Growth problems with fetus

Question 1

IUGR causes

Answer 1

Infant wt is less then the 10th percentile for GA or less then 2500g
Causes
Maternal causes - Malnutrition, smoking, drug abuse, Eoth, Cyanotic heart disease, Type 1 D, SLE, pulmonary insufficiency, previous IUGR
Maternal fetal - Any disease causing placental insufficiency e.g. HTN, Renal insufficiency, gross placental morphological abnormalities e.g. infarction, heangiomas
Fetal - TORCH infections, multiple gestation, congenital anomalies.

Question 2

TORCH infections

Answer 2

Toxoplasmosis
Other - Syphillis, varicella, 
Rubella
CMV
HSV , Varicella, Parvo

Question 3

Clinical features of IUGR

Answer 3

Symmetric or type 1 occurs in early pregnancy
- Head/abdomin ratio is normal. Usually associated with congenital anomalies or TORCH infections
- Unsymmetric/type 2: occurs later in pregnancy. Head:abdomen ratio increased. Brain is spared. Usually caused by placenta insufficiency.
C

Question 4

Cx of IUGR

Answer 4

Prone to meconium aspiration, asphyxia, polycythemia, hypoglycaemia and mental retardation. Greater risk of perinatal morbidity and mortality

Question 5

Ix IUGR

Answer 5

Measure fundal ht at every visit. if mother at risk or fundal ht out by greater then 2 cm then USS for head and abdominal circumference, femur length, fetal weight and Amniotic fluid volume
Doppler of blood flow

Question 6

Mx of IUGR

Answer 6

Prevent by modification of RF prior to pregnancy.
Modify controllable factors - smoking, alcohol, nutrition and treat maternal illness
Bed rest in left lateral decubitus position
Monitor fetal growth and look for cause
Delivery when extrauterine existence is less dangerous than continue intrauterine e.g. abnormal function tests, absent growth or severe oligohydramnios esp if greater then 34 weeks, usually by C/S as IUGR fetus withstands labor poorly.

Question 7

DDX for incorrect uterine size for dates

Answer 7

Inaccurate dates
lateral DM
Maternal fetal polyhydramnios/oligohydramnios
fetal causes - abn karyotype, IUGR, Macrosomia, fetal anomaly, abn lie, multiple gestation.

Question 8

Macrosomia

Answer 8

when infant is greater then 90th percentile for GA or greater then 4000g
Causes/RF - maternal obesity, GDM, PmHx of macrocosmic infant, prolonged gestation, multiparity.
Cx - increase risk of perinatal mortality, Birth injuries e.g. shoulder dystocia, fetal bone fracture.
Ix - serial fundal ht, USS if SFH greater then 2cm.
Mx - CS if infant is greater then 5000g non diabetic or 4500g in a diabetic. Risk of CS vs risk of shoulder dystocia. Induction vs CS.

Question 9

Polyhydramnios

Answer 9

Definition - Amniotic fluid index greater then 25cm, with single deepest pool greater then 8cm.
DDX - Most common is idiopathic. material - T1DM. Maternal vs fetal - Chorioangiomas, multiple gestation, fetal hydrops. Fetal - chromosomal, respiration of malformed lung, CNS - anencephaly, hydrocephalus, meningocele, GI - tracheoesophageal fistula, duodenal atresia, facial clefts.
Presentation - large for dates, difficulty palpating fetal parts or hearing fetal HR.
Cx - pressure symptoms eg dyspnea, edema, hydronephrosis, cord prolapse, placental abruption, malpresentation, preterm labor, uterine dysfunction and PPH
Mx - Admit and Ix to rule out ROM, Fetal monitoring, USS doppler, Maternal hydration, injection fluid via amniocentesis, deliver if term,
Prognosis - poor if earlier onset,

Question 10

Oligohydramnios

Answer 10

define - Amniotic fluid index of less then 5 cm and USS showing single deepest pocket less then 2 cm.
Causes - most common cause idiopathic., uteroplacental insufficiency e.g. preeclampsia, or nephropathy, medications e.g. ACE i, Fetal - congenital UT abn e.g. renal agenesis, obstruction, posterior urethral valves, Demise/chronic hypoxemia, IUGR, Ruptured membranes,
Presentation - uterus small for dates,
Cx - Fetal 15-20% have fetal anomalies, amniotic fluid bands can lead to potter’s facies, limb deformities, abdominal wall defects. Ob Cx - Cord compression, pulmonary hypoplasia
Mx - Find underlying cause. mild to moderate no tx, Severe requires hospitalise and consider therapeutic.
Prognosis - 2-5 fold increase in risk of perinatal mortality.