IUGR/Small for dates

Question 1

Define IUGR and SFD

Answer 1

IUGR - failure of a foetus to reach its genetic growth potential (pathological)

SFD - foetus <10th centile for GA (physiological)

Question 2

List 3 risk factors for IUGR/SFD for each of the following: maternal, foetal, placenta, cord, medical/social history.

Answer 2

Maternal: small (height/BMI), Asian ethnicity, extremes of age

Foetal: chronic infection, twins, chromosomal

Placenta: insufficiency, infarction, inflammation

Cord: hypercoiling, single umbilical artery, abnormal insertion

Medical/social: chronic disease (asthma, heart, kidneys), anti-epileptics, smoking/drugs

Question 3

Define symmetrical and list some causes.

Answer 3

Head and abdo circumference both <10th centile

3 C’s:
constitutional
chronic infection (TORCH)
chromosomal

Question 4

Define asymmetrical and list some causes.

Answer 4

Head circumference is normal, abdo circumference <10th centile

Placental insufficiency and “SCAM”
S - smoking/drugs
C - chronic disease
A - alcohol, anaemia, autoimmune, antiphospholipid
M - malnutrition

Question 5

List 5 causes of SFH small for dates.

Answer 5

1. Wrong dates
2. IUGR
3. Oligohydramnios
4. Transverse lie
5. User error

Question 6

List 5 causes of SFH large for dates.

Answer 6

1. Wrong dates
2. Macrosomia (GDM)
3. Polyhydramnios
4. Twin pregnancy
5. User error

Question 7

How would you investigate SFD?

Answer 7

1. Bloods (FBC, CRP, PET bloods, group and hold)
2. Ultrasound (7 parameters)
3. CTG (acute foetal hypoxia)
4. TORCH screen
5. Harmony and anomaly scan

Question 8

What are the seven parameters on ultrasound?

Answer 8

1. Foetal movements
2. Foetal heart rate
3. Presentation
4. Biometry
5. Liquor volume (AFI, DVP)
6. Placenta
7. Umbilical artery Doppler

Question 9

How would you manage IUGR/SFD? (Conservative/medical/delivery)

Answer 9

Conservative:
- Check dates
- Optimise nutrition
- Optimise risk factors (smoking cessation, HTN, DM)
- Serial growth scans

Medical:
- MgSO4 (if <32w)
- Steroids (if <34w)
- Labetalol (PIH)

Plan for delivery:
- if SFD and normal parameters = 39-40w
- if IUGR and normal parameters = 36-37w
- if IUGR and abnormal Doppler’s = 37w

Question 10

List 5 potential complications of SFD/IUGR.

Answer 10

1. Preterm labour
2. Emergency C-section
3. Neonatal death
4. Hypoglycaemia
5. Necrotising enterocolitis