[61] Intrauterine Growth Restriction Flashcards

1
Q

What is IUGR?

A

Refers to poor growth of fetus while in the mothers womb during pregnancy

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2
Q

What are the major categories of IUGR?

A
  • Symmetrical

- Asymmetrical

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3
Q

What kind of IUGR is more common?

A

Asymmetrical

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4
Q

What % of cases of IUGR are asymmetrical?

A

70%

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5
Q

What happens in asymmetrical IUGR?

A

There is a restriction of weight followed by length, but the head continues to grow at normal or near-normal rates, called head sparing

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6
Q

What does a lack of subcutaneous fat lead to in asymmetrical IUGR?

A

A thin and small body out of proportion with the liver

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7
Q

When does asymmetrical IUGR occur?

A

When the embryo/fetus has grown normally in the first 2 trimesters, but encounters difficulties in the third

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8
Q

What is asymmetrical IUGR most commonly caused by?

A

Extrinsic factors that affect the fetus at later gestational ages

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9
Q

What does symmetrical IUGR indicate?

A

The fetus has developed slowly throughout the duration of the pregnancy, and thus was affected from a very early stage

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10
Q

Is the head circumference of the newborn with symmetrical IUGR in proportion to the rest of the body?

A

Yes

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11
Q

Is permanent neurological sequelae more common in symmetrical or asymmetrical IUGR?

A

Symmetrical

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12
Q

Why are permanent neurological sequelae more common in symmetrical IUGR?

A

Because most neurones have developed by 18 weeks gestation

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13
Q

Give 4 examples of causes of symmetrical IUGR

A
  • Early intrauterine infection
  • Chromosomal abnormalities
  • Anaemia
  • Maternal substance abuse
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14
Q

What are the categories of causes of IUGR?

A
  • Maternal
  • Uteroplacental
  • Fetal
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15
Q

What are the maternal causes of IUGR?

A
  • Pre-pregnancy weight and nutritional status
  • Poor weight gain during pregnancy
  • Poor nutrition
  • Anaemia
  • Alcohol, smoking, or drug-use
  • Pre-gestational diabetes or gestational diabetes
  • Pulmonary, renal, or cardiovascular disease
  • Hypertension
  • Coeliac disease
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16
Q

What are the uteroplacental causes of IUGR?

A
  • Pre-eclampsia
  • Multiple gestation
  • Uterine malformations
  • Placental insufficiency
17
Q

What are the fetal causes of IUGR?

A
  • Chromosomal abnormalities

- Vertically transmitted infections

18
Q

What is the main symptom of IUGR?

A

A small for gestational age baby, specifically being below the 10th percentile

19
Q

What are the other clinical features of IUGR?

A
  • Dry, peeling skin
  • Overly-thin umbilical cord
  • Hypoxia
  • Hypoglycaemia
20
Q

What investigations may be useful in IUGR?

A
  • Estimating babies size
  • Ultrasound
  • Doppler flow
  • Weight checks
  • Fetal monitoring
  • Amniocentesis
21
Q

How is the babies size estimated in IUGR?

A

Measurement from fundus to pubic bone

22
Q

How might estimating the babies size be useful in IUGR?

A

Can help initially identify IUGR

23
Q

What is the importance of ultrasound in IUGR?

A

It is the main test for checking baby’s growth in the uterus

24
Q

What are the management strategies for mothers whose fetus is diagnosed with IUGR based on?

A

Monitoring and delivery methods

25
Q

Give an example of a monitoring method for a fetus with IUGR

A

Umbilical artery Doppler

26
Q

What is recommended for women with spontaneous labour with a small for gestational age fetus?

A

Early admission

27
Q

Why is early admission recommended for a mother in spontaneous labour with a small for gestational age fetus?

A

In order to instigate continuous fetal heart rate monitoring

28
Q

What are the potential complications of IUGR?

A
  • Polycythaemia
  • Hypothermia
  • Thrombocytopenia
  • Leukopenia
  • Hypocalcaemia
  • Pulmonary haemorrhage
  • Neurodevelopmental disorders