Transcript IUGR - Netmedico | A medico hangout

IUGR
• Babies whose birth weight is below the
10th percentile for their gestational ageSGA
• 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 retardationpropotionally small.due to insult early in pregnancychemichal 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 anaemiafatigue,breathlessness,palpitations
• In most cases anemia does not cause IUGR.exceptionsickle 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 pregnancychromosomal abnormalities cause altered placental
function-fetal malnutrition.also affects fetal growth
potential
• PAST HISTORY
• h/o any chronic maternal vascular diseaseschronic 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 expectedIUGR 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 insufficiencyuterus 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.reasonsabnormal placentation,abnormal placental vascular
anastomoses.more seen in monochorionic placentation.