IUGR Flashcards
What’s the Barker hypothesis?
Birthweight is inversely related to risk of hypertension, diabetes, dyslipidaemia and related vascular condition
What are the main chromosomal abnormalities?
Trisomy 21, 18, and 13
What is UPD? What is the problem with it?
Uniparental disomy - 2 chromosomes from the same parent
More likely to get recessive disorders
What is maternal restraint on foetal growth? How does it work?
Maternal restriction of foetal growth so foetus fits into the mother
Maternal genes control growth in utero
What is CPM?
Confined placental mosaicism
- Placental has a trisomy but foetus doesn’t
What infections cause IUGR?
CMV
Toxoplasma
Where do you get CMV from? How do you prevent it?
From children
Hand washing
Where do you get toxoplasma from? How do you prevent it?
Stray cats - gardening, sandpit
Undercooked/raw meat
Hand washing
What are the maternal causes of IUGR?
Vascular disease
- HTN, diabetes, atherosclerosis, vasculitis
Thrombophilia
- Acquired: anti-phospholipid syndrome, smoking, rest, surgery, cancer, pregnancy
- Congenital: hyperhomocysteinsaemia, Factor 5 leiden, thromboc, protein S and C, anti-thrombin 3 deficiency)
Toxins - eg alcohol Malnutrition Anaemia Cardiac disease Respiratory disease/high altitude
What are the placental causes of IUGR
Multiple pregnancy
Placental abruption - haemorrhagic infarct, trauma
Placental abnormalities
How do you screening for IUGR?
Symphyseal-Fundal height
US - 34 weeks looking at abdominal circumference (not routine)
How do you prevent IUGR?
Therapy
- Aspirin - start before 16 weeks
- Work and rest optimisation
- Not vitamin E or C
How do you Mx IUGR?
Confirm Dx Aetiology Dx and Rx Foetal surveillance Therapy - not a lot, optimise cause Delivery
How do you differentiate genetically small vs placental insufficiency?
Parental small stature
Absence of recognised risk factor
Symmetrically small (genetically)
Normal growth trajectory (genetic)
How do you Ix IUGR?
Tertiary US
Bloods
- FBE, UEC, anti-phospholipid
NIPS
Why screen for trisomy in IUGR?
To prevent emergency cesarean for non-viable baby
Emotional preparation for parents
Give option for termination
When can you terminate a child?
Up until delivery
No reason required
Needs two doctors to okay it
In what situation do you terminate late?
If the foetal pathology presents late eg CMV
Twins discordant for abnormality because safer to terminate when foetus is older
At what gestational age are foetus’ viable?
24 weeks
What doesn’t hyperalimentation work?
You get a larger baby that outgrows the placenta and you get hypoxia
When delivery in placental insufficiency?
38 weeks
If corticosteroids if before 34 and Mg if before 30 weeks
