IUGR

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  • S/D ratio (systolic/diastolic ratio), Resistance index (RI = systolic velocity - diastolic velocity/systolic velocity)Rulsatility index (systolic velocity - diastolic velocity/mean velocity).
  • IUGR

    1. 1. IUGRHow to diagnose?<br />AlokKishanRamsewak<br />Serial No: 019<br />Roll No: 050101029<br />
    2. 2. IUGR<br />History<br />Maternal weight less than 10th percentile for height;<br />Previous IUGR baby;<br />Twin pregnancies;<br />Maternal vascular diseases:<br />Essential hypertension;<br />Diabetes mellitus;<br />Collagen Disorder;<br />Maternal cardiac disease;<br />
    3. 3. IUGR<br />History<br />Heavy smokers;<br />Alcoholics and drug addicts;<br />Women with sickle cell disease;<br />With recurrent APH;<br />With raised MSAFP. <br />
    4. 4. IUGR<br />Weight Gain<br />Decreased maternal weight gain is a relatively insensitive sign of IUGR baby…<br />
    5. 5. IUGR<br />Uterine Fundal Height<br />Most common clinical method used to estimate fetal growth;<br />Upper border of symphisis pubis to the top of fundus of uterus;<br />Fundal height = gestational age (within 2 cm) at &gt; 20 weeks (± 2 weeks);<br />Reasonably accurate screening (Sensitivity 80-85%).<br />Less accurate than certain LMP but more accurate than uncertain LMP.<br />
    6. 6. IUGR<br />Signs rarely occur before 28 weeks of gestation<br />
    7. 7. IUGR<br />Errors in Fundal Height Estimation:<br />Inter-observer variations<br />Obese patients<br />Transverse lie<br />Multiple gestation<br />Polyhydramnios / Oligohydramnios<br />Uterine fibroids<br />
    8. 8. IUGR<br />Fetal Kick Count<br />Patient counts fetal movements starting at 9am until 10 movements are perceived;<br />Count is done daily;<br />Patient has to alert her physician if:<br />&lt; 10 movements occur within 12h on 2 consecutive days;<br />No movements are perceived within 12h in a single day.<br />
    9. 9. kickTrak, A Tool for Pregnancy Health.<br />
    10. 10. IUGR<br />Signs:<br />Seldom elicited before 28 weeks of gestation:<br />Failure of fetus and uterus to grow at the normal rate over a 4 week period;<br />Uterine fundal height should beat least 2cm less than expected for the length of gestation;<br />Poor maternal weight gain;<br />Diminished fetal movements.<br />
    11. 11. IUGR - Investigations<br />UltrasonographyBiometry<br />Fetal biparietal diameter (BPD);<br />Head circumference ;<br />Abdomninal circumference;<br />Femur length;<br />Ratio :- Head circumference to the abdominal circumference (HC/AC)<br />Look for: Congenital anomalities.<br />
    12. 12.
    13. 13. IUGR - Investigations<br />Amniotic Fluid Index<br />Mild IUGR – Normal amniotic fluid<br />Severe IUGR – Oligohydramnios (AFI is ≤ 5) Incidence 40%<br />On ultrasonography - a pocket of fluid &lt; 1cm is diagnosed as oligohydramnios.<br />
    14. 14. IUGR - Investigations<br />Doppler Waveform Analysis<br />Assess resistance to blood flow<br />In normal pregancies, fetal and maternal arteries show low resistance.<br />S/D ratio (systolic/diastolic ratio), <br />Resistance index<br />Pulsatility index<br />
    15. 15. IUGR - Investigations<br />Ponderal Index (PI)<br />Ultrasound criteria for diagnosis of fetal malnutrition;<br />Gestation age independent;<br />Constant in second part of pregnancy;<br />Normal Value = 8.325 + 2.5 (2SD);<br />Useful in the evaluation of small baby.<br />
    16. 16. IUGR<br />
    17. 17. IUGR<br />
    18. 18. Thank you.<br />

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