IUGR - GM Flashcards
what is IUGR
fetus does not grow to its genetic potential in the uterus, associated with increased risk of marbidity and mortality
what is SGA
small for gestational age
any fetus with a foetal abdominal circumference or estimated foetal weight less than the 10th centile for its gestational age.
the fetus may be constitutionally small without being at increased risk of complications
why is IUGR different to SGA
IUGR is pathological in-utero growth restriction
asymmetrical IUGR
disproportionate growth restriction with a greater decrease in foetal body and limbs compared to head circumference
caused by extrinsic factors such as placental insufficency oxygen and nutrients are directed towards vital organs (brain and heart) bypassing other organs (e.g. feotal liver, muscle, fat tissue)
symmetrical IUGR
proportional growth restriction in all parts of the fetus
caused by instrinsic factors such as genetic abnormalities and intrauterine infections
maternal risk factors for IUGR
maternal medical conditions: pre-existing diabetes mellitus, chronic hypertension, gestational hypertension, pre-eclampsia, SLE, sickle cell, severe anemia, anorexia
substance use
exposure to terotogenic drugs
previous pregnancy with IUGR
teratogenic drugs
ACE-inhibitors
warfarin
carbamazepine
phenytoin
cyclophosphamide
valprioc acid
uroplacental risk factors for IUGR
placental insufficiency caued my maternal conditions or pregnancy related conditions
plcenta prevue or placental abruption
umbilical artery thrombosis or infarction
uterine abnormalities
multiple gestation
foetla risk factors for IUGR
congenital/early intrauterine infections: toxoplasmosis, rubella, cytomegalovirus infection, varicella, tuberculosis, herpes infections, HIV, syphilis, malaria
genetic abnormalities: aneuploidy
congenital anomalies: tracheosophageal fistula, cyanotic congenital heart disease, gastroschosis, nueral tuber defects
clinical examination findings for IUGR
symphysial-fundal height is decreased compared to gestational age
foetus is small for gestational age
foetal movements are reduced or absent
bedside investigations for IUGR
maternal vital signs
urine dipstick
CTG
lab investigations for IUGR
OGTT for gestational diabetes mellitus or serological screening for congenital intrauteriine infections
imaging for IUGR
serial ultrasound scans: to assess foetal biometry and estimated foetal weight which are plotted on a customised growth chart.
umbilical artery doppler: shows abnormalities such as reduced or reversed diastolic flow
biophysical profile
typical findings of a biophysical profile for IUGR
amniotic fluid measurement of <5 (oligohydramnios)
absent foetal breathing movements
decreased foetal movements and tone
a BPP score of <4 indicated the need for delivery
how is a diagnosis of IUGR made
made from serial US scans and umbilical artery doppler (UA doppler)
estimated foetal weight <10th centile
oligohydramnios
abnormal UA doppler and/or poor interval growth velocity
EFW <3rd centile
conservative management of IUGR
optimising modifiable risk factors during pregnancy
smoking cessation, drug counselling, healthy diet and exercise
medical manegement
treat any underlying maternal condition (eg. treatment of gestational diabetes mellitus or pre-eclampsia) and medically optimise any co-morbidities before and during pregnancy
maternal vital signs should be closely monitored alongside foetal status
surgical management/delivery
should be perfomed if there are signs indicating non-reassuring foetal status or maternal compromise
goal is to prolong intrauterine life
prevention of IUGR
reviewing and managing underlying causes (eg. maternal comorbidities)
lifestyle advice such as smoking cessation and dietary advice
consider administration of low dose aspirin prior to 16 weeks gestation
complications of IUGR
preterm labour and delivery
stillbirth
perinatal asphyxia
necrotising enterocolitis
cognitive delay and behavioural issues
adult onset diseases (eg. diabetes, obesity, coronary artery disease, hypertension)
notor and neurological disabilities
intrauterine/neonatal death
