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MIDS 187 > Ch 5 IUGR > Flashcards

Ch 5 IUGR Flashcards

1
Q

Define IUGR?

A

Sonographic estimated fetal weight that is less than the 10th percentile

(aka fetal growth restriction)

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2
Q

When would we use the term “small for gestational age” (SGA)?

A

For newborns - defined as a neonate with a birth weight less than 10th percentile

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3
Q

How many infants in a low risk population will be affected by IUGR?

A

10%

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4
Q

What 2 things can cause a women to have an increased risk for IUGR up to 25% more?

A

-Hypertension
-Previous growth restricted infant

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5
Q

Growth restricted fetuses make up how much of the population?

A

5-8%

(can complicate 10-15% of all pregnancies)

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6
Q

List some risks of IUGR to the fetus?

A

-Intrauterine demise
-Neonatal morbidity + death
-Cognitive delays in childhood
-Diseases in adulthood

(can have lifelong effects)

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7
Q

What is the perinatal period?

A

Interval from onset of fetal viability at 24 weeks to end of neonatal period 28 days after delivery

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8
Q

Is fetal growth restriction (FGR) associated with stillbirths?

A

Yes, accounts for up to 43% of them + responsible for majority of “unexplained” stillbirths

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9
Q

What is the 2nd leading cause of perinatal mortality + morbidity worldwide?

A

IUGR

(preterm delivery is first)

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10
Q

Why does IUGR cause perinatal mortality + morbidity?

A

-Intrauterine hypoxia (not enough O2)
-Birth asphyxia (not enough O2)
-Sudden sentinel/unexpected events (such as abruption, cord prolapse or congenital anomalies)

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11
Q

A fetus with poor IUGR has how many times increased risk for perinatal death?

A

5-10x

(we do an u/s every 2 weeks for these babies b/c high risk)

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12
Q

What is the survival rate for fetuses under 28 weeks?

A

Less than 50%

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13
Q

List newborn affects?

A

-Meconium/poop aspiration
-Hypoglycemia (low blood sugar)
-Hypocalcemia (low calcium)
-Hematologic complications (blood disorders)
-Hypothermia
-Polycythemia (increased RBCs)

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14
Q

Why is polycythemia seen in newborns with IUGR?

A

B/c of increased synthesis or erythropoietin (RBC production), secondary to chronic intrauterine hypoxia

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15
Q

Why is hypoglycemia seen in newborns with IUGR?

A

-Decreased glycogen stores
-Increased sensitivity to insulin
-Decreased adipose tissue
-Decreased ability to oxidize free fatty acids + triglyceride effectively

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16
Q

What affects does IUGR have during childhood?

A

Physical, metabolic + neurologic complications:

-Learning disabilities
-Behavioral problems
-Worse performance in school

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17
Q

Would children affected by IUGR have higher or lower BP?

A

Higher

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18
Q

By what age do most IUGR children typically catch up on growth?

A

By 18 years

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19
Q

Fetuses below 3rd percentile tend to have what in physical appearance?

A

-Lower weight
-Shorter stature/height

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20
Q

Fetuses have a small but significant increased risk for what?

A

Cerebral palsy

(group of disorders that affect a person’s ability to move and maintain balance and posture)

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21
Q

Adults who had IUGR are at an increased risk for what?

A

-Acquired heart disease
-Lipid abnormalities
-Diabetes later on

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22
Q

What do detrimental long term intrauterine vascular changes result in?

A

-Hypertension
-Cerebral vascular accidents
-Diabetes
-Atherosclerosis
-Obesity

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23
Q

Cause of IUGR?

A

Half idiopathic, half multi-factorial

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24
Q

3 groups that RFs + etiologies are divided into?

A

Maternal, fetal + placental

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25
Q

How do we know if a fetus has IUGR or is just naturally small due to race/ethnicity?

A

Race: will grow at consistent rate
IUGR: not consistent + in less than 10th percentile

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26
Q

What condition is associated with the most severe growth deficits?

A

Preeclampsia

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27
Q

What “drug” reduces birth weight by 150-200g + is a leading cause of preventable IUGR?

A

Tobacco use when pregnant

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28
Q

Maternal medical conditions that effect blood circulation result in a decrease in what?

A

Uteroplacental blood flow

(conditions like hypertension, diabetes, systemic lupus erythematosus, antiphospholipid syndrome + sickle cell disease)

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29
Q

What is one of the m/c leading causes of IUGR?

A

Maternal hypertension

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30
Q

What 2 maternal ages can cause IUGR?

A

-Less than 16 y/o
-Over 35 y/o

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31
Q

Previous delivery of a SGA newborn showed to have what kind of maternal factors going on that influenced this?

A

-Low socioeconomic status (ex not eating good food)
-Use of artificial reproduction technologies
-Nicotine exposure (tobacco)
-Infection

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32
Q

What are the 3 m/c chromosomal abnormalities that increase a fetuses risk for IUGR?

A

-Trisomy 13 (patau syndrome)
-Trisomy 21 (down syndrome)
-Trisomy 18 (edwards syndrome)

50% have growth restriction with these conditions

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33
Q

What are other fetal factors of IUGR?

A

-Metabolic disorders
-Genetic syndromes
-Multiple gestations
-Congenital infections (5% of cases) such as toxoplasmosis (cat liter box) + cytomegalovirus

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34
Q

What type of insufficiency is associated with majority of IUGR cases?

A

Placental

35
Q

M/c placental factor?

A

Alteration in uteroplacental + fetal placental circulations

36
Q

What causes diminished maternal uteroplacental blood flow?

A

Incomplete trophoblastic invasion of spiral arteries in placental bed

37
Q

Is small placental weight associated with IUGR?

A

Yes

38
Q

Why do cord anomalies + a single umbilical artery cause an increased risk?

A

B/c they decrease transfer of nutrients. Such as with a velamentous cord insertion.

39
Q

What does villous damage to placenta from under perfusion lead to?

A

Increased placental resistance + high BP

40
Q

What are the 2 IUGR categories?

A

-Symmetric
-Asymmetric (m/c)

41
Q

Difference b/w symmetric + asymmetric IUGR?

A

Sym:
-growth restriction in all biometric measurements, small head + abdominal size
-impairment + decrease in fetal cellular proliferation of all organs

Asym:
-growth restriction in only abdominal size when compared to head size
-large head, small abdomen (when HC to AC ratio is greater than 95th percentile)

42
Q

When do symmetric + asymmetric IUGR occur in the pregnancy?

A

Sym: 1st or 2nd trimester
Asym: 3rd trimester

43
Q

How common are symmetric + asymmetric IUGR?

A

Sym: 20-30%
Asym: 70-80% m/c

44
Q

What category of IUGR is known as the “head sparing phenomenon”?

A

Asymmetric

45
Q

Is symmetric + asymmetric IUGR worse?

A

Symmetric b/c most growth occurs in the first part of pregnancy, causing increased morbidity + mortality (unlike asymmetric)

46
Q

What 3 things are markers for IUGR?

A

-Serum analysis
-Fundal height
-Weight percentiles

47
Q

What is PAPP-A?

A

Hormone made by placenta in pregnancy

(pregnancy associated plasma protein - A)

48
Q

Why is serum analysis a marker for IUGR? What 2 things are associated with a low birth weight?

A

-Increased alpha fetoprotein (AFP) is linked with increased risk of LBW
-Low PAPP-A associated with LBW

(positive predictive value of these markers are low)

49
Q

What is SFH?

A

-Distance from top pubic symphysis to top uterine fundus (in cm)
-Should equal the gest age in weeks

50
Q

After 20 weeks gest, a difference greater than how many cm is suspicious for growth restriction with SFH?

A

Over 3cm

51
Q

Is SFH accurate?

A

No, often inaccurate as doctors measure wrong

(still recommended to be done with each prenatal visit after 24 weeks)

52
Q

What measurements do we use to calculate weight percentiles?

A

BPD, HC, AC + FL

(use BC womens chart, are derived from women living at/near sea level)

53
Q

Can we use growth to redate a pregnancy after its been dated by u/s after 7 weeks?

A

NO

54
Q

How much do LBW fetuses weigh at 38-40 weeks of pregnancy?

A

Approx 2,510-2,750g

55
Q

List 3 SF that are associated with IUGR?

A

-Echogenic bowel (in 2nd trimester - m/c with trisomy 21)
-Grade 3 placenta (in relation to bone)
-TRV cerebellar diameter (can be mildly reduced)

56
Q

How can we make the most accurate diagnosis of IUGR?

A

By using multiple biometric + structural parameters

57
Q

Serial growth assessments should be carried out every how many weeks?

A

2-4 weeks, b/c risk of false positives if done sooner

58
Q

What does a nonstress test (NST) or cardiotocography measure?

A

FHR in response to fetal movement over time

(m/c cardiotocographic method used to assess fetal well being)

59
Q

What does an abnormal FHR pattern suggest during a NST?

A

Heart failure

(serves as indirect measurement of CNS function)

60
Q

What is considered a normal/reactive NST?

A

2 or more accelerations within 20 mins

61
Q

What is considered an abnormal/nonreactive NST?

A

Lack of 2 or more accelerations in 40 mins

62
Q

A BPP combines a NST with 4 biophysical features, what are they?

A

-Fetal movements
-Fetal tone
-Fetal breathing
-Estimate amniotic fluid volume

(each component can get up to 2 points)

63
Q

Do we do biophysical profiles (BPP) on the island?

A

No

64
Q

What would be a good BPP score?

A

Good: 8-10
Equivocal: 6
Need more testing: under 4

65
Q

If there is not enough amniotic fluid, should BPP assessments become more frequent?

A

Yes, or delivery may be an option regardless of what the BPP score was

66
Q

Why is the baby’s brain bigger than their abdomen with asymmetric IUGR?

A

B/c baby preserves their brain + takes away from the growth of the abdomen which is why it gets smaller

67
Q

What does a normal middle cerebral artery doppler look like?

A

High peaks with no end diastolic flow

68
Q

What does the ductus venosus do?

A

Shunts oxygenated umbilical venous blood directly to the heart

69
Q

How are doppler waveforms acquired of the ductus venosus?

A

In TRV or SAG of fetal abdomen at level of diaphragm

(CD can help identify the DV as it branches from umbilical vein)

70
Q

Explain the ductus venosus waveforms in regards to systole + diastole?

A

-1st peak is ventriuclar systole, 2nd peak is passive filling in ventricular diastole
-Peaks followed by a nadir (lowest point) which represents atrial contraction, known as a-waves

71
Q

What would an abnormal DV waveform look like?

A

Decreased, absent or reversed flow in a-wave

72
Q

If a fetus has an abnormal DV, does this correlate to an increased risk of perinatal mortality?

A

Yes, it goes from 20% to 50% if the a wave is absent or reversed as well

73
Q

What does the umbilical vein do?

A

Transports oxygenated blood from placenta to liver

74
Q

What does a normal umbilical vein doppler waveform show?

A

Linear forward flow

75
Q

Physiologic pulsations occur in the umbilical vein until what week of gestation?

A

Until 13 weeks, after the pulsations are associated with fetal breathing or movement

76
Q

Are pulsations of the umbilical vein that are synchronous with fetal cardiac cycle indicative of abnormal cardiac function?

A

Yes

77
Q

Does IUGR due to placenta insufficiency cause polyhydramnios or oligohydramnios?

A

Oligo - may be due to decreased fetal urine + lung liquid production

(fetus has poor outcome)

78
Q

How can moms manage IUGR?

A

-Bed rest
-Vitamins/antioxidants
-Aspirin
-Fish oil
-Hyperoxygenation
-Hypervolumic hemodilution

(none of these show significance in preventing or improving IUGR)

79
Q

During what weeks of gestation is aspirin recommended?

A

B/w 12-16 weeks - if mom has 2 or more risk factors such as diabetes, multiple gestations, previous placental abruption or infarction

80
Q

Which type of IUGR is m/c?

A

Asymmetric 70-80%

81
Q

At what percentile is IUGR considered?

A

< 10%

82
Q

Nonstress testing measures which 2 fetal parameters?

A

FHR + fetal movements

83
Q

What is the leading, preventable cause of IUGR?

A

Maternal smoking

MIDS 187 (19 decks)

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