Flashcards in IUGR Deck (15)
What is the definition of IUGR?
Intra-uterine growth restriction = failure of fetus to reach growth potential
How is IUGR different from Small for Dates (SFD)?
SFD = birthweight
Name 5 short-term consequences of IUGR
Perinatal mortality (stillbirth and neonatal death)
Neonatal morbidity (hypothermia, hypoglycaemia, infection, polycythaemia, meconium aspiration, HIE)
Name 2 long-term consequences of IUGR
Motor and intellectual disability (CP, mental retardation)
Can extend into adult comorbid disease as well (Barker hypothesis - HT, DM, dyslipidaemia, vascular disease)
Name 5 foetal causes of IUGR
Congenital - chromosomal (Trisomys, Turner syndrome), single gene disorders (Russel-Silver, Fanconi), structural defects (gastroschisis, omphalocoele, diaphragmatic hernias, skeletal dysplasia, heart disease), infection (toxo, CMV)
Name 5 maternal causes of IUGR
Vascular disease (HT, pre-eclamp, DM, connective tissue disease)
Thrombophilia - acquired (APLS, Ca, smoking) or congenital (Protein S and C, antithrombin III, Factor V Leiden etcccc)
Toxins (smoking, EtOH, cocaine, narcotics)
Name 2 placental causes of IUGR
How do you screen for IUGR in utero on examination? How accurate is this?
Symphyseal-fundal height from 20 weeks - only 66% accurate
What Ix can you do for IUGR? When is best to do it? What measurement is most accurate?
U/S at 34 weeks. Abdo circumference most accurate.
Name 2 Mx to prevent IUGR
Work and rest optimisation
Name 3 factors that would suggest a foetus is suffering from IUGR rather than just being genetically small
Parents are tall
Aberrant growth trajectory
Abnormal amniotic fluid, umbilical or Doppler studies
What are the 5 principles of management for a foetus with IUGR?
Find and treat cause (if there is one)
Fetal surveillance - CTG and U/S
Should you supplement an IUGR foetus with extra nutrition (hyperalimentation)? Why/why not?
No - even if it increases size of foetus (which it might not if the IUGR has a foetal etiology), it still doesn't correct the inadequate oxygenation (from defective placental vessels or maternal circulation) = ends up dying from hypoxia
Name 3 therapies to best optimise IUGR before delivery
Steroids if delivery