IUGR

Question 1

What is the definition of IUGR?

Answer 1

Intra-uterine growth restriction = failure of fetus to reach growth potential

Question 2

How is IUGR different from Small for Dates (SFD)?

Answer 2

SFD = birthweight

Question 3

Name 5 short-term consequences of IUGR

Answer 3

Preterm labour
Perinatal mortality (stillbirth and neonatal death)
Neonatal morbidity (hypothermia, hypoglycaemia, infection, polycythaemia, meconium aspiration, HIE)

Question 4

Name 2 long-term consequences of IUGR

Answer 4

Motor and intellectual disability (CP, mental retardation)

Can extend into adult comorbid disease as well (Barker hypothesis - HT, DM, dyslipidaemia, vascular disease)

Question 5

Name 5 foetal causes of IUGR

Answer 5

Congenital - chromosomal (Trisomys, Turner syndrome), single gene disorders (Russel-Silver, Fanconi), structural defects (gastroschisis, omphalocoele, diaphragmatic hernias, skeletal dysplasia, heart disease), infection (toxo, CMV)

Question 6

Name 5 maternal causes of IUGR

Answer 6

Vascular disease (HT, pre-eclamp, DM, connective tissue disease)
Thrombophilia - acquired (APLS, Ca, smoking) or congenital (Protein S and C, antithrombin III, Factor V Leiden etcccc)
Toxins (smoking, EtOH, cocaine, narcotics)
Malnutrition
Cardiac disease
Anaemia
Respiratory disease

Question 7

Name 2 placental causes of IUGR

Answer 7

Multiple pregnancy
Placental abruption
Placental abnormalities

Question 8

How do you screen for IUGR in utero on examination? How accurate is this?

Answer 8

Symphyseal-fundal height from 20 weeks - only 66% accurate

Question 9

What Ix can you do for IUGR? When is best to do it? What measurement is most accurate?

Answer 9

U/S at 34 weeks. Abdo circumference most accurate.

Question 10

Name 2 Mx to prevent IUGR

Answer 10

Aspirin

Work and rest optimisation

Question 11

Name 3 factors that would suggest a foetus is suffering from IUGR rather than just being genetically small

Answer 11

Parents are tall
Risk factors
Asymmetrically small
Aberrant growth trajectory
Biophysically inactive
Abnormal amniotic fluid, umbilical or Doppler studies

Question 12

What are the 5 principles of management for a foetus with IUGR?

Answer 12

Confirm diagnosis
Find and treat cause (if there is one)
Fetal surveillance - CTG and U/S
Treat IUGR
Deliver

Question 13

Should you supplement an IUGR foetus with extra nutrition (hyperalimentation)? Why/why not?

Answer 13

No - even if it increases size of foetus (which it might not if the IUGR has a foetal etiology), it still doesn’t correct the inadequate oxygenation (from defective placental vessels or maternal circulation) = ends up dying from hypoxia

Question 14

Name 3 therapies to best optimise IUGR before delivery

Answer 14

Rest

Steroids if delivery

Question 15

When should you aim to deliver an IUGR baby? Name 1 indication to deliver earlier than this

Answer 15

38 weeks or later, unless signs of foetal hypoxia