Classification<br />Campbell and Thoms (1977) described the use of the sonographically determined head-to-abdomen circumference ratio (HC/AC) to differentiate growth-restricted fetuses.<br />Symmetrical IUGR (type I)<br />Asymetrical IUGR (type II)<br />Combined type<br />
Classification<br />1.Symmetrical growth restriction<br />20 % of IUGR Infants <br />proportional decrease in all organs<br />HC/AC ratio is normal<br />Occurs inearly pregnancy : cellular hyperplasia<br />Increase risk for long term neurodevelopmental dysfunction<br />
Resultant diminished glucose transfer and hepatic storage would primarily affect cell size and not number, and fetal abdominal circumference which reflects liver size would be reduced.</li></ul>LOGO<br />
Classification<br /><ul><li>Such somatic growth restriction is proposed to result from preferential shunting of oxygen and nutrients to the brain, which allows normal brain and head growth, so-called brain sparing.
The fetal brain is normally relatively large and the liver relatively small. Accordingly, the ratio of brain weight to liver weight during the last 12 weeks, usually about 3 to 1, may be increased to 5 to 1 or more in severely growth-restricted infants.</li></ul>LOGO<br />
Symmetricalasymmetrical </li></ul> More morbidities and mortalities <br /> More long term effects<br />LOGO<br />
Classification<br />3. Combine type<br /><ul><li>A fetus with asymmetrical IUGR might confront with cause of IUGR until cannot be compensated with brain sparing effect, may cause restriction of head circumference.
A fetus with symmetrical IUGR how have complication with circulation in late gestational aged, may cause reduction of abdominal circumference.</li></ul>LOGO<br />
Between 18 and 30 weeks, the uterine fundal height in centimeters coincides with weeks of gestation. If the measurement is more than 2 to 3 cm from the expected height or < 1oth percentile from normal curve, inappropriate fetal growth may be suspected</li></li></ul><li>Diagnosis<br />I. Clinical assessment<br /><ul><li>Physical examination
Diagnosis<br />II. Ultrasonic measurement<br /><ul><li>Initial U/S at 16 to 20 weeks to establish gestational age and identify anomalies and repeated at 32 to 34 weeks to evaluate fetal growth</li></li></ul><li>Diagnosis<br />II. Ultrasonic measurement<br /><ul><li>Abdominal circumference (AC) ***
characterized by absent or reversed end-diastolic flow
associated with fetal growth restriction</li></ul>Normal velocimetry pattern with an S/D ratio of <30.<br /> The diastolic velocity approaching zero reflects increased placental vascular resistance. <br />During diastole, arterial flow is reversed (negative S/D ratio), which is an ominous sign that may precede fetal demise<br />
Prevention<br /><ul><li>Stop and avoid all of the risk factors
If diagnosed in prior to 34 weeks, and amnionic fluid volume and fetal surveillance are normal</li></ul> “Observation is recommended± screening for toxoplasmosis,herpes,rubella,CMV and others”<br /> Specific treatment(causes of IUGR) and supportive care<br /><ul><li>If severe IUGR or bad obstetric conditions </li></ul> Terminate pregnancy should be considered<br />