anatomy should be assessed. If symmetrical restriction, amniocentesis for fetal karyotypeS

Question 15

Surveillance for FGR fetus

Answer 15

1. Serial Biometry + Amniotic Fluid Volume @ 2 wk interval
2. Fetal Dynamic tests
   Umbilical artery Doppler wave form analysis (absent or reverse flow = deliver soon)
3. CTG

Question 16

FGR prognosis

Answer 16

Symmetrical: depends on defect
Asymmetrical: good prognosis for survivors (catch up) after birth