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.