IUGR

Question 1

You are attached to a general practice antenatal clinic. You review a 19 year old woman who smokes 25 cigarettes per day attending at 32 weeks gestation. You have palpated her abdomen and the symphysio-fundal height measured 26cm. Her blood pressure is 120/70mmHg and there is no protein in her urine. She reports that foetal movements are good and you find the foetal heart rate is normal on auscultation. You diagnose intra-uterine growth restriction (IUGR) and refer her for hospital consultation.

a. The patient attends and her consultant decides to regard this as a high-risk pregnancy and to monitor the foetus closely. Apart from foetal heart monitoring, give 2 methods by which foetal wellbeing might be assessed. (2)

Answer 1

USS

1. Measure abdo circumference and BPD to confirm IUGR
2. Assess liquour volume
3. Doppler umbilical arterial MCA
4. Ductus venous doppler

Question 2

b. On review of the hx, what advice would you give this patient to reduce the impact of IUGR? (1)

Answer 2

Smoking cessation

Question 3

c. The patient continues with monitoring to 37 weeks when she goes into spontaneous labour. Because the pregnancy is regarded as high-risk, the condition of the foetus during labour is monitored with a foetal heart monitor (cardiotocograph/CTG).

Give 2 examples of abnormalities you would look for on the foetal heart monitor trace which would indicate a foetal problem. (2)

Answer 3

1. Reduced variability (<5bpm changes for >40 mins)
2. Baseline tachycardia
3. Late decelerations

Question 4

d. What short-term (i.e. pregnancy and peri-natal period) consequences are there of IUGR? (3)

Answer 4

1. Respiratory distress syndrome
2. Low brith weight = ↑ risk perinatal morbidity, stillbirth, NEC
3. Hypoglycaemia
4. Hypothermia

Question 5

e. What 2 potential long-term medical complications may this baby be exposed to when it becomes an adult? (2)

Answer 5

1. T2DM
2. Coronary artery disease
3. Cerebral palsy
4. Mental retardation