IUGR Definition : Is a fetal weight that is below the 10th percentile for gestational - PowerPoint Presentation

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IUGR

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Definition

:

Is a fetal weight that is below the 10th percentile for gestational age as determined through an ultrasound. This can also be called small-for gestational age (SGA) or fetal growth restriction.

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Phases

of fetal growth

First 16 weeks:

mostly cellular hyperplasia

16-32 weeks:

both hyperplasia and hypertrophy

>32 weeks:

mostly hypertrophy

Thus: early growth restriction will affect cell numbers and have a global (symmetrical IUGR) effect. Later cell size will be affected (asymmetrical IUGR)

 

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Etiology of IUGR

Maternal Factors

Placental Factors

Fetal Factors

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Maternal Factors

1. Genetic size

2. Demographics:

Age (extremes of reproductive age)

Socioeconomic status

3. Underweight before pregnancy or malnutrition

4. Exposure to teratogens (drugs, radiation, etc.)

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5

. Factors that interfere with placental flow and function:

-Heart disease

-Renal disease

-Hypertension

-Pulmonary disease

-

Hemoglobinopathies

-Collagen-vascular disease

-Diabetes

-

Postmaturity

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-

Multiple gestation

-Uterine anomalies

-Thrombotic disease

-High altitude environment

-Smoking

-Cocaine

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Placental

Factors

-Malformations

-Abruption

-Previa

-Abnormal trophoblast invasion

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Fetal

Factors

-Constitutional – genetically small, but genetically normal

-Chromosomal abnormality – only about 5% of SGA babies

-Malformations – CNS, skeletal

-Congenital infections – CMV, rubella

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Characteristics of IUGR

symmetric:

1. Early onset

2. Head circumference, length &weight are all proportionally reduced for gestational age(below 10

th

percentile)

3. Could be constitutional or normal small.

4. Examples:

-Genetic causes, chromosomal

-TORCH infections

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Asymmetrical

:

1. Late onset 2

nd

-3

rd

trimester.

2. Growth arrest.

3.Brain sparing ,which means transfer of oxygen & nutrients to the brain .This allows normal brain and head growth while diminished glucose transfer and hepatic storage would primarily affect cell size and not number, and fetal abdominal circumference—which reflects liver

size—would be reduced.

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4

. Examples:

-

Chronic hypoxia

-Preeclampsia, chronic hypertension

-malnutrition

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Diagnosis

of IUGR

Abdominal examination:

Serial Fundal height measurement in centimeters usually corresponds with the number of weeks of pregnancy after the 20th week. If the measurement is low for the number of weeks (2-3 cm), the baby may be smaller than expected.

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Ultrasound

more accurate method of estimating fetal size. Measurements can be taken of the fetus' head and abdomen and compared with a growth chart to estimate fetal weight. The fetal abdominal circumference is a helpful indicator of fetal nutrition. , obtaining a second growth assessment over a 2- to 4-week interval is important unless strong supportive data or risk factors warrant an immediate change in management plans

.

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Amniotic

fluid volume

An association between pathological fetal-growth restriction and oligohydramnios has long been recognized. Hypoxia and diminished renal blood flow explain oligohydramnios

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Doppler

flow

Doppler velocimetry is considered standard in the evaluation

and management of the growth-restricted fetus. abnormal umbilical artery Doppler velocimetry

findings—characterized by absent or reversed end-diastolic

flow—have been uniquely linked with fetal-growth restriction. Other

modality of Doppler

velocimetry, include middle cerebral arteries & ductus

venosus

assessment

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MANAGEMENT

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Important

points regarding managements:

1.If fetal-growth restriction is suspected, then efforts are made

to confirm the diagnosis, assess fetal condition, and search for

possible causes.

2. antepartum fetal surveillance should include Daily fetal heart rate tracings, weekly Doppler velocimetry, and sonographic assessment

of fetal growth every 3 to 4 weeks are initiated

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3

. growth-restricted fetuses

may not

tolerate the metabolic effects of corticosteroids in the

same way

as an unstressed fetus, increased surveillance

during administration.

4. timing of delivery is crucial, and the risks of fetal death

versus the hazards of preterm delivery must be considered.

5. delivery between 34

and 37

weeks when there are concurrent conditions such as oligohydramnios. With a reassuring fetal heart rate pattern,

vaginal delivery

is planned

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However

, some of these fetuses do not tolerate labor, necessitating cesarean

delivery,why

?

Answer:

- Fetal-growth restriction is commonly the result of placental

insufficiency , this condition is likely aggravated by labor

- diminished

amnionic

fluid volume increases the likelihood of cord compression during labor

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Early

neonatal morbidities in IUGR

Birth asphyxia

Meconium aspiration

Hypoglycemia

Hypocalcemia

Hypothermia

Polycythemia,hyperbilirubiemia

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Thrombocytopenia

Pulmonary

haemorrhage

Malformation

Sepsis

Respiratory distress syndrome

Necrotizing

enterocolitis

.

Later in life

Hypertension and atherosclerosis.

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