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8. causes of IUGR?
•Maternal medical conditions
•Chromosomal anomalies & aneuploidy
•Genetic & Structural anomalies
•Exposure to drugs & toxins
•1ry placental disease
•Low socioeconomic status
•Infections
•Multiple gestation
9. maternal medical conditions result in IUGR?
•HPT
•Preeclampsia
•DM with vascular involvement
•SLE
•Anemia
•Sickle cell disease
•Antiphospholipid syndrome
•Renal disease
•Malnutrition
•Inflammatory bowel disease
•Intestinal parasites
•Cyanotic pulmonary disease
10. How does the placenta play a role in the development of IUGR?
•Abnormalities in placental development & trophoblast
invasion Idiopathic or due to maternal disease eg.
SLE, PET, DM, HPT
•Chronic partial abruption
•Placental infarcts
•Placenta previa
•Chorioangioma
•Circumvallate placenta
•Placental mosaicism
•Twin to twin transfusion Syndrome
11. infections result in IUGR:
Congenital infections:
•CMV
•Rubella
•Herpes
•Vericella zoster
•Toxoplasmosis
•Malaria
•Listeriosis
5-10% of IUGR
12. drugs can result in IUGR:
•Alcohol
•Cigarette smoking 3-4X
•Heroin & coccaine
•Methotrexate
•Anticonvulsants
•Warfarin
•Antihypertensives /ß-blockers
•Cyclosporin
13. genetic disorders that can result in IUGR:
•Down’s syndrome T21
•Trisomy 13,18
•Turner syndrome
•Neural tube defects
•Achondroplasia
•Osteogenisis imperfecta
•Abdominal wall defects
•Duodenal atresia
•Renal agenesis/ Poter’s S
15% of IUGR
•Symmetric IUGR
•AFV/ Doppler N
•Structural abnormalities
•Maternal age
•Nuchal translucency
•Biochemical screening results
Features suspicious of trisomy
14. How multiple pregnancy result in IUGR?
•Placental insufficiency /inadequate
placental reserve to sustain N growth of >
one fetus
•Twin to twin transfusion syndrome
•Anomalies
• with higher order gestations
• monozygotic twins
15. types of IUGR?
1-Symmetric –20%
•Proportionate decrease in many organ weights
including the brain
•Deprivation occurs early
•The fetus is more likely to have an endogenous
defect that preclude N development
•U/S biometry All measurements BPD, FL, AC
16. Types of IUGR
2-Asymmetric IUGR—80%
•Relative sparing of the brain
•Deprivation occurres in the later half of
pregnancy
•The infant is more likely to be N but small in size
due to intrauterine deprivation
•U/S biometry BPD, Fl N, AC
17. Why IUGR often associated with olighydramnios?
blood flow to the lungs pulmonary
contribution to amniotic fluid volume
blood flow to the kidneys GFR
urine output
It is present in 80-90% of IUGR fetuses
19. 2-EXAMINATION
•Symphysis fundal height in cm = gest age in wks after 24 wk
•Sensitivity 46-86% in detecting IUGR
•Adifference of more than 2cm requires fetal assessment
•Oligohydramnious may be detected on palpation
3-U/S
•Fetal biometry for dating then serial measurements
•Anomaly scan
•AF index
•Doppler umbilical artery resistance index, MCA
•Repeat tests every1-2 wks
20. 4-Invasive fetal testing
•Amniocentesis or placental biopsy/ fetal blood sampling
for karyotyping if aneuploidy is suspected
for viral studies if infections suspected
•Caries the risks of infection, PROM, Preterm labor
5-Retrospective tests
•Maternal blood tests for CMV, Rubella, Toxo
Metabolic disorders
thrombophilia
•Placenta should be sent for HP
•Postmortem examination
21. The constitutionally small fetus
•A fetus growing parallel to the lower centiles through out preg
•Anatomically N
•AFV N
•Doppler N
•Slim petite women
23. Treatment
•Stop smoking / alcohol
•Bed rest uterin e blood flow for pt with asymmetric IUGR
•Low dose aspirin
•Weekly visits attention to : FM, SFH, maternal wt, BP, CTG,
AFV
•U/S every 4 wks
•BPP
•Delivery 38 wks or earlier if there is fetal compromise
•Glucocorticoids if planing delivery before 34 wks
•Close monitoring in labor/ continuous monitoring /scalp PH
•CS may be necessary
24.
25. IUFD
Diagnosis
Absence of uterine growth
Serial ß-hcg
Loss of fetal movement
Absence of fetal heart
Disappearance of the signs & symptoms of pregnancy
X-ray Spalding sign
Robert’s sign
U/S 100% accurate Dx
Definition: dead fetuses or neoborns weighing > 500gm
28. IUFD complications
•Hypofibrinogenemia 4-5 wks after IUFD
•Coagulation studies must be started 2 wks after IUFD
•Delivery by 4 wks or if fibrinogen < 200mg/ml
29. Evaluation of still born infants
Infant description
Malformation
Skin staining
Degree of maceration
Color-pale ,plethoric
Umbilical cord
Prolapse
Entanglement-neck, arms, ,legs
Hematoma or stricture
Number of vessels
Length
Amniotic fluid
Color-meconium, blood
Volume
Placenta
Weight
Staining
Adherent clots
Structural abnormality
Velamentous insertion
Edema/ hydropic changes
Membranes
Stained
Thickening
30. Psychological aspect & counseling
•A traumetic event
•Post-partum depression
•Anxiety
•Psychotherapy
•Recurrence 0-8% depending on the cause of IUFD