IUGR

Question 1

Mx of IUGR

• incidental finding of viable early onset IUGR (asymmetrical) in context of medical conditions
• incidental finding of IUGR in women with minimal antenatal care
• incidental finding of IUGR in women with minimal antenatal care on bkg of substance use
• IUGR in setting of primary CMV infection in pregnancy
• early onset IUGR in setting of renal tx/T1DM
• early onset IUGR in setting of chronic hypertension on anti-HTN

Answer 1

DDx
- asym - plac insufficiency (PET/med)
- sym - infection/genetic/structural
(don’t stop investigating just because it’s asymmetrical…)

• M risk - mirror syndrome/IOL/emCS
• F risk - PTB/RDS/IVH/NEC/NICU
• Ensure accurate dating
• Check aneuploidy screen
• PET screen + TORCH
• Refer Tertiary - rpt scan
• MDI - MFM/Paed +/- Obs Med+/-ID
• +/- amnio/sFLT/PIGF
• regular ANC
• once viable twice weekly Doppler+CTG
• once viable consider steroid loading
• serial G/S - biometry/AFI/Doppler
• timing/MOD
  1. individualized
  2. consult MFM & local guidelines
  3. AREDF unlikely to tolerate labor
• PN
  1. routine care
  2. recurrence risk based on cause
  3. prevent - lifestyle mod/LDA/Ca/optimize comorbid

e.g. IUGR from aneuploidy, risk may increase as aneuploidy assoc with increase in age