IUGR

Question 1

Causes of baby being small? Placental?

Answer 1

Multiple preg
Abrupt ion
Placental abnormalities?

Question 2

4 congenital disease

Answer 2

Chromosomal
Genetic
Structural
Familial?

Question 3

UPD uni parental disomy dangerous why?

Answer 3

Because will get all autosomal recessive disorders

Question 4

Maternal restraint of growth?

Answer 4

Prevent too big a baby in uterus

Question 5

If have UPD both from mom? Dad?

Answer 5

Double growth genes from mother = big baby

Dad: both growth genes off = small Abby

Question 6

How to get UPD?

Answer 6

trisomy and loses drops one

Question 7

Confined placental mosaicism?

Answer 7

Placenta has trisomy, fetus doesn’t

Question 8

important Structural defect

Answer 8

Gastroschisis

Question 9

two infections that cause IUGR?

Answer 9

CMV

Toxoplasma

Question 10

Where to get CMV?

Answer 10

Day care

Question 11

What kind of CMV virus is virus?

Answer 11

Herpes Virus

Question 12

How to prevent CMV?

Answer 12

Hand-washing!!!

Hand-washing!!!

Question 13

Where do you get toxo?

Answer 13

Stray cats - pooing in garden and your gardening/sandbox.

HAND WASHING!

Question 14

Toxoplasmosis is What species?

Answer 14

Parasite

Question 15

Vascular diseases?

Answer 15

Hypertension
DM - atherosclerosis
Renal disease
SLE
Vasculitis

Question 16

Thrombophilia

Answer 16

Congenital 
Acquired: anti phospholipid
-preg
-smoking
-Rest, sx, cancer

Question 17

6 hereditary thrombophilias?

Answer 17

Hyperhomocystenaemia
Factor V
Prothrombin
Protein S, C
Anti-thrombin II

Question 18

Toxins?

Answer 18

Smoking
Alcohol
Malnutrition
Anaemia
High altitude (lower O2)

Question 19

Common reason for placenta abrupt ion?

Answer 19

Hemorrhagic infarct (99%)
Trauma(1%)

Question 20

Screening for IUGR

Answer 20

Symphysis-fundal height

~34 weeks

Question 21

Optimal single biometric measure?

Answer 21

Abdominal circumference

Question 22

Preventing IUGR?

Answer 22

• Aspirin
• Work and rest optimization
• NOT vitamin E or C

Question 23

Mx of IUGR?

Answer 23

Confirm Dx
Look for cause
Surveillance
Therapy
Delivery

Question 24

How to confirm genetically small?

Answer 24

Small parents
Absence of risk factors
Symmetrical small
Normal growth trajectory
Bio physically active
Normal amniotic fluid
Normal umbilical and other Dopller studies

Question 25

How to investigate IUGR

Answer 25

Tertiary ultrasound

ANTI-phospholipid syndrome

Question 26

Karyotyping NIPS, why do it at 35weeks?

Answer 26

-Won’t compromise future reproduction, prevent unnecessary C-section if baby was destined to die anyways.

• psychological
• prepare the paediatricians
• termination in late preg

Question 27

Can you terminate pregnancy?

Answer 27

Inject KCl

Need 2 doctors, not reason

Question 28

Viability of baby after how many weeks?

Answer 28

24-weeks

Question 29

Why terminate late?

Answer 29

• If prognosis is not known until late preg (eg. CMV)

- twins discordant

Question 30

Rx of IUGR?

Answer 30

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)

Question 31

Hyperalimentation works?

Answer 31

Yes, will grow, but will outgrow O2 placenta supply and die. Not use.

Question 32

If lung immaturity and need neuro protection if less than 30 weeks.

Answer 32

MgS04

Steroids