IUGR

Question 1

Definition of IUGR

Question 2

Maternal disorders that can cause IUGR?

Answer 2

1. APL ab syndrome–NOT factor V Leiden, PT mutation, MTHFR
2. Pregestational DM
3. Renal insufficiency
4. Cyanotic cardiac disease
5. Autoimmune disease
6. HTN

Question 3

When should IUGR babies be delivered?

Answer 3

1. 38-39 6/7wks if just ISOLATED IUGR

2. 34-37 6/7 wks IUGR with other risk factors

Question 4

What are risk factors that may influence earlier delivery of babies with IUGR?

Answer 4

1. Abnormal dopplers
2. Maternal risk factors/comorbidities
3. oligo

Question 5

What are risk factors that may influence earlier delivery of babies with IUGR?

Answer 5

1. Abnormal dopplers
2. Maternal risk factors/comorbidities
3. oligo

Question 6

Does maternal nutrition effect fetal growth?

Answer 6

Studies show poor protein intake prior to 26 wks

Extremely low calorie (600-900kcal/day)…but increasing calories may not solve problem

Question 7

Teratogens that cause IUGR

Answer 7

Cyclophosphamide, Valproate, Warfarin

Question 8

Infectious Diseases that cause IUGR

Answer 8

1. Malaria
2. Toxo
3. Rubella
4. RPR
5. CMV
6. VZV

Question 9

Genetic/structural disorders causing IUGR

Answer 9

trisomy 13, 18 (50% have IUGR) congenital heart disease, gastroschisis

Question 10

Placental/Cord abnormalities that cause IUGR

Answer 10

Single umbilical artery in some studies
Velamentous/marginal cord
Placental abruptions, infarction, circumvallate, hemangioma, chorioangioma

Question 11

Why do we have to consider delivering IUGR babies earlY?

Answer 11

Significantly increased risk for stillbirth:

Question 12

IUGR babies same comps as preterm birth babies in NICU

Answer 12

NEC
RDS
IVH
Hypoglycemia
Hyperbili
Hypothermia
Sepsis
Neonatal death

Question 13

Fundal height measurments specificity and sensitivity for detecting IUGR?

Answer 13

More SPECIFIC than sensitive.
SN = 65-85%
SP = 96%

Question 14

Does measuring umb artery dopplers reduce rate of perinatal death?

Answer 14

YES, by 29%

Question 15

Sono measurements can deviate from actual birthweight by what percentage and in what percentage of cases?

Answer 15

Deviates by 20% in 95% of cases

Question 16

Fundal Ht discrepancy that you should suspect fetal growth restriction.

Answer 16

3cm

Question 17

Risk of recurrence of IUGR?

Answer 17

20%

Question 18

History of IUGR in prior pregnancy need additional monitoring in this pregnancy? What about known APL ab syndrome?

Answer 18

NOT indicated

Has not been shown to improve outcomes to increase surveillance pre-emptively for APL ab

Question 19

Can we prevent IUGR?

Answer 19

Not really: changing diet, ASA use does not work/insufficient evidence

Question 20

When do you offer genetic counseling/prenatal diagnostic testing in setting of IUGR?

Answer 20

IUGR + Structural abnormalities

Early onset IUGR (much higher risk for aneuploidy), midtrimester

Question 21

What is the optimal surveillance regimen for IUGR babies?

Answer 21

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

Question 22

Does absent end diastolic flow have an increased risk of perinatal mortality?

Answer 22

Yes

Question 23

Is it useful to measure MCA or precordial venous system dopplers in IUGR?

Answer 23

Have not been shown to improve perinatal outcome, role of these measurements uncertain

Question 24

Is SVD contraindicated in severe IUGR?

Answer 24

No…not an indication for primary C/S

Question 25

What is abnormal S/D ratio?

Answer 25

> 3.0 at >/= 28wks

Question 26

What is abnormal Resistance Index (RI)?

Answer 26

> 0.6 at >/= 28 wks

Question 27

When do you deliver IUGR babies?

Answer 27

1. 38w0d-39w6d if ISOLATED IUGR
2. 34w0d to 37w6d if IUGR with additional risk factors for adverse outcome (oligo, abnormal UA dopplers, maternal risk factors, comorbidities)

Question 28

What if you need to deliver before 34 weeks?

Answer 28

MFM consult
steroids
Hospital with NICU
Mag for NP