Intrauterine growth restriction

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  • i am highly delighted to view such a comprehensive presentation on IUGR , wonderfull work done. provided complete understanding on IUGR.
    GREAT WORK.
    THANKS
    RIZWANULLAH KHAN
    PAKISTAN
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Intrauterine growth restriction

  1. 1. Intrauterine Growth Restriction <ul><li>By Donna Adelsperger RN, M.Ed. </li></ul>
  2. 2. Intrauterine Growth Restriction <ul><li>IUGR is important cause of AP fetal death </li></ul><ul><li>Leading contribution to PMR (perinatal mortality rate) </li></ul><ul><li>PMR = 6 X > than for AGA babies </li></ul><ul><li>30% of all stillborns are growth restricted </li></ul><ul><li>Incidence of intrapartum asphyxia in cases of complicated IUGR = 50% </li></ul><ul><li>With good management PMR = lower </li></ul>
  3. 3. Intrauterine Growth Restriction <ul><li>IUGR also known as SGA (small for gestational age) based on on estimated fetal size alone (failure to reach growth potential) </li></ul>
  4. 4. Intrauterine Growth Restriction Etiology - Fetoplacental <ul><li>Chromosomal abnormalities </li></ul><ul><li>Genetic syndromes </li></ul><ul><li>Congenital malformations </li></ul><ul><li>Infectious diseases </li></ul><ul><ul><li>CMV (cytomegalic virus) </li></ul></ul><ul><ul><li>Toxoplasmosis </li></ul></ul><ul><ul><li>Rubella </li></ul></ul>
  5. 5. Intrauterine Growth Restriction Etiology - Fetoplacental <ul><li>Placental pathology </li></ul><ul><ul><li>Previa </li></ul></ul><ul><ul><li>Abruption </li></ul></ul><ul><ul><li>Circumvallate </li></ul></ul><ul><ul><li>Mosaicism </li></ul></ul><ul><ul><li>Infarction </li></ul></ul><ul><ul><li>Twins </li></ul></ul>
  6. 6. Intrauterine Growth Restriction Maternal Origins <ul><ul><li> uteroplacental blood flow responsible for majority of IUGR </li></ul></ul><ul><ul><li>Maternal vascular disease I.e. chronic hypertension, preeclampsia, diabetes </li></ul></ul><ul><ul><li>In preeclampsia IUGR is asymmetric (normal head growth) </li></ul></ul><ul><ul><li>Maternal pre-pregnancy weight and weight gain = 2 of most important variables </li></ul></ul>
  7. 7. Intrauterine Growth Restriction Maternal Origins (cont’d) <ul><ul><li>Maternal drug use, alcohol use & smoking </li></ul></ul><ul><ul><li>Prior birth of IUGR baby </li></ul></ul><ul><ul><li>History of poor pregnancy outcome </li></ul></ul><ul><ul><li> Maternal serum AFP </li></ul></ul><ul><ul><li>Multiple gestation </li></ul></ul><ul><ul><li>Anemia, hemoglobinopathies, bleeding </li></ul></ul><ul><ul><li>Preterm labor, vaginal bleeding </li></ul></ul><ul><ul><li>Abnormal placentation </li></ul></ul>
  8. 8. IUGR - Diagnosis <ul><li>Assessment of risk factors </li></ul><ul><li>Key physical finding is determination of uterine size i.e. fundal height (should be used for screening only) </li></ul><ul><li>IUGR incorrectly diagnosed 50% of time </li></ul><ul><li>All pregnancies screened for serial fundal height measurements </li></ul><ul><li>One measurement at 32-34 weeks is approx70-85% sensitive and 96% specific </li></ul><ul><li>3 rd trimester US with 1 measurement of AC detects about 80% IUGR </li></ul>
  9. 9. IUGR - Diagnosis <ul><li>Amniotic fluid volume = diagnostic & prognostic parameter in IUGR babies </li></ul><ul><li>Oligohydramnios is highly suggestive of restricted growth </li></ul><ul><li>IUGR indicative of increased risk of fetal death (also diagnosed by US) </li></ul><ul><li>IUGR babies may have normal AF volumes </li></ul><ul><li>Doppler velocimetry useful if IUGR confirmed </li></ul>
  10. 10. Intrauterine Growth Restriction Diagnosis <ul><li>US is used to identify: </li></ul><ul><ul><li>2/3 of case BPD (biparietal diameter)  normally till late pregnancy </li></ul></ul><ul><ul><li>Abdominal circumference has > sensitivity in identification of IUGR </li></ul></ul><ul><ul><li>AC (abdominal circumference) used in combination with HC (head circumference) </li></ul></ul><ul><ul><li>In US most common assessment is fetal weight** </li></ul></ul><ul><ul><li>Birth weight below 10 th % most used criteria** </li></ul></ul>
  11. 11. IUGR - Diagnosis <ul><li>Four standard fetal measurements part of OB US </li></ul><ul><ul><li>Fetal abdominal circumference </li></ul></ul><ul><ul><li>Head circumference </li></ul></ul><ul><ul><li>Biparietal diameter </li></ul></ul><ul><ul><li>Femur length </li></ul></ul>

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