IUGR

Question 1

definition of IUGR

Answer 1

EFW < 10% or AC < 10%

Most bad outcomes happen with EFW and AC < 5% or with abnormal dopplers

Question 2

ddx

Answer 2

• maternal: tobacco use, < 16 or > 35 years, smoking, HTN disorders, diabetes, APAS, poor maternal weight gain in pregnancy, low pre-pregnancy weight, poor nutrition,
• fetal: CMV, anueploidy, structural anomalies, multiple gestation
• placental: placental infarction, chorioangioma, umbilical cord anomalies
• infection: toxoplasmosis, CMV, rubella, malaria (worldwide 5-10% of IUGR)

Question 3

how is s/d ratio calculated? what are the units involved?

Answer 3

in one umbilical artery: peak systolic flow and end diastolic flow are the important markers. these are cm/sec

the ratio of these two can be elevated, absent, or reversed.

Question 4

what are differences between symmetric and asymmetric IUGR?

Answer 4

symmetric tend to present earlier, follow along growth curve, due to infection, structural or chromosomal anomaly. this is more common

asymmetric tends to present later, and is associated with placental compromise. HC/AC ratio >95% is a good surrogate.

Question 5

what is SGA?

what are risks?

Answer 5

birth weight in < 10%

hyperbilirubinemia, IVH, NEC, sepsis, RDS, deatu

Question 6

surveillance?

Answer 6

q2week growth US
NST/BPPs 2-3x week
UA dopplers

Question 7

delivery timing?

Answer 7

singleton, uncomplicated: 38-39w6d
abnormal UA or EFW <3%: 37w0d
if AEDF: 33-34w0d
if REDF: 30-32w0d