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