IUGR - GM

Question 1

what is IUGR

Answer 1

fetus does not grow to its genetic potential in the uterus, associated with increased risk of marbidity and mortality

Question 2

what is SGA

Answer 2

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

Question 3

why is IUGR different to SGA

Answer 3

IUGR is pathological in-utero growth restriction

Question 4

asymmetrical IUGR

Answer 4

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)

Question 5

symmetrical IUGR

Answer 5

proportional growth restriction in all parts of the fetus
caused by instrinsic factors such as genetic abnormalities and intrauterine infections

Question 6

maternal risk factors for IUGR

Answer 6

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

Question 7

teratogenic drugs

Answer 7

ACE-inhibitors
warfarin
carbamazepine
phenytoin
cyclophosphamide
valprioc acid

Question 8

uroplacental risk factors for IUGR

Answer 8

placental insufficiency caued my maternal conditions or pregnancy related conditions
plcenta prevue or placental abruption
umbilical artery thrombosis or infarction
uterine abnormalities
multiple gestation

Question 9

foetla risk factors for IUGR

Answer 9

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

Question 10

clinical examination findings for IUGR

Answer 10

symphysial-fundal height is decreased compared to gestational age
foetus is small for gestational age
foetal movements are reduced or absent

Question 11

bedside investigations for IUGR

Answer 11

maternal vital signs
urine dipstick
CTG

Question 12

lab investigations for IUGR

Answer 12

OGTT for gestational diabetes mellitus or serological screening for congenital intrauteriine infections

Question 13

imaging for IUGR

Answer 13

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

Question 14

typical findings of a biophysical profile for IUGR

Answer 14

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

Question 15

how is a diagnosis of IUGR made

Answer 15

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

Question 16

conservative management of IUGR

Answer 16

optimising modifiable risk factors during pregnancy
smoking cessation, drug counselling, healthy diet and exercise

Question 17

medical manegement

Answer 17

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

Question 18

surgical management/delivery

Answer 18

should be perfomed if there are signs indicating non-reassuring foetal status or maternal compromise
goal is to prolong intrauterine life

Question 19

prevention of IUGR

Answer 19

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

Question 20

complications of IUGR

Answer 20

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