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Obstetrics > IUGR > Flashcards

IUGR Flashcards

1
Q

MATERNAL CAUSES OF IUGR

A

MATERNAL 1. Smoking and other drug use

  1. Diabetes
  2. GPH/chronic hypertensive disorder
  3. Anemia
  4. Alcohol
  5. Other medical conditions such as malignancies, cardiopulmonary disease
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2
Q

Complications of IUGR

A
  1. stillbirth2. Birth asphyxia3. Meconium Aspiration Syndrome4. Preterm delivery (Iatrogenic)5. Preterm neonatal complications - hypo… Poly6. Impaired neurodevelopment7. Metabolic syndrome in adulthood - Barker’s hypothesis
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3
Q

Risk of developing IUGR

A
  1. Previous hx2. Hx of hypertensive disorder3. Smoking and recreational drug use4. Any bleeding at any stage during pregnancy5. Multiple pregnancy
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4
Q

IUGR CASE 1:Reduced growth by SFM and US measures, but normal EDF on doppler and fetal condition (not distressed)

A
  1. Identify and address possible reversible cause and risk factors
  2. Watch out for GPH - BP and urine dipstix every visit
  3. Growth USS every 2-3 weeks
  4. Fetal kick chart
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5
Q

CASE 2: Reduced growth by USS and SFM, abnormal AFI and raised EDF and ABSENCE EDF, but normal CTG

A 
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
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6
Q

Implication of Reverse EDF

A

Deliver asap

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7
Q

Implication of absence EDF

A

Admission to 2’ hospital

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8
Q

Implication of increased resistance in EDF

A

High level of suspicion and regular checkups

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9
Q

Case 3:Reduced growth rate, decreased AFI, REDF and normal CTG

A 
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
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10
Q

What are growth restricted infants at a greater risk of?

A 
Stillbirth
Birth asphyxia
Neonatal complications
Hypothermia and hypoglycaemia
Impaired neurodevelopment
Possible type two diabetes and HPT
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11
Q

Fetal causes of IUGR?

A
  1. Congenital infection (TORCHS)
  2. Chromosomal abnormalities (E.g Trisomy)
  3. Structural congenital abnormalities
  4. Inborn errors of metabolism
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12
Q

Placental causes of IUGR?

A

PLACENTAL1. Twin to twin transfusion

  1. Placenta praeiva
  2. Recurrent APH
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13
Q

Uterine causes of IUGR?

A

Congenital anomalies of the uterus

Arteriosclerosis of the decidual spiral arteries

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14
Q

Causes of symmetrical IUGR?

A

Chromosomal abnormality
Fetal infections
Structural abnormalities

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15
Q

Causes of asymmetrical IUGR?

A 
Hypertensive disorders
Chronic maternal illness, including lupus
Substance abuse
Malnutrition 
Multiple pregnancy
Recurrent APH
Placental dysfunction
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16
Q

What are the 4 fetal adaptive mechanisms that respond to hypoxaemia?

A

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

17
Q

How does placental dysfunction affect the CNS?

A

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

18
Q

What are two signs of fetal decompensation and how do they present?

A

Progressive metabolic acidosis- oligohydramnios, loss of fetal breathing and movement, decreased fetal tone
Worsening cardiac function - abnormal FHR pattern, decreased variability, decelerations

19
Q

How is gestational age determined?

A

Early USS- 11-14/40- crown rump length; >14/40- BPD
Naegele’s rule (LMP + 3/7 - 3/12)
Pregnancy calculator

20
Q

With fetal movement count, what indicates impaired fetal welfare requiring CTG?

A

Sudden decrease in number
Sudden increase in number
Less than 4 movements in 1 hour
More than 12 hours to perceive 10 movements

21
Q

What is the normal AFI?

A

5-20

22
Q

How is oligohydramnios diagnosed and what causes it?

A

AFI

23
Q

What regulates fetal cardiac physiology

A

Chemoreceptors and baroreceptors through sympathetic and parasympathetic systems

24
Q

When is fetal blood sampling indicated?

A

In cases of suspicious FHR patten when immediate delivery not indicated

25
Q

When is fetal blood sampling contraindicated?

A

Maternal infection- HIV, hepatitis, herpes
Fetal bleeding disorder
Prematurity

Obstetrics (18 decks)

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