Fetal Growth Assessment 1 - IUGR

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Fetal Growth Assessment 1 - IUGR Powered By Docstoc
					Reem Al-Qudah
Small for Gestational Age (SGA)

 (SGA) babies are those
  whose birth weight below the
  10th percentile for that
  gestational age , which is not
  always pathological

 Not all IUGRs are below 10th
  centile ,and not all those below the
  10th centile are IUGRs.
Why the fetus is small?

 Failure of the fetus to
  achieve its growth
        Significance of IUGR
• Major cause of neonatal morbidity and

• Significant cost in terms of the

• There is a growing appreciation that
certain adult diseases (including
hypertension and diabetes) are related to
birth weight
  Causes of IUGR
1- maternal factors
2- placental factors
3- fetal factors
Maternal factors:
 cigarette smoking
 high blood pressure
 chronic kidney disease
 advanced diabetes.
 Heart disease
 Respiratory disease
 malnutrition, anemia
 autoimmune disorders: SLE, thrombophilia,
 Drugs: ACE inhibitors, substance abuse
Fetal causes:
    Multiple gestation, twin, triplet, etc..
              singleton   Dichorionic   monochorionic
  Growth        5%           10 %           20 %

    Congenital malformations
    Chromosomal abnormality(triploidy,
    trisomy 18,21,13)
trisomy 18
Placental factors:
 Placenta previa.
 Abnormal placentation..
 Circumvallate placenta
 Placental tumours.
Types of IUGR:
   1.Asymmetrical (80%)

   2. Symmetrical (20%)
Types of IUGR
Asymmetrical( brain sparing)

- the fetus is usually with normal potential
- Mostly caused by fetal hypoxia
- seen in cases where fetal access to
  nutrients is compromised, such as with
  severe maternal nutritional deficiencies or
- Normal HC, and abnormal AC

Symmetrical ( all parameters involved )

- Usually the fetus loses its potential
- all fetal structures (including both head
  and body size) are proportionately
  diminished in size
- Mostly caused by chromosome
  abnormalities congenital anomalies and
  viral infections
 A 38-year-old G4P3 at 33 weeks gestation
 is noted to have a fundal height of 29
 centimeters on routine obstetrical visit. An
 ultrasound is performed by the maternal
 fetal medicine specialist. The estimated
 fetal weight is determined to be in the fifth
 percentile for the estimated gestational
 age. The biparietal diameter and
 abdominal circumference are concordant in
 size. Which of the following is associated
 with this type of growth restriction?
 a. Nutritional deficiencies
 b. Chromosome abnormalities
 c. Hypertension
 d. Uteroplacental insufficiency
Complications of growth restriction
    Antenatal Complications

 Metabolic changes in fetus
 Oligohydramnios (80%)
 Abnormal fetal heart patterns.
 Abnormal Doppler studies.
 Intra uterine fetal death.
   Intrapartum complications:

 Abnormal CTG.
 Meconium stained liquor.
 Increased incidence of
  instrumental and caesarean
 Fetal death.
       Neonatal complications
 1- related to hypoxia and acidosis:
   a- meconium aspiration.
   b- persistent fetal circulation.
   c- hypoxic ischemic encephalopathy.

 2- metabolic:
   a- hypoglycemia
   b- hypocalcaemia
   c- hypothermia
   d- hyperviscocity syndrome

   3- related to the etiology:
    a- chromosomal abnormalities.
    b- congenital anomalies.
    c- fetal infection
Possible long term complications:
 Lower IQ
 Learning and behavioral problems .
 Neurological deficits(Cerebral
 Hypertension and Ischemic Heart
 Metabolic disorders(type 2 D.M).
 A 26-year-old G1 at 37 weeks presents to
 the hospital in active labor. She has no
 medical problems and has a normal
 prenatal course except for fetal growth
 restriction. She undergoes an
 uncomplicated vaginal delivery of a
 female infant weighing 1950 g. The infant
 is at risk for which of the following
 a. Hyperglycemia
 b. Fever
 c. Hypertension
 d. Anemia
 e. Hypoxia
Management principles

 Pre-pregnancy

 Antepartum
 Modify lifestyle habits.
 Balanced nutrition
 Magnesium & Foliate supplements decrease
  rate of SGA
 Quit smoking, alcohol, & drug abuse
 Detect and treat medical disorders
 Correction of anemia.
 Control any chronic illnesses (anti-
  phospholipids syndrome , sickle cell disease,
  DM, HTN, thyroid dysfunction )
 Regular antenatal care
 Serial fetal growth assessment.
 Fetal surveillance & serial US
  measurements at three weekly intervals
  are indicated
 Fetal weight every 2 weeks
 Serial fetal wellbeing assessment.
    1-Biophysical profile
    2-Computerized CTG
    3-Umblical artery Doppler
 Betamethasone administration between
  GA 30-35weeks.
 Timing of delivery : to maximize
  gestation without the fetus suffering
  any neurological abnormality, and
  increasing maturity as possible
  before delivery.

 Mode of delivery.
 Main danger is neurological injury

 Some will suffer morbidity or die
  as a result of prematurity .

 Height and weight curves remains
  slightly below 50th centile .
 Infants with IUGR secondary to
  placental insufficiency show “catch
  up” growth after delivery when
  feeding is optimized.

 New researches suggest a link
  between IUGR and birth weight and
  increased incidence of HTN and
  diabetes in adults
16-year-old is admitted to the labor ward
at 36 weeks gestation. She gives a
history suggestive of rupture of
membrane and is experiencing uterine
contractions. She didn’t attend for
antenatal care. She smokes 20
cigarettes/day. A caesarean section is
performed and a male infant weighing
1900 g is delivered.
Discuss risk factors for SGA in this case
Discuss complications related to IUGR in
this infant

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