IUGR

Question 1

Name two groups of SGA infants.

Answer 1

Constituionally small fetuses which are small due to genetic factors but are “fully grown”

Growth Restricted Fetus
Failed to reached genetic determined potential

Question 2

Why are all IUGR not SGA

Answer 2

IUGR will not always be below 10 centile

Question 3

What are IUGR fetus at risk of?

Answer 3

Still Birth
Birth asphyxia - may lead to HIE
MECONIUM ASPIRATION
iatrogenic preterm delivery

Question 4

What is SGA?

Answer 4

The threshold is usually below the 10th centile for weight.

Question 5

What are growth restricted fetuses at risk of?

Answer 5

• still birth
• birth asphyxia …can cause HIE
  -meconium aspiration
• iatrogenic preterm delivery
  NEONATAL Complications
• hypothermia due to decreased subcut fat
  -hypolgycaemia due to depleted glycogen stores
• polycythaemia due to chronic hypoxia
  -neurological damage eg: CP

Question 6

What is symmetrical IUGR?

Answer 6

Cause is usually early pregnancy onset, could be genetic or infection.

Question 7

What is asymetrical IUGR

Answer 7

Cause is usually late pregancy onset(3rd trimester) commonly placental insufficiency.

Brain Sparing. Vasoconstriction of splanchnic and peripheral arteries and vasodilation of cerebral vessels.

Question 8

What happens if placental dysfuction is sustained in asymm IUGR ?

Answer 8

Adaptive mechanism decompensates

• metabolic acidosis : loss of breathing movements
• worsening cardiac function : decreased variability and decelerations

Question 9

What are asymmetrically growth restricted fetus at risk of?

Answer 9

Birth Aspyxia due to poor reserve to cope with placental perfusion decrease during contractions

Question 10

Aetiology of IUGR

Answer 10

-nutrient and O2 delivery to placenta (cyanotic heart disease, smoking)
- nutrient and oxygen transfer across placenta (vascular disease - diabetes,hpt, smoking
-fetal uptake of 02 and nutrients (congen anom)
-

Question 11

Stepwise approach to causes of IUGR

Answer 11

Maternal
- chronic hpt -diabetes - smoking -cardiorespiratory disorders -alcohol

Fetal

• congen infection (torches)
• structural congen anomaliea (cardio)
• chromosomal anomalies

Placental Causes
-praevia -placental usufficiency -infarction

Question 12

Risk Factors of IUGR

Answer 12

Markers of poor nutrition 
Smoking >10/day
Recreational drugs 
Hx of HPT 
Multi pregnancy

Question 13

Clinical findings of IUGR

Answer 13

Smal hard head
Irritable uterus
Heights if fundus small of GA
Oligohydramnios

Question 14

What are biometric tests

Answer 14

Sf height
U/S

Both measure size and over time measure growth

Question 15

What are biophysical tests?

Answer 15

Preduct fetal well being 
- fetal movement count 
-auscul fetal heart 
Amniotic fluid vol (asymm IUGR is associated with Oligohydramnios)
Doppler studies 
Antenatal CTG 
biophysical profile

Question 16

General Managenent of Iugr

Answer 16

Finding reversible factora
Monitoring fetal growth and wellbeing
Deciding in best time to deliver fetus

Question 17

When to investigate for IUGR

Answer 17

• sf height that less than two previous measurements
• one sf height that is below the 10th centile
• 3 consecutuve sf height with no growth

Question 18

What are maternal causes for placental insufficiency/ reduced uteroplacental blood flow?

Answer 18

Smoking 
Hypertension 
Pre-eclampsia 
Anaemia 
Malaria 
HIV Infection 
Drug abuse (cocaine, heroin, tik)

Question 19

What are maternal causes for placental insufficiency/ reduced uteroplacental blood flow?

Answer 19

Smoking 
Hypertension 
Pre-eclampsia 
Anaemia 
Malaria 
HIV Infection 
Drug abuse (cocaine, heroin, tik)