IUGR and IUD Flashcards
What intrinsic factors cause IUGR?
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What extrinsic factors cause IUGR?
Pollution
DV
Stress
What problems are associated with symmetrical IUGR?
Stillbirth Chromosomal abnormality Infection Reduced intellect Changes to brain organisation, memory and ability to learn Short stature Increased death rate in 1st year
What problems are associated with asymmetrical IUGR?
Stillbirth Meconium aspiration Perinatal asphyxia – cerebral palsy Hypoglycaemia / hypothermia/ hypocalcaemia NEC Pulmonary haemorrhage Premature delivery Oligohydramnios increases the risks
What is a doppler and why do we use it?
Doppler ultrasound uses sound waves to detect the movement of blood in vessels. Used to study blood circulation in the baby, uterus and placenta. Cochrane review: Nineteen trials involving 10,667 women were included. Results showed that Doppler ultrasound of the umbilical artery may decrease the number of babies who die, and may lead to fewer caesarean sections and inductions of labour. There was no clear difference in the number of stillbirths, births using forceps or ventouse, or babies with a low Apgar score five minutes after birth. In babies with growth restriction, when the decision to deliver was based on late ductus venosus changes or abnormalities on computerised CTG, this appeared to improve long-term (two-year) developmental outcome
Umbilical Artery Doppler
Umbilical artery Doppler is of no value for screening the low-risk singleton pregnancy. •24-30 wks, fetus can have absent EDF for several weeks; reversed EDF –several days. •at early gestations absent or reversed EDF must not be sole indication for delivery .•30-34 weeks delivery decisions in IUGR fetus must be made on amniotic fluid, movements, CTG and UAD •After 34 weeks abnormal UAD (absent or reversed EDF) is unusual suggesting severe feto-placental pathology warranting delivery. •Cannot be reassured by normal UAD after 34 weeks. •Need fetal dopplers or biophysical profile as well
EDF?
end diastolic flow (describing the flow of blood through the umbilical artery)
What is oligyhdramnios, what are the causes and effects?
Abnormally small volume of liquor. At term 300-500mls or less. Affects 3-5% of pregnancies Diagnosed in first half of pregnancy likely to be associated with renal agenesis (absence of kidneys) or potter’s syndrome – baby has pulmonary hypoplasia Later may be associated with fetal abnormality or PPROM In post-term pregnancy may be associated with placental insufficiency. Lack of amniotic fluid reduces intrauterine space- can cause compression malformations i.e. talipes
What is the management/treatment of IUGR?
Depends on gestational age, severity, and cause. 1st trimester – increased risk of miscarriage. 2nd trimester – often associated with fetal death and malformations 3rd trimester - risk of preterm birth Liquor volume estimated by USS If fetal prognosis appears good – ? prophylactic amnioinfusion to prevent compression malformations, hypoplastic lung disease, and prolonged pregnancy. Although evidence for pros and cons is sketchy - one study suggests it may be useful! At term – IOL. In labour: ? Epidural - contractions often more painful Continuous EFM – cord and placental compression more likely Maternal hydration?
What is the importance of FMs?
Fetal death may be preceded by a day or more of loss of fetal movements. Occasionally extreme activity precedes fetal death. Two randomised controlled trials failed to show that routine recording of fetal movements reduced the incidence of IUD
How is an IUD diagnosed?
Diagnosis MUST be confirmed by ultrasound scan (USS). Qualified and experienced sonographer to confirm absent fetal heart, -? confirmed by second clinician (definitely if fetal death is in early pregnancy). If the baby is dead some mothers want to arrange delivery ASAP others need time to be sure (does local Trust policy influence this?). Prolonged delay can increase risk of APH- why do you think that is?
What is an IUD?
Death of fetus at any stage in pregnancy after the first trimester and before the onset of labour.
What is a late fetal loss?
A baby born between 22+0 and 23+6 weeks gestation, showing no signs of life, irrespective of when the death occurred.
What is a stillbirth?
A baby born at or after the 24+0 weeks gestational age showing no signs of life, irrespective of when the death occurred
What is a neonatal death?
A live born baby (born at 20+0 weeks gestation or later, or with a birth weight of 400g or more if accurate estimation of gestation is not available) who died before 28 completed days after birth.
What are the causes of perinatal deaths?
