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Iugr
 

Iugr

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    Iugr Iugr Presentation Transcript

    • IUGR &UltrasoundBY: Dr. Nooria Atta
    • BACKGROUND 10% for all pregnancies 3-5% for healthy mothers 25% or higher for some high-risk groups Increased risk of perinatal mortality and morbidity Most fetuses with IUGR are constitutionally small Timely diagnosis and management of IUGR iscrucial Ultrasound biometry is the gold standard forassessment of fetal size and the amount ofamniotic fluid
    • DEFINITION fetus whose estimated weight is below the 10thpercentile for its gestational age Has a NPV of 99%, a sensitivity of 89%, and aspecificity of 88% for the detection of IUGR, Fetal growth is dependent on genetic, placental andmaternal factors The cutoff birth weight for IUGR is 2,500 g at term, 70% of fetuses with a birth weight below the 10thpercentile for gestational age are constitutionallysmall Only in 30%, the cause of IUGR is pathologic.
    • FETAL WEIGHT PERCENTILES THROUGHOUTGESTATION
    • IMPORTANCE OF ACCURATE DATING Essential for making the diagnosis of IUGR LMP Ultrasound examination performed before 20thgestational week( the margin of error is seven to 10 days) More accurate estimation of gestational age isbased on early ultrasound examination, ideally ateight to 13 weeks of gestation Third-trimester ultrasonogram is only accurate toabout three weeks Ultrasound assessment is used later in pregnancyto estimate fetal weight
    • SYMMETRIC AND ASYMMETRIC IUGR Low growth potential – symmetrical Loss of growth support - asymmetrical HC/AC ratio is normal in the fetus with symmetricgrowth restriction and elevated in the infant withasymmetric growth restriction
    • IUGR - LOW GROWTH POTENTIAL Symmetrical growth restriction Measurements reduced from mid-pregnancy Short & light with all measurements Mother may be biologically small (< 45kg) May be pathological cause Chromosomal abnormality Viral infection
    • IUGR - LOSS OF GROWTH SUPPORT Usually found after 30 weeks Due to Restriction of oxygen & nutrients Vascular disease affecting uteroplacental circulation egpre-eclampsia Foetus : long, light, reduced abdominal girth Asymmetrical growth restriction Starvation - Glycogen stores in liver are depleted AC is reduced
    • DIAGNOSIS Ultrasound is the gold standard for assessing fetalgrowth biparietal diameter, head circumference, abdominalcircumference and femur length Accurate dating of the pregnancy is essential in theuse of any parameter In the absence of reliable dating, serial scans attwo- or three-week intervals must be performed toidentify IUGR Do not forget error potential for each parameters Transcerebellar diameter is an unbiased measureof gestational age up to 22 wks
    • BPD & HC
    • AC
    • FL
    • FETAL WEIGHT PERCENTILES THROUGHOUTGESTATION
    • HC/AC RATIO ratio of the head circumference to the abdominalcircumference (HC/AC) Between 20 - 36 wks, the HC/AC ratio normallydrops almost linearly from 1.2 to 1.0 An elevated HC-to-AC ratio has a negativepredictive value of 98%, a sensitivity of 82%, and aspecificity of 94% for the detection of IUGR.
    • AMNIOTIC FLUID INDEX Less than 5cm= oligohydramniosisPercentiles for amniotic fluid index based on gestational age
    • TRIPLEX MODE Is used for the evaluation of the umbilical vesselsblood flow Includes color Doppler sonography of the umbilicalvessels, pulsed Doppler velocimetry, and real-timesonography to measure the diameter of theumbilical vessels Use of Doppler in IUGR is associated with areduction in perinatal death and induction of laborand less emergency cesarean sections(Cochrane).
    • UMBILICAL ARTERY DOPPLERDoppler waveform assessmentIndicates flow resistanceProgressive vessel obliteration in the placentaAbsent/ reversed end-diastolic flow Progressive deterioration of Placenta
    • DOPPLER WAVEFORM OF UMBILICAL ARTERY ININTRAUTERINE GROWTH RETARDATION (IUGR)DEMONSTRATES LOSS OF DIASTOLIC FLOWNormal loss of diastolic flow
    • STAGING OF IUGR (STUDY) 1. abnormal UA or MCA index; 2. abnormal MCA peak systolic velocity, UAabsent/reversed diastolic flow, UV pulsation & anabnormal ductus venosus pulsatility index; 3. Reversed flow at the ductus venosus or reversedflow at the UV, an abnormal tricuspid E wave (earlyventricular filling)/A wave (late ventricular filling)ratio, and tricuspid regurgitation. Each stage was divided into A (amniotic fluid index[AFI] <5 cm) and B (AFI >5 cm)
    • SUMMARY The key parameters for diagnosing IUGR are thefollowing: Estimated fetal weight according to gestational age Volume of amniotic fluid Mothers blood pressure status Triplex mode is best for detection of severity andprogression of IUGR
    • Thanks