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Intrauterine growth restriction (IUGR) and small for gestational age (SGA) are not the same thing.
FGR: Fetal growth rate.
Fetal growth rates
- 15 weeks: 5 g/day
- 24 weeks: 15-20 g/day
- 34 weeks: 30-35 g/day
- Small-sized mother.
- Poor nutrition. Low BMI.
- Social deprivation.
- Fetal infections: viral, bacterial, protozoan, and spirochaetal. CMV, rubella, toxoplasmosis, TB, syphilis.
- Congenital malformations.
- Chromosomal aneuploidies: trisomy 21, trisomy 18, and trisomy 13.
- Cartilage and bone disorders.
- Vascular disease such as preeclampsia.
- Renal disease.
- Chronic hypoxia.
- Anemia such as sickle cell disease.
- Placental and cord abnormalities.
- Multiple fetuses.
- Antiphospholipid antibody syndrome.
- Ectopic pregnancy.
- Antimalarial prophylaxis.
- Antibiotics to prevent UTI.
- Reduce maternal smoking.
- Balanced protein supplementation.
- Early detection of gestational age.
- Attention to maternal weight gain.
- Careful measurement of uterine fundal growth rate throughout the pregnancy.
- History of previous growth restricted fetus (GRF).
- Fundal height measurements. Between 18-30 weeks gestation, fundal height in cm coincides with weeks of gestation.
- Routine ultrasound exam between 16-20 weeks to establish gestational age and identify anomalies.
- Measurement of head, abdomen, and femur dimensions. Abdominal circumference is accepted by experts as the most reliable index of fetal size.
- 30% of GRF are never detected.
- Association between GRF and oligohydraminos.
- Doppler velocimetry: to detect absent or reversed end diastolic flow in the umbilical artery.
- Systole-diastole (SD) ratio.
- Resistance index (RI) = S-D/S
- Pulsatility index (PI)
- Abdominal palpation.
- Measurement of symphyseal fundal height.
- Ultrasound biometry.
- Ultrasound estimated fetal weight.
- Ultrasound doppler flow velocimetry.
- Once FGR is suspected, the diagnosis must be confirmed.
- Risk of fetal death vs hazards of of preterm delivery must be assessed.
- It is best to promptly deliver if the fetus is at or near full term.
- Most clinicians recommend delivery after 34 weeks if there is significant oligohydraminos.
- C-section must be considered if it is decided that the fetus cannot tolerate vaginal delivery.
- Assessment for chromosomal defects.
- Biophysical profile (BPP)
- Delivery indicated if results are abnormal.
- Screening for toxoplasmosis, rubella, CMV, herpes, and other infections.
- Amniocentesis is sometimes conducted to assess pulmonary maturity.
- If end diastolic flow is absent or reversed, administer steroids and keep under close surveillance in the hospital.
- Nutrient supplements.
- Oxygen therapy.
- Antihypertensive drugs.
- Plasma volume balancing attempts.
- Bed rest.