IUGR Flashcards
IUGR
Manifestation of disease due to maternal, fetal, Placental problems.
Criteria for IUGR
Weight of fetus : < 10 percentile for that gestational age
> 2 SD
First change seen in IUGR
Abdominal circumference in fetus.
Smoking _____ IUGR
Leads to IUGR
smoking leads to vasoconstriction which dec volume and substrates leading to IUGR
Classification of IUGR
Type 1 and Type 2
Type 1 IUGR
Early pregnancy
Symmetrical IUGR
Bad prognosis
All fetal parameters dec.- AC, BPD, FL, Wt, HC,
Ponderal index is normal
causes : Chronic anomaly, TORCH infection and genetic Dis
Causes of Type 1 IUGR
Chronic chromosomal anomalies
TORCH infxn
Genetic diseases
Type 2 IUGR
Late pregnancy. Asymmetrical IUGR Good Prognosis. seen btw 32-34 weeks Brain Sparing effect is seen AC and Wt - dec HC, BPD, FL remain normal. Ponderal index = dec. Causes Placental insufficiency PIH chronic renal disease
causes of Type 2 IUGR
Chronic renal disease
PIH
Placental Insufficiency
Ponderal Index
Est Fetal weight / (FL) 3
Maternal causes of IUGR
PIH Placental insufficiency Heart disease - NYHA 3 and 4 Connective tissue disorder Infection Diabetes with Vasculopathy Diabetes with PIH
Only conditions of diabetes where IUGR is found
D + Vasculopathy / PIH
Placental causes of IUGR
Placental Insufficiency
Abnormal Placenta
Placental calcifications.
Fetal causes of IUGR
Chronic anomaly
Genetic diseases
Infections.
Maternal Risk factors for IUGR
PIH, Chronic renal disease , Low BMI and Wt gain during pregnancy, Infections.
Clinical diagnosis of IUGR
Lag in Symphysio-Fundal height by 4cms.
On USG best parameter - AC
Single best measurement of fetal growth
AC
Plane for measuring AC
Plane with visible
F-Fetal stomach
U- Umbilical vein
P- Portal sinus
Age independant ratio
HC/AC
in normal pregnancy This ratio dec as pregnancy advances
In IUGR - asymmetric - This increases
Placental Morphology
Grade 0, 1, 2, 3.
Grade 1 placenta -
randomly dispersed echogenic area
Grade 2 placenta
comma shaped indentations on chorionic plate
Distinct indentations and cotyledon formations are seen in grade ______ placenta
3
Best war to assess IUGR
Doppler
UA doppler findings in IUGR
S/D ratio is inc
MCA Doppler findings in IUGR
S/D ratio is dec
Complication in IUGR
Oligohydramnios leading to fetal distress leading to meconium aspiration syndrome
LBW
Fetal Distress - Hypoxia or acidosis
Stillbirth
Fetal Surveillance in IUGR
Bi weekly NST
Definite Mx of IUGR
Based on Doppler findings .
if UA doppler is normal - TOP at >38wks and continue NST biweekly
If UA doppler shows - S/D Dec - TOP @ 37wks .
If UA doppler shows - Absent flow - TOP @ 34 wks
If UA doppler shows - Reversed flow - immediate TOP
