IUGR

Question 1

Define IUGR

Answer 1

IUGR is defined when a baby is not reaching it’s growth potential.

Small for GA: <10th centile for GA

Question 2

Describe the ST & LT consequences of IUGR

Answer 2

ST: increased risk preterm birth, higher neonatal morbidity/mortality, poor feeders, hypoglycaemia, hypothermia

LT: - CP risk & developmental delay
- Baker’s Hypothesis (IUGR babies = increased risk HTN, vasc dx, DM); DOAD (developmental origins of adult dx)

Question 3

Outline 3 causes of IUGR

Answer 3

PLACENTAL = insufficiency (e.g. abn dev, ischaemia PE, twins), abruption

MATERNAL = Vasc dx (HTN, DM, renal dx –> reduce uteroplacental BF), Chronic asthma, Toxins (smoking, cocaine, alcohol), Anti-phospholipid syndrome, CTD, Malnutrition/anaemia, Extremes age, Strenuous exercise

FETAL = congenital (chromosomal, structural, genetic), familial, infections (CMV, toxo)

Question 4

How would you diagnose IUGR?

Answer 4

CLINICAL = fundal-symphyseal height: check LMP, dating US –> once SGA, then need serial US

US = serial US (clinical suspicion or RF’s), AC = abdo-circumference (symmetric vs asymmetric IUGR)

Question 5

How would you manage IUGR?

Answer 5

• Confirm the diagnosis: IUGR or genetically small (no RF’s, parental stature, norm trajectory growth scan, norm CTG & doppler results)
• Determine aetiology - Maternal (FBE, serology, coags), US (AC value) + Doppler (UA, DV, MCA), CTG, Foetal genetics/karyotype/structural anomalies
• Assess fetal well-being - US, doppler, CTG, fetal movements
• Assess gestational age - serial US, growth trajectory
• Treatment? (Rest (increase BF baby, increase O2 & nutrition - note calorie input means bigger baby, but this strains O2 requirements!)
• Delivery: mode and gestation - deliver if foetal hypoxia (placental insuf), cont CTG & foetal bloods (lactate) if induced, corticosteroids & MgSO4 if prem