IUGR

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Block C2 - Safe Motherhood & Neonates


Iugrfoeto.jpg

Intrauterine growth restriction (IUGR) and small for gestational age (SGA) are not the same thing.

FGR: Fetal growth rate.

Fetal growth rates[edit]

  • 15 weeks: 5 g/day
  • 24 weeks: 15-20 g/day
  • 34 weeks: 30-35 g/day

Risk Factors[edit]

  • 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.
  • Teratogens.
  • 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.

Prevention[edit]

  • Antimalarial prophylaxis.
  • Antibiotics to prevent UTI.
  • Reduce maternal smoking.
  • Balanced protein supplementation.

Diagnosis[edit]

IUGR[edit]

  • Early detection of gestational age.
    Doppler velocimetry
  • 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)

SGA[edit]

  • Abdominal palpation.
  • Measurement of symphyseal fundal height.
  • Ultrasound biometry.
  • Ultrasound estimated fetal weight.
  • Ultrasound doppler flow velocimetry.

Management[edit]

  • 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.

Ineffective[edit]

  • Nutrient supplements.
  • Oxygen therapy.
  • Antihypertensive drugs.
  • Heparin.
  • Aspirin.
  • Plasma volume balancing attempts.
  • Bed rest.