Intrauterine growth restriction Flashcards
Constitutional reasons for small babies (note: NOT IUGR)
Low maternal height/weight
Nulliparity
Asian
Female fetal gender
Risk factors for IUGR
Pre-existing maternal disease Pre-eclampsia, PIH, antepartum haemorrhage, low BMI Multiple pregnancy Smoking Drug usage - cocaine CMV infection Extreme malnutrition Congenital abnormalities Daily vigorous exercise Previous or family history of SFD baby or stillbirth Fetal echogenic bowel
Complications
Stillbirth Cerebral palsy Preterm delivery C-section Intrapartum fetal distress or asphyxia Intrauterine death Postnatal hypoglycaemia/hypocalcaemia Impaired neurodevelopment Meconium aspiration
Clinical features
Reduced fetal movements - not consistent feature
Serial measurement of symphysis fundal height reduced/slowing
Pre-eclampsia often co-exists
US for diagnosis; umbilical artery Doppler
Can also check for CMV and congenital abnormalities
Management
SFD only: growth rechecked fortnightly; small but consistently growing with normal Doppler values needs no intervention
IUGR at term: SFD + abnormal Doppler delivered if >36w
IUGR preterm: varies greatly, checked 2x week; steroids 34w often deliver; <34w delay delivery until CTG/fetal dopplers abnormal
Small for dates definition
Fetus’s weight below 10/5/3 centile
Intrauterine growth restriction
Compromise
Growth has slowed or is less than expected taking into account constitutional factors
