Obs - IUGR and Oligohydramnios

Question 1

primigravida, presented with decreasing trend of growth parameters at 33 week.
Growth chart given:
• At ~18 weeks, all parameters are within normal range (around median)
• At 33 weeks, BPD, FL or HC below median but above 10th percentile, AC below 10th percentile
Examiner tells AFI 7, no other structural abnormalities seen.

Please describe the growth chart.

Answer 1

It is a case of asymmetrical late onset intrauterine growth retardation with oligohydramnios, as AC has fallen below the 10th percentile at 33 weeks but HC, BPD and FL are relatively normal

Question 2

Plan of management?

Answer 2

Investigate for underlying cause
Placental insufficiencies
PET: Measure BP; If high BP uPCR 24-hour urine protein
GDM or EDM: Fasting blood glucose +/- OGTT +/- Hba1c
USG for PP, abruptio
+ Autoimmune screening: ANA, dsDNA, anti-cardiolipin, lupus anticoagulant
+ Medical disorders: HTx, CRF: RFT, urate, cardiac disease
+ Toxins: drugs, smoking

Growth scan biweekly
Liquor and Doppler for pulsatility index twice weekly (AFI <8)
CTG monitoring weekly

IOL at 37 weeks if IUGR +/- olighydramnios
Neonatologist on standby
C/S at 34 weeks if AEDF/REDF

Umbilical cord blood for blood gas, placenta for histology