IUGR Flashcards
definition of small for gestational age?
less than 10th percentile, or less than 2.5 kg
what are the causes of small for gestational age ?
- wrong dates
- constitutional (look at parents)
- placenta pathology/insuficiency
- maternal disease: DM, HTN, chronic illnes
- abnormal cord (two vessel cord - only one umbilical artery instead of 2) - fetal defect:
- chromosomal
- structural - congenital infection
- TORCHES
what are risks associated with small for gestational age ?
advanced maternal age
obesity
multiple pregnancy
previous IUGR
pre-eclampsia
substance use
what are the 3 main causes of death in IUGR?
- congenital abnormalities
- prematurity
- normally formed stillbirth
what investigations are commonly performed?
- serial growth measurements - ultrasound (low risk)
- serology - torch infections
- uterine artery doppler (screens for placenta insufficiency) - moderate risk
- umbilical artery doppler
- pulsatility: difference between maximum and minimum blood flow
- done in high risk patients - MCA doppler
- CTG
what do you look for on ultrasound ?
1) symmetrical vs asymmetrical growth
- symmetrical is either constitutional or pathological
- asymmetric is usually placenta pathology
2) fetal biometry
- biparietal diameter
- abdominal circumference
- femur length
3) liquour volume
indications for delivery in IUGR?
- reversed end-diastolic flow
- oligohydraminos
- decels on CTG
- 32 weeks gestation
- > 500 g (viable)
steroids should be given if before … and dose
2 doses of 12 mg betamethasone 24 hours apart
causes of oligohydraminos?
- idiopathic
- rupture of membranes
- reduced fetal urine production - kidney abnormality, IUGR, post dates
how is amniotic fluid measured?
- deepest vertical pool (2-8 cm)
- amniotic fluid index (5-25 cm)
what are complications of oligohydraminos?
fetal anomalies: potter sequence
premature ROM
causes of polyhydraminos?
- idiopathic
- maternal
