Intrauterine growth restriction

Question 1

LO: Explain the implications of IUGR with respect to the short and long term consequences

Answer 1

Short term

• preterm labour
• perinatal death (goes up almost exponentially from 38wks)
• neonatal morbidity (hypothermia, infection, hypoglycaemia, polycythemia, irritable and poor feeders, meconium aspiration, HIE= hypoxic ischaemic encephalopathy)

Long term disability
Childhood
-motor and or intellectual handicap eg cerebral palsy 
Adulthood (developmental origins of adult disease= Barker hypothesis)
-hypertension
-DM
-dyslipidaemia
-vascular dz assoc with the above

Question 2

LO: Appreciate the importance of IUGR diagnosis

Answer 2

Not in lec?
-allow for planning, monitoring +/- intervention e.g. Treat cause if possible, Steroids and Induction at 38wks?

With genetically small: parents small, abscence of recognised RFs, symmetrically small, normal growth trajectory, biophysically active, normal AF, normal umbilical and other doppler studies.

Diagnosis of IUGR:

• Hx,
• Ex,
• Ix (IgM or paired IgG. Torch screen, preeclampsia testing eg uric acid, FBE, thrombophilia screen)

? Karyotyping (will it change the management)

Question 3

LO: Describe the principles of management of IUGR

Answer 3

1. Confirm the diagnosis (restricted vs genetically small)
2. Determine aetiology
3. Assess fetal well-being/surveillance (CTG, US)
4. Assess gestational age
5. Treatment?
6. Delivery: mode (aim for vaginal birth, as if have CS more likely to need to do classical, and increased risk of uterine rupture subsequently) and gestation (usually get it out if > or = 38wks). May require corticosteroids and neuroprotection!!

Question 4

Definition of IUGR

Answer 4

Failure of fetus to achieve its growth potential.

Small for dates: BW <10th centile

Question 5

Aetiology of IUGR (see lecture for details)

Answer 5

Fetal
-congenital (chromosomes, genetic, structural anomalies, familial)
-infections (esp CMV and toxo)
Maternal
-vascular dz, thrombophilia, toxins, cardiac dz, anaemia, malnutrition, hypoxia
Placental
-multiple preg
-abruption
-placental abnormalities

Question 6

Diagnosis of IUGR

Answer 6

Screening

• sypmhyseal fundal height (detects ~2/3 of SFD BUT intra vs inter-observer reliability, so trend/continuity of care useful)
• US (more effective, but only done if suspect IUGR. Optimal timing ~34wks. Optimal single biometric measure= AC?)