IUGR Flashcards
Causes of baby being small? Placental?
Multiple preg
Abrupt ion
Placental abnormalities?
4 congenital disease
Chromosomal
Genetic
Structural
Familial?
UPD uni parental disomy dangerous why?
Because will get all autosomal recessive disorders
Maternal restraint of growth?
Prevent too big a baby in uterus
If have UPD both from mom? Dad?
Double growth genes from mother = big baby
Dad: both growth genes off = small Abby
How to get UPD?
trisomy and loses drops one
Confined placental mosaicism?
Placenta has trisomy, fetus doesn’t
important Structural defect
Gastroschisis
two infections that cause IUGR?
CMV
Toxoplasma
Where to get CMV?
Day care
What kind of CMV virus is virus?
Herpes Virus
How to prevent CMV?
Hand-washing!!!
Hand-washing!!!
Where do you get toxo?
Stray cats - pooing in garden and your gardening/sandbox.
HAND WASHING!
Toxoplasmosis is What species?
Parasite
Vascular diseases?
Hypertension DM - atherosclerosis Renal disease SLE Vasculitis
Thrombophilia
Congenital Acquired: anti phospholipid -preg -smoking -Rest, sx, cancer
6 hereditary thrombophilias?
Hyperhomocystenaemia Factor V Prothrombin Protein S, C Anti-thrombin II
Toxins?
Smoking Alcohol Malnutrition Anaemia High altitude (lower O2)
Common reason for placenta abrupt ion?
Hemorrhagic infarct (99%) Trauma(1%)
Screening for IUGR
Symphysis-fundal height
~34 weeks
Optimal single biometric measure?
Abdominal circumference
Preventing IUGR?
- Aspirin
- Work and rest optimization
- NOT vitamin E or C
Mx of IUGR?
Confirm Dx Look for cause Surveillance Therapy Delivery
How to confirm genetically small?
Small parents Absence of risk factors Symmetrical small Normal growth trajectory Bio physically active Normal amniotic fluid Normal umbilical and other Dopller studies
How to investigate IUGR
Tertiary ultrasound
ANTI-phospholipid syndrome
Karyotyping NIPS, why do it at 35weeks?
-Won’t compromise future reproduction, prevent unnecessary C-section if baby was destined to die anyways.
- psychological
- prepare the paediatricians
- termination in late preg
Can you terminate pregnancy?
Inject KCl
Need 2 doctors, not reason
Viability of baby after how many weeks?
24-weeks
Why terminate late?
- If prognosis is not known until late preg (eg. CMV)
- twins discordant
Rx of IUGR?
Can’t use aspirin - too late
Nutrition
Control DM better
Treat toxo
TPN will work - hyperalimentation but will die: grow too big for placenta (O2)
Hyperalimentation works?
Yes, will grow, but will outgrow O2 placenta supply and die. Not use.
If lung immaturity and need neuro protection if less than 30 weeks.
MgS04
Steroids
