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Simple yet important aspects covered under IUGR.
Dedicated to all B.Sc Nursing Studies.

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  1. 1. Presented by: Mr. Jay V. Sanap III yr Basic B.sc Nsg (TNC)
  2. 2.  Intrauterine growth restriction (IUGR) refers to poor growth of a baby while in the mother's womb during pregnancy.  The causes can be many, but most often involve poor maternal nutrition or lack of adequate oxygen supply to the fetus
  3. 3.  At least 60% of the 4 million neonatal deaths that occur worldwide every year are associated with low birth weight (LBW), caused by:  intrauterine growth restriction (IUGR)  preterm delivery  Genetic/chromosomal abnormalities, demonstrating that under-nutrition is already a leading health problem at birth.
  4. 4.  Intra Uterine Growth Restriction is said to be present in those babies whose birth weight is below the tenth percentile of the average for the gestational age.  Growth Restriction can occur in preterm, term or post-term babies.
  5. 5.  Fetuses those are small and healthy. The birth weight is less than 10th percentile for their gestational age. They have normal ponderal index, normal subcutaneous fat and usually have uneventful neonatal course.  Fetuses where growth is restricted by pathological (true IUGR). Depending upon the relative size of their head, abdomen and femur, the fetuses are subdivided into:  Symmetrical or Type I  Asymmetrical or Type II
  6. 6.  Symmetrical IUGR (20 per cent)  In this state there is noxious effect on the fetus, which in turn leads to cellular hyperplasia.  The total number cells are less. This form of growth retardation is often caused by structural or chromosomal abnormalties or congenital infection (TORCH).  The pathological process is intrinsic to the fetus and involves all the organ including the head
  7. 7.  Asymmetrical IUGR (80 per cent) is most commonly caused by extrinsic factors that affect the fetus at later gestational ages.  It shows cellular hypertrophy. The total number remains same but size is smaller than normal.  These diseases alter the fetal size by reducing uteroplacental blood flow or by restricting the oxygen and nutrient transfer or by reducing the placental size.
  8. 8.  Maternal  pre-pregnancy weight and nutritional status  poor weight gain during pregnancy  poor nutrition  anemia  alcohol and/or drug use  Maternal smoking  recent pregnancy  Pre-gestational diabetes  Gestational diabetes  pulmonary disease  cardiovascular disease  renal disease  Hypertension
  9. 9.  Uteroplacental  preeclampsia  Multiple gestation  Uterine malformation  Placental praevia  Infarction  Abruption  Mosaicism
  10. 10.  Fetal  Chromosomal abnormalities  intrauterine infection  Structural Anomalies.  Multiple pregnancy.
  11. 11.  If the cause of IUGR is extrinsic to the fetus (maternal or uteroplacental), transfer of oxygen and nutrients to the fetus is decreased. This causes a reduction in the fetus’ stores of glycogen and lipids. This often leads to hypoglycemia at birth.  Polycythemia can occur secondary to increased erythropoietin production caused by the chronic hypoxemia.  Hypothermia, thrombocytopenia, leucopenia, hypocalcaemia and pulmonary hemorrhage are often results of IUGR.  If the cause of IUGR is intrinsic to the fetus, growth is restricted due to genetic factors or as a sequela of infection.
  12. 12.  Doctors have many ways to estimate the size of babies during pregnancy. One of the simplest and most common is measuring the distance from the mother's fundus (the top of the uterus) to the pubic bone. After the 20th week of pregnancy, the measure in centimeters usually corresponds with the number of weeks of pregnancy. A lower than expected measurement may indicate the baby is not growing as it should.
  13. 13.  Ultrasound.  Doppler flow.  Weight checks.  Fetal monitoring.  Amniocentesis.
  14. 14.  Weight deficit at birth is about 600g below the minimum in percentile standard.  Every hospital should have their own birth weight- gestational age chart.  Length is unaffected.  Head Circumference is relatively larger than the body in asymmetric variety.  Physical features shows dry and wrinkled skin because of less subcutaneous fat, scaphoid abdomen, thin meconium stained vernix caseosa and thin umbilical cord.  All these gives the baby an ‘’old man look’’.  Pinna of ear is cartilaginous ridges. Plantar creases are well defined.  The baby is alert, active and having normal cry. Eyes are open.  Reflexes are normal including Moro-reflex.
  15. 15.  Fetal:  (a) Antenatal – Chronic Fetal Distress, fetal death.  Intranatal – Hypoxia & Acidosis.
  16. 16.  Immediate:  Asphyxia, Broncho-pulmonary dysplasia and RDS.  Hypoglycemia due to shortage of glycogen reserve in liver.  Meconium aspiration syndrome.  Microcoagulation leading to DIC.  Hypothermia.  Pulmonary Hemorrhage.  Polycythemia, Anemia, Thrmobocytopneia.  Hyperviscocity – thrombosis.  Necrotising enterocolitis due to reduced intestinal blood flow.  Intraventricular Hemorrhage.  Electrolyte abnormalties, Hyper phosphatemia, Hypokalemia due to impaired renal function.  Multi organ failure.  Increased Perinatal morbidity and mortality.
  17. 17.  Retarded neurological and intellectual development in infancy. (Cong.infection, abnormalities & defects)  Increased risk of metabolic syndrome in adult life: obesity, HTN, DM & CHD.  LBW infants- increased appetite bt low satiety.  Reduced Nephrons – causes renal vascular hypertension.
  18. 18.  No harm to mother.  But underlying disease such as pre- eclampsia,heart disease & malnutrition may be life threatening.  Risk of having another child retarded too.
  19. 19.  The best way to manage IUGR depends on the severity of growth restriction and how early the problem began in the pregnancy.  Improving nutrition.  Bed Rest.  Delivery.
  20. 20.  Thermoregulation  Hypoglycemia  Feeding  Environment promotion  Handling & touch  Noise & light hazard  Sleeping Position  Prevention of Infection
  21. 21.  Impaired Gas Exchange.  Ineffective Breathing Pattern.  Ineffective Thermoregulation.  Risk for deficient fluid volume.  Risk for imbalanced nutrition less than body requirement.  Risk for Infection.  Risk for Constipation/Diarrhea.
  22. 22.  Although IUGR can occur even when a mother is perfectly healthy, there are things mothers can do to reduce the risk of IUGR and increase the odds of a healthy pregnancy and baby.  Keep all of your prenatal appointments. Detecting potential problems early allows you treat them early.  Be aware of your baby's movements. A baby who doesn't move often or who stops moving may have a problem. If you notice changes in your baby's movement, call your doctor.
  23. 23.  Check your medications. Sometimes a medication a mother is taking for another health problem can lead to problems with her unborn baby.  Eat healthfully. Healthy foods and ample calories help keep your baby well nourished.  Get plenty of rest. Rest will help you feel better and it may even help your baby grow. Try to get eight hours of sleep (or more) each night. An hour or two of rest in the afternoon is also good for you.  Practice healthy lifestyle habits. If you drink alcohol, take drugs, or smoke, stop for the health of your baby.