IUGR

Question 1

Distinguish between SGA & IUGR.

Answer 1

For both, EFW < 10 %ile
SGA does not imply pathologic abnormalities in growth (fetus might simply be constitutionally small)
An IUGR fetus has not attained its biologically determined growth potential for some pathologic reason

Question 2

What pattern of abnormal biochemical markers (part of prenatal screening) is associated with placental insufficiency, including IUGR?

Answer 2

Low PAPP-A

High AFP, inhibin A, hCG

Question 3

What is the value of repeat uterine artery Dopplers in patients who had abnormal Dopplers at 19-23 weeks?

Answer 3

Repeat at 26-30 weeks
Persistently abnormal Dopplers = highest risk of IUGR
Normal Dopplers = intermediate risk (“delayed normalization”)

Question 4

In a low risk patient, SFH is measured at each prenatal visit. What abnormalities in SFH measurement should prompt US screening for abnormal growth?

Answer 4

SFH < GA in weeks by 3+ cm

SFH plateaus

Question 5

How would you treat uncomplicated IUGR secondary to placental insufficiency?

Answer 5

No treatment of IUGR once develops
ASA may prevent development of IUGR
(no evidence for heparin)