IUGR Flashcards
What are the two different types of IUGR?
primary/symmetry and secondary/asymmetry
What is primary/symmetry IUGR?
Characterized by all internal organs being reduced in size
Usually syndrome
What is secondary/asymmetry IUGR?
Small abdomen. Typically this is not evident until the third trimester (more common)
usually due to reduced oxygen and nutrient transfer- better outcome- large head as body prioritizes brain
What are the effects of IUGR?
Hypoxia, Meconium aspiration, Hypoglycemia,
Polycythemia – increased no. RBC, Hyperviscosity – decrease in blood flow due to having too many RBC,
Development and neurological disabilities
What are the causes of IUGR?
A maternal weight of less than 100 pounds Poor nutrition in pregnancy Birth defects and chromosomal abnormalities Pregnancy-induced hypertension Placental abnormalities Umbilical cord abnormalities Multiple pregnancy (twins or triplets) Gestational diabetes Oligohydramnios
What causes primary/symmetry IUGR?
Early intrauterine infections, such as cytomegalovirus, rubella or toxoplasmosis
Chromosomal abnormalities
Anemia
Maternal substance abuse
Can have pathological impact on neurological development
What causes secondary/asymmetry IUGR?
Placental insufficiency Pre-eclampsia Chronic high blood pressure Severe malnutrition Genetic mutations
What are the characteristics of a pre-term baby vs IUGR?
Head: PT Large, IUGR Proportionate
Swallowing and sucking reflex: PT Poor, IUGR Normal
Skin: PT Shiny, red, thin, IUGR Loose, dry, wrinkled
Lanugo and vernix: PT present, IUGR not present
Cord: PT thick, IUGR thin
Chest: PT small and narrow + large abdomen, IUGR ribs easily visible, abdomen hollow and wasted
Muscle tone: PT poor, IUGR good
Legs: PT may be extended, IUGR body + legs flexed
Alert: PT sleepy, IUGR alert and eager to feed
Clinical features of IUGR?
Relatively large head compared with whole body
Shrunken abdomen with “scaphoid” appearance (must be distinguished from diaphragmatic hernia)
Loose skin, sometimes dry, peeling, with the appearance of “hanging”, occasionally meconium stained
Long fingernails, especially in term and postterm infants with severe IUGR, occasionally meconium stained
Face with shrunken appearance or wizened
Widened or overriding cranial sutures, anterior fontanel larger than usual
Thin umbilical cord, sometimes meconium stained
Absence of buccal fat (old man look)
Lack of creases in foot- worry of down’s syndrome
In terms of pathophysiology what are the causes of symmetric IUGR?
impaired cell division
decreased cell number
irreversible
In terms of pathophysiology what are the causes of asymmetric IUG?
impaired cellular hypertrophy
decreased cell size
reversible
