IUGR (21.02.2020)

Question 1

What is FGR?

Answer 1

Foetal Growth Restriction

Failure of the fetus to achieve its predetermined growth potential for various reasons

• The term FGR should only be used for fetuses with definite evidence that growth has altered.
• Growth is a dynamic process of a change of size over time and, therefore, it can only be assessed by serial observation.

Question 2

What is SGA?

Answer 2

• ‘small for gestational age’
• birth weight < 10th centile
• The terms ‘small for gestational age’ (SGA) and ‘small-for-dates’ are statistical definitions of weight at birth (below a subjective centile on charts of birth weight standards)
• The centiles most commonly employed are the tenth, fifth or third.

Question 3

LBW and VLBW

Answer 3

Low: less than 2.5 kg
very low: less than 1 kg

most LBW neonates are not growth restricted

Question 4

Choosing centiles

Answer 4

When choosing which centile to use, a balance between sensitivity and specificity is being made – the tenth centile is most sensitive and the third centile is most specific.

• The tenth centile will capture all babies with FGR, but will also include those babies that are just small for gestational age, i.e. you get a number of false positives.
• All babies recorded using the third centile will have FGR, but some FGR babies may be missed, i.e you get a number of false negatives.

Question 5

What are short and long term sequelae of FGR

Answer 5

• IUGR is the most common factor identified in stillborn babies.
• In addition, it has serious consequences for babies who survive.
• Furthermore, there is an increased risk of IUGR and intrauterine death (IUD) in mother’s subsequent pregnancy.

Question 6

What are problems of LBW / FGR / Prematurity?

Answer 6

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Question 7

What are the causes of SGA?

Answer 7

• dating problem (consistent growth, normal dopplers and amniotic fluid)
• normal (Growth may reduce in 2w, normal dopplers and fluid)
• fetal problem 5% (foetal abnormalities, foetal infection)
• placental insufficiency 20% (reduction in AC/FL, reduced liquor, deranged dopplers)

Question 8

Factors associated with FGR and the SGA fetus

Answer 8

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Question 9

Pre-eclampsia

Answer 9

Multisystem disease that usually manifests as hypertension and proteinuria

• Hypertension (BP > 140/90 mmHg)
• Proteinuria (proteinuria >0.3g/24hour (PCR>30))

HBP in 10% all pregnancies Only 1-2% severe form “Fetal syndrome” is relatively rare

Question 10

Which fetuses need growth monitoring?

Answer 10

Bad Obstetric History
Previous
Previous FGR Stillbirth
Placental Abruption

Concerns  in index pregnancy
- Abnormal serum biochemistry
- maternal hypertension
   /????????
symphysis
systemic disease e.g. hypertension,
haemorrhage
   Reduced Maternal coagulation Antepartum
A <0.3 fundal height
PAPP
MoM
    renal
,