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TAS Perinatal Medicine ✅ > Intrauterine Growth Restriction ✅ > Flashcards

Intrauterine Growth Restriction ✅ Flashcards

1
Q

Why is an infant’s gestation and birth weight important?

A

It influences the nature of the medial problems likely to be encountered in the neonatal period

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2
Q

What is low birth weight defined as?

A

<2.5kg

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3
Q

What % of babies in the UK have low birth weight?

A

7%

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4
Q

What % of neonatal deaths are accounted for by babies with low birth weight?

A

Around 70%

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5
Q

What is small for gestational age defined as?

A

Babies with birth weight below the 10th centile for their gestational age

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6
Q

What is true of the majority of infants born SGA?

A

They are normal, but constitutionally small

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7
Q

What are the potential scenarios resulting in SGA babies?

A
  • Have grown normally but are small
  • Have experienced intrauterine growth restriction, i.e. have failed to reach their full genetically determined growth potential
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8
Q

How do babies with IUGR appear?

A

Thin and malnourished

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9
Q

Are all IUGR babies SGA?

A

No, babies with a birth weight above the 10th centile may be growth restricted, e.g. a fetus growing along 80th centile who develops growth failure and falls to 20th centile

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10
Q

What is the term SGA sometimes restricted to?

A

Babies whose birth weight falls below the 2nd centile

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11
Q

Why is the term SGA sometimes restricted to babies with birth weights below the 2nd centile?

A

Because the incidence of congenital abnormalities and neonatal problems is higher in these babies

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12
Q

What can fetal centiles be customised to take into account?

A
  • Maternal characteristics
  • Gestation
  • Gender
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13
Q

What maternal characteristics might fetal centiles be customised on the basis of?

A
  • Weight
  • Height
  • Parity
  • Ethnicity
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14
Q

What is the advantage of customising fetal centiles?

A

More predictive of morbidity and mortality

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15
Q

What does the use of the term ‘intrauterine growth restriction’ to describe a fetus imply?

A

Pathological restriction of genetic growth potential

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16
Q

How can IUGR be identified/monitored?

A

Looking for evidence of fetal compromise

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17
Q

What evidence of fetal compromise might be identified in IUGR?

A
  • Reduced liquor volume

- Abnormal Doppler waveforms

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18
Q

What has IUGR traditionally been classified as?

A

Symmetrical or asymmetrical

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19
Q

What is the more common type of IUGR?

A

Asymmetrical

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20
Q

What is meant by asymmetrical growth restriction?

A

The weight or abdominal circumference lies on a lower centile than that of the head

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21
Q

What causes asymmetrical IUGR?

A

When the placenta fails to provide adequate nutrition late in pregnancy

22
Q

Why is brain growth spared at the expense of in asymmetrical IUGR?

A
  • Liver glycogen

- Skin fat

23
Q

What can cause the uteroplacental dysfunction leading to asymmetrical IUGR?

A
  • Maternal pre-eclampsia
  • Multiple pregnancy
  • Maternal smoking
  • Idiopathic
24
Q

What happens to asymmetrical IUGR infants after birth?

A

They rapidly put on weight

25
Q

What happens in symmetrical growth restriction?

A

The head circumference is equally reduced

26
Q

What does symmetrical growth restriction suggest?

A

A period of poor intrauterine growth starting in early pregnancy

27
Q

What is symmetrical growth restriction usually due to?

A

A small but normal fetus

28
Q

What are the pathological causes of symmetrical IUGR?

A
  • Fetal chromosomal disorder or syndrome
  • Congenital infection
  • Maternal drug and alcohol abuse
  • Chronic medical condition or malnutrition
29
Q

What happens to infants with symmetrical IUGR after birth?

A

They are more likely to remain small permanently

30
Q

What is a fetus with IUGR at increased risk of?

A
  • Intrauterine hypoxia/intrauterine death

- Asphyxia during labour and delivery

31
Q

What is the purpose of close monitoring of an IUGR fetus?

A

Determine the optimal time for delivery

32
Q

What does progressive uteroplacental failure result in?

A
  • Reduced growth in femur length and abdominal circumference
  • Reduced amniotic fluid volume
  • Abnormal umbilical artery Doppler waveform
  • Redistribution of blood flow in the fetus
  • Abnormal ductus venosus Doppler waveform
  • Reduced fetal movements
  • Abnormal CTG
  • Intrauterine death or hypoxic damage to the fetus
33
Q

What causes the abnormal umbilical artery Doppler in progressive uteroplacental failure?

A

Increased placental impedance

34
Q

What is found on umbilical artery Doppler in progressive uteroplacental failure?

A

Absent and then reversed end-diastolic flow velocity

35
Q

How is blood redistributed when there is progressive uteroplacental failure?

A

Increased to brain, reduced to GI tract, liver, skin, and kidneys

36
Q

What does the abnormal ductus venosus Doppler waveform in progressive uteroplacental failure?

A

Diastolic cardiac dysfunction

37
Q

What are the risks/complications of IUGR after birth?

A
  • Hypothermia
  • Hypoglycaemia
  • Hypocalcaemia
  • Polycythaemia
38
Q

Why are IUGR babies at risk of hypothermia after birth?

A

Because of their relatively large surface area

39
Q

What is polycythaemia defined as?

A

Venous haematocrit >0.65

40
Q

How does the umbilical artery Doppler waveform appear in the healthy fetus?

A

Forward flow in the umbilical artery throughout systole and diastole

41
Q

How does the umbilical artery Doppler waveform appear in IUGR due to placental disease?

A

Reduced, then absent or reversed flow during diastole

42
Q

What causes the abnormal umbilical artery Doppler in IUGR due to placental disease?

A

Increased resistance in the placenta due to loss of placental villi or pre-eclampsia

43
Q

What is indicated if end-diastolic flow is absent on umbilical artery Doppler in IUGR?

A

Detailed Doppler studies of the middle cerebral artery and ductus venosus

44
Q

What happens to blood flow as IUGR becomes increasingly severe?

A

There is redistribution of fetal blood flow, with an increase in flow to the brain and increased end-diastolic velocity

45
Q

What should evidence of cerebral redistribution in a fetus indicate?

A

A need for invasive regular monitoring

46
Q

What does a ductus venosus Dopper reflect?

A

The physiological state of the right heart

47
Q

What may be found on ductus venosus Doppler in IUGR?

A

Reversed flow during atrial contraction (in the second trimester)

48
Q

What does reversed flow during atrial contraction in a second trimester IUGR represent?

A

Cardiac decompensation

49
Q

Why is ductus venosus Doppler a useful test?

A

Finding of reversed flow during atrial contraction is a better predictor of stillbirth than umbilical artery Doppler alone

50
Q

What is timing of delivery based on in IUGR?

A
  • Doppler findings
  • Gestation
  • Estimated fetal weight

TAS Perinatal Medicine ✅ (16 decks)

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