Intrauterine Growth Restriction _IUGR_ by ert554898

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									Intrauterine Growth
Restriction (IUGR)

Dr. Hazem Al-Mandeel
 Intrauterine Growth Restriction
• Definition: if estimated fetal weight or newborn
  birth weight below 10th percentile (< 5th or < 3rd)

• IUGR vs. Small for Gestation Age (SGA)

• Growth-restricted fetuses are prone to:
  asphyxia, meconium aspiration, hypoglycemia,
  polycythemia, and mental retardation
Etiology
• Maternal: poor nutritional intake, smoking, drug
  abuse, alcohol intake, heart & pulmonary disease,
  APA syndrome, and thromobophilias
• Fetal: intrauterine infection (TORCH &
  Listeriosis) and congenital anomalies
• Placental: essential hypertension, pre-
  eclampsia,
  and chronic renal disease
Clinical Manifestation
• Two types of IUGR:
  1. Symmetric: head to abdomen is normal
  early, e.g. infections or congenital anomalies
  2. Asymmetric: head > abdomen; late occurrence

• Methods of gestational age calculation:
  determination of GA is essential for the
  diagnosis.
Diagnosis of IUGR
• History: to identify risk factors
• Physical exam: fundal height measurement in
  each antenatal visit
• Investigation: ultrasound assessment
  (sometimes serial) can identify 50-90% of cases
  esp. if there is an indication
   – Sonographic parameters: fetal biometry, calculated
     fetal weight, amniotic fluid volume, umbilical artery
     doppler
   – Plot of measurements on a standard growth curve
Management
• Prepregnancy: to prevent it by identifying risk
  factors and treat as necessary (e.g. improve
  nutrition intake, stop smoking or alcohol, ASA in
  APA syndrome, and Heparin in thrombophilias)
• Antepartum: identify risk factors that can be
  changed. Fetal surveillance by ultrasound (BPP)
  and fetal heart monitoring (Non-Stress Test). To
  decide on timing and mode of delivery.
Management
• Labour & Delivery: IUGR is not a
  contraindication for induction of labour or
  vaginal delivery. Continuous electronic fetal
  monitoring (use of cardiotocography) during
  labour is necessary. Low-threshold for caesarean
  section

• Prognosis: depends on the etiology. If treatable
  then prognosis is generally good

								
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