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Flashcards in IUGR Deck (16):
1

What is IUGR?

Failure of foetus to achieve its growth potential

2

What is SFD?

Small for dates. BW

3

What is the short term clinical significance of IUGR?

Increased incidence of:
-Preterm labour
-Perinatal mortality (stillbirths, neonatal deaths)
-Neonatal morbidity (hypothermia, infection, hypoglycaemia, irritable and poor feeders, meconium aspiration)

4

What is the long term clinical significance of IUGR?

Increased:
-Childhood long term morbidity (motor / intellectual handicap)
-Adulthood morbidity and mortality (DOAD)

5

What is DOAD?

Developmental origins of adult disease (Barker hypothesis).
Birthweight is inversely related to risks of:
-HTN
-DM
-Dyslipidemia
-Vascular disease a/w above

6

What are the foetal sources of IUGR?

-Chromosomal: chromosomal, single gene d/o, structural anomalies, familial
-Infections

7

What are the maternal sources of IUGR?

-Vascular disease
-Thrombophilia
-Toxins
-Cardiac disease
-Malnutrition
-Anaemia
-Atmospheric respiratory hypoxia / high altitude
-Infection (rubella, VZV, CMV)
-Smoking, alcohol, substance use

8

What are the placental sources of IUGR?

-Multiple pregnancy
-Abruption
-Placental abnormalities

9

What are the methods of screening for IUGR?

-Symphyseal fundal height (2/3 of SFDs detected, intra observer reliability > inter)
-US (more effective, optimal at 34 weeks)

10

What is the management of IUGR?

-Confirm Dx (IUGR or genetically small)
-Aetiology Dx and Rx
-Foetal surveillance
-Therapy
-Delivery

11

What are the factors in diagnosing being genetically small (as part of confirming diagnosis)?

-Parental small stature
-absence of recognised risk factors
-Symmetrically small
-Normal growth trajectory
-Biophysically active
-Normal amniotic fluid
-Normal umbilical and other doppler studies

12

Why is early IUGR especially significant?

Early in pregnancy foetal growth occurs primarily through hyperplasia; early onset IUGR may lead to irreversible diminution of organ size / function.

13

Which medications are associated with IUGR?

-Anticonvulsants
-Warfarin
-Folic acid antagonists

14

What are the standard foetal size assessment on US?

-1) Biparietal diameter
-2) head circumference
-3) Abdominal circumference
-4) Femur length

15

Why is amniotic fluid volume assessed on US in IUGR evaluation?

Combination of oligohydramnios (dec amniotic fluid volume) and IUGR a/w significant morbidity and mortality

16

What is the mechanisms of decreased amniotic fluid?

Thought to be decreased placental perfusion of O2 and nutrients, compensatory redistribution of foetal blood to heart, adrenal and brain.
Decreased renal perfusion = decreased amniotic fluid due to limited urine output.