IUGR Flashcards
Definition of IUGR
Maternal disorders that can cause IUGR?
- APL ab syndrome–NOT factor V Leiden, PT mutation, MTHFR
- Pregestational DM
- Renal insufficiency
- Cyanotic cardiac disease
- Autoimmune disease
- HTN
When should IUGR babies be delivered?
- 38-39 6/7wks if just ISOLATED IUGR
2. 34-37 6/7 wks IUGR with other risk factors
What are risk factors that may influence earlier delivery of babies with IUGR?
- Abnormal dopplers
- Maternal risk factors/comorbidities
- oligo
What are risk factors that may influence earlier delivery of babies with IUGR?
- Abnormal dopplers
- Maternal risk factors/comorbidities
- oligo
Does maternal nutrition effect fetal growth?
Studies show poor protein intake prior to 26 wks
Extremely low calorie (600-900kcal/day)…but increasing calories may not solve problem
Teratogens that cause IUGR
Cyclophosphamide, Valproate, Warfarin
Infectious Diseases that cause IUGR
- Malaria
- Toxo
- Rubella
- RPR
- CMV
- VZV
Genetic/structural disorders causing IUGR
trisomy 13, 18 (50% have IUGR) congenital heart disease, gastroschisis
Placental/Cord abnormalities that cause IUGR
Single umbilical artery in some studies
Velamentous/marginal cord
Placental abruptions, infarction, circumvallate, hemangioma, chorioangioma
Why do we have to consider delivering IUGR babies earlY?
Significantly increased risk for stillbirth:
IUGR babies same comps as preterm birth babies in NICU
NEC RDS IVH Hypoglycemia Hyperbili Hypothermia Sepsis Neonatal death
Fundal height measurments specificity and sensitivity for detecting IUGR?
More SPECIFIC than sensitive.
SN = 65-85%
SP = 96%
Does measuring umb artery dopplers reduce rate of perinatal death?
YES, by 29%
Sono measurements can deviate from actual birthweight by what percentage and in what percentage of cases?
Deviates by 20% in 95% of cases
Fundal Ht discrepancy that you should suspect fetal growth restriction.
3cm
Risk of recurrence of IUGR?
20%
History of IUGR in prior pregnancy need additional monitoring in this pregnancy? What about known APL ab syndrome?
NOT indicated
Has not been shown to improve outcomes to increase surveillance pre-emptively for APL ab
Can we prevent IUGR?
Not really: changing diet, ASA use does not work/insufficient evidence
When do you offer genetic counseling/prenatal diagnostic testing in setting of IUGR?
IUGR + Structural abnormalities
Early onset IUGR (much higher risk for aneuploidy), midtrimester
What is the optimal surveillance regimen for IUGR babies?
No optimal one exists:
Should not do BPPs, NSTs at gest age before you think delivery would benefit the baby
IGS q3-4 wks, no more frequent than every 2 wks
Does absent end diastolic flow have an increased risk of perinatal mortality?
Yes
Is it useful to measure MCA or precordial venous system dopplers in IUGR?
Have not been shown to improve perinatal outcome, role of these measurements uncertain
Is SVD contraindicated in severe IUGR?
No…not an indication for primary C/S
