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Intra uterine growth restriction

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Intra uterine growth restriction

  1. 1. IUGR M ARSHAD HUSSAIN FRCOG
  2. 2. IUGR  Failure of the fetus to achieve its genetic growth potential  Usually results in a fetus that is small for gestational age (SGA)  Babies born below a particular centile weight for gestation (3rd or 5th) are classified as IUGR  3% if 3rd or 5% if the 5th centile is chosen
  3. 3. IUGR  SGA & IUGR are not synonymous  SGA – fetus or neonate is below a certain defined centile of wt or size for a particular gestational age  Some SGA fetuses are constitutionally small due to normal genetic influences
  4. 4. IUGR  IUGR – a particular pathological process is operating to modify the intrinsic growth potential of the fetus by reducing its growth rate  Some IUGR fetuses may not fall into any definition of SGA, but will have failed to achieve their full growth potential
  5. 5. IUGR  Major cause of neonatal morbidity and mortality  Significant cost involve in the care of these fetuses  Certain adult diseases (Hypertension & DM) are related to IUGR
  6. 6. Aetiology  Factors that directly affect the intrinsic growth potential of the fetus:  Chromosome defects (Trisomy 18, Triploidy)  Single gene defects (Seckel’s syndrome)  Structural abnormalities (Anencephaly, Renal agencies)  Infections (CMV, Toxoplasmosis)
  7. 7. Aetiology  External factors that reduce the support for fetal growth: Maternal factors  Under nutrition (Poverty, Eating disorders)  Maternal hypoxia (Altitude, Cyanotic heart disease)  Drugs (Alcohol, Cocaine, Cigarette smoke)
  8. 8. Aetiology  External factors that reduce the support for fetal growth: Placental factors  Reduced utero-placental perfusion (Inadequate trophoblast invasion, APS, DM, Sickle-cell disease, Multiple gestation)  Reduced fetoplacental perfusion (Single umbilical artery, Twin-twin transfusion syndrome)
  9. 9. Pathophysiology  Symmetrical IUGR  Asymmetrical IUGR  Mechanisms
  10. 10. Diagnostic Tools  History        Previous Obstetric History Medical history Drug History APH/Abruption Family History Personal & Family History Fetal Movements
  11. 11. Diagnostic Tools  Abdominal Palpation      24 weeks onward Symphysis Fundal Height Measurement in cm equates gestation in weeks Difference of more than 2 cm requires further fetal assessment Gross oligo - or polyhydramnios are evident on palpation
  12. 12. Diagnostic Tools  Ultrasound scanning  Biometry    Anatomy   BPD, AC, HC, FL, Cerebellum Valuable in diagnosis, DD and surveillance of IUGR fetuses Structural abnormalities (Chromosomal abnormalities causing IUGR) Amniotic Fluid Volume   AFI – sum of the deepest pool in each quadrant Reproducible measure of AFV for the DD and surveillance of IUGR
  13. 13. Diagnostic Tools  Doppler Waveform Analysis  Invasive Fetal Testing   Amniocentesis (FISH - Fluorescent in situ hybridization) Placental Biopsy  Retrospective Tests    Maternal blood (CMV, Rubella, Toxoplasmosis, metabolic disorders) Placenta (H/P) Fetus/Neonate (PM examination)
  14. 14. Management  No widely accepted treatments for placental dysfunction  Avoidance of smoking, alcohol & drug abuse  Control of DM, Thyroid disease, etc  Bed rest  Aspirin, nitric oxide donors or antioxidents  Delivery
  15. 15. Prognosis  IUD  Morbidity or death due to immaturity  Long term survivals – good prognosis  Height and wt below 50th centile  Majority show “catch up” growth when feeding optimised  Congenital infection or chromosomal abnormality – development is determined by the abnormality

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