IUGR counselling

Question 1

explain IUGR & 2 types

Answer 1

Baby’s growth slows or ceases when in it is in the uterus.

May be small for gestational age (failed to achieve their growth potential) // constitutionally small (Mother small, foetus small)

Question 2

explain potential causes

Answer 2

Maternal: ++maternal age, hypertension, heart disease, diabetes, alcohol (eg FAS), other drugs (inc cannabis), smoking (30 to 40%) renal disease, thrombophilia, medicines (eg warfarin, steroids).

Placental: small placenta insufficient nutrition, placental apoptosis, pre-eclampsia (+BP, proteinuria).

Fetal causes: multiple pregnancy (twins IUGR in 15 to 20% of cases), chromosomal abnormalities (inc Down’s, Edwards’, Patau’s, Turner’s), congenital defects, intrauterine infection (eg. cytomegalovirus, toxoplasmosis, rubella, syphilis). Sometimes no cause is found

Question 3

how is it diagnosed

Answer 3

Palpation only detects ~30%.

Ultrasound - IUGR criteria include: elevated femoral length:abdominal circumference (AC) ratio, elevated head circumference (HC): AC ratio, unexplained oligohydramnios (amniotic fluid < 5 cm).

Question 4

IUGR mx steps

Answer 4

enquire about foetal movement

Keep a kick chart

Foetal monitoring required
- daily CTGs
- 1-2 weekly Dopplers
- Repeat growth scan in 2 weeks (inpx/outpx)

Need for BP and urine checks

Question 5

early delivery if

Answer 5

steroids < 34 weeks for lung maturity

prognosis good after 34 weeks

Question 6

possible complications

Answer 6

RDS
Feeding difficulties
Hypothermia

Major complications rare (intrapartum asphyxia, hypoglycaemia, impaired neurodevelopment,
meconium aspiration, intrauterine death)

If birth weight low, may be at increased risk of later developing coronary artery disease,
hypertension, type 2 diabetes, and autoimmune thyroid disease.