IUGR Flashcards
MATERNAL CAUSES OF IUGR
MATERNAL 1. Smoking and other drug use
- Diabetes
- GPH/chronic hypertensive disorder
- Anemia
- Alcohol
- Other medical conditions such as malignancies, cardiopulmonary disease
Complications of IUGR
- stillbirth2. Birth asphyxia3. Meconium Aspiration Syndrome4. Preterm delivery (Iatrogenic)5. Preterm neonatal complications - hypo… Poly6. Impaired neurodevelopment7. Metabolic syndrome in adulthood - Barker’s hypothesis
Risk of developing IUGR
- Previous hx2. Hx of hypertensive disorder3. Smoking and recreational drug use4. Any bleeding at any stage during pregnancy5. Multiple pregnancy
IUGR CASE 1:Reduced growth by SFM and US measures, but normal EDF on doppler and fetal condition (not distressed)
- Identify and address possible reversible cause and risk factors
- Watch out for GPH - BP and urine dipstix every visit
- Growth USS every 2-3 weeks
- Fetal kick chart
CASE 2: Reduced growth by USS and SFM, abnormal AFI and raised EDF and ABSENCE EDF, but normal CTG
Admit to 2' Hospital Identify cause and risk factors Daily BP and urine dipstix BMZ 12 mg daily for 2 days CTG everydayAFI and doppler twice weekly Fetal kick chart DELIVER WHEN:-34 week-fetal distress on CTG-umbilical artery doppler becomes REDF
Implication of Reverse EDF
Deliver asap
Implication of absence EDF
Admission to 2’ hospital
Implication of increased resistance in EDF
High level of suspicion and regular checkups
Case 3:Reduced growth rate, decreased AFI, REDF and normal CTG
Admit to hospital Identify and address cause Daily BP and urine dipstix BMZ two days At least 8 hrly CTG Deliver as soon as BMZ treatment finishes
What are growth restricted infants at a greater risk of?
Stillbirth Birth asphyxia Neonatal complications Hypothermia and hypoglycaemia Impaired neurodevelopment Possible type two diabetes and HPT
Fetal causes of IUGR?
- Congenital infection (TORCHS)
- Chromosomal abnormalities (E.g Trisomy)
- Structural congenital abnormalities
- Inborn errors of metabolism
Placental causes of IUGR?
PLACENTAL1. Twin to twin transfusion
- Placenta praeiva
- Recurrent APH
Uterine causes of IUGR?
Congenital anomalies of the uterus
Arteriosclerosis of the decidual spiral arteries
Causes of symmetrical IUGR?
Chromosomal abnormality
Fetal infections
Structural abnormalities
Causes of asymmetrical IUGR?
Hypertensive disorders Chronic maternal illness, including lupus Substance abuse Malnutrition Multiple pregnancy Recurrent APH Placental dysfunction
What are the 4 fetal adaptive mechanisms that respond to hypoxaemia?
Gluconeogenesis from hepatic stores –> decreased abdominal circumference
Shunting- peripheral artery construction leading to increased truncal resistance
Fetal cerebral circulation dilates –> brain sparing
Redistribution of well oxygenated LV output to heart and brain
How does placental dysfunction affect the CNS?
Delays maturation of several fetal behaviours such as fetal movement.
Delays maturation or development of autonomic reflexes that determine FHR –> higher baseline FHR with lower short term variability
What are two signs of fetal decompensation and how do they present?
Progressive metabolic acidosis- oligohydramnios, loss of fetal breathing and movement, decreased fetal tone
Worsening cardiac function - abnormal FHR pattern, decreased variability, decelerations
How is gestational age determined?
Early USS- 11-14/40- crown rump length; >14/40- BPD
Naegele’s rule (LMP + 3/7 - 3/12)
Pregnancy calculator
With fetal movement count, what indicates impaired fetal welfare requiring CTG?
Sudden decrease in number
Sudden increase in number
Less than 4 movements in 1 hour
More than 12 hours to perceive 10 movements
What is the normal AFI?
5-20
How is oligohydramnios diagnosed and what causes it?
AFI
What regulates fetal cardiac physiology
Chemoreceptors and baroreceptors through sympathetic and parasympathetic systems
When is fetal blood sampling indicated?
In cases of suspicious FHR patten when immediate delivery not indicated
When is fetal blood sampling contraindicated?
Maternal infection- HIV, hepatitis, herpes
Fetal bleeding disorder
Prematurity
