IUGR Placenta Previa

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					                   IUGR
• Babies whose birth weight is below the
  10th percentile for their gestational age-
  SGA
• SGA-1.CONSTITUTIONALLY SMALL
  BUT HEALTHY
         2.TRUE IUGR

• Growth restriction can occur in
  preterm,term or post term babies.

• IUGR-symmetrical/asymmetrical
                         IUGR
• symmetrical IUGR –uniform growth retardation-
  propotionally small.due to insult early in pregnancy-
  chemichal exposure,viral infection,inherent cellular
  developmental abnormality-aneuploidy.

• assymetric IUGR-dispropotionately lagging abdominal
  growth,defeciency of nutrients due to chr.placental
  insufficiency-pre eclampsia,malnutrition.placental
  insufficiency-marginal/velamentous insertion of
  cord,circumvallate/placenta previa

• Intrinsic IUGR ,extrinsic IUGR,combined IUGR,
  idiopathic IUGR.

• Incidence of IUGR is 2%-5%.
                        History

• Age-teenage and elderly gravidas-malnutrition,chronic
  vascular disease. Increased matenal age-^ risk of
  chromosomal abnormalities

• High altitudes-chronic hypoxia

• h/o consanguinity-since iugr is seen in congenital
  anomalies-cvs,renal and in familial
  chondrodystrophies,osteogenesis imperfecta.
  possibility of fetal congenital disorder should always be
  considered in idiopathic/unexplained IUGR.

• h/o loss of wt/absence of wt gain during pregnancy-lack
  of wt gain in 2nd trimester is strongly associated with
  decreased BW and iugr.
                       History
• h/o symptoms of malabsorption-steatorrhoea

• h/o drug intake-warfarin/phenytoin

• h/o symptoms of anaemia-
  fatigue,breathlessness,palpitations
• In most cases anemia does not cause IUGR.exception-
  sickle cell anemia.
                       History

• h/o symptoms of pre-eclampsia-before 37 weeks

• h/o symptoms suggestive of APLA syndrome-recurrent
  thrombotic events,recurrent pregnancy loss

• h/o infections-TORCH,parvovirus-direct infection of the
  fetus and placenta,chronic villitis,accelerated fetal
  metabolism-IUGR.infection with hepatitis A/B,congenital
  malaria,TB,syphilis
• CMV-cytolysis,loss of functional cells,rubella-vascular
  insufficiency due to endothelial damage
• OBSTETRIC HISTORY-
• h/o iugr/stillbirths with small fetus/h/o IUD in previous
  pregnancy

•    ^ incidence of stillbirth in IUGR.20-25% of stillbirths
    show IUGR.

• Fetal death in IUGR may occur at any time-more
  frequent >35 weeks

• h/o chromosomal abnormalities in previous pregnancy-
  chromosomal abnormalities cause altered placental
  function-fetal malnutrition.also affects fetal growth
  potential
• PAST HISTORY
• h/o any chronic maternal vascular diseases-
  chronic hypertension,chronic renal
  disease,diabetes,connective tissue
  disorders(SLE),IDDM,sickle cell anaemia,heart
  disease -especially with superimposed pre
  eclampsia

• h/o congenital cyanotic heart disases-chronic
  hypoxia

• h/o tuberculosis,syphilis,malaria
• h/o consumption of alcohol,IUGR found in 91% of fetal
  alcohol syndrome

• h/o Smoking -reduced intervillous blood flow,effect of
  carbon monoxide & thiocyanate on fetus-decreased
  prostacyclin synthesis.
• tobacco chewing gravidas,passive smokers also
  affected.
• reduction in BW by 150-400 gm at term

• H/o heroin,morphine ,cocaine use-direct effect on
  fetus,maternal malnutrition
                       Examination
• Small built women-racial,genetic factors-small babies-not
  worrisome.

• Look for maternal malnutrition-major cause in developing countries

• Maternal weight during pregnancy remains stationary or falls.

• Look for anemia,cyanosis,icterus,

• Signs of pre-eclampsia-edema,hypertension
• There is absence of normal trophoblastic invasion of the spiral
  arteries in cases of IUGR-similar to pre-eclampsia.the extent of this
  abnormality and the maternal compensatory mechanisms will
  determine manifestation as pre-eclampsia,IUGR,or both.

• CVS-evidence of heart disease
                 Examination

• Early establishment of gestational age-careful
  mesurement of uterine fundal height throughout
  pregnancy.
• Fundal ht is a reasonably accurate screening
  method to detect SGA fetuses-40% of such
  fetuses are identified.
• b/w 18-30 weeks-symphysiofundal ht jn cm
  coincides with weeks of gestation.if
  measurement is 2-3 cm less than expected-
  IUGR may be suspected.
• P/A-reduction in fundal ht - fundal ht falls below
  the 10th percentile
                  Examination

• Abdominal girth measurement shows stationary or falling
  values
• Oligohydramnios due to chronic placental insufficiency-
  uterus full of fetus.
• Cause of oligohydramnios-decreased urinary output
  caused by redistribution of bloodflow with preferential
  shunting to the brain and decreased renal perfusion
• Mild iugr-amniotic fluid may be normal.
• When AFI is normal,incidence of iugr-5%.when AFI was
  decreased incidence of iugr-40%
• Look for evidence of IUGR in multiple pregnancy-iugr of
  1 or more fetuses is seen in 21% of the cases.reasons-
  abnormal placentation,abnormal placental vascular
  anastomoses.more seen in monochorionic placentation.

				
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posted:6/15/2011
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