Iugr

INTRAUTERINE GROWTH RESTRICTION

FAHAD ZAKWAN

Sex

• term males 150 gm. heavier and 0.9 cm longer than females

Parity

• 1st born infants smaller

• effect loss after 3rd birth

Race, ethnicity, nationality Altitude

• Denver population growth curves under estimate weights of infants born at sea level

Maternal size

• maternal pre-pregnancy weight and pregnancy weight gain correlate with fetus size

Toxoplasmosis

Rubella

Trisomy 18 Turner syndrome

Trisomy 13

SYMMETRICAL IUGR ASYMMETRICAL IUGR

EARLY ONSET. SEEN IN 20% CASES LATE ONSET. SEEN IN 80% CASES

ETIOLOGY: GENETIC DISEASE/ INFECTION (INTRINSIC TO FETUS)

ETIOLOGY: CHRONIC PLACENTAL INSUFFICIENCY(EXTRINSIC TO FETUS)

TOTAL CELL NUMBER : LESS, CELL SIZE : NORMAL

TOTAL CELL NUMBER : NORMAL, CELL SIZE : SMALLER

USG : ALL PARAMETERS (HC, BPD, AC, FL) SMALLER THAN EXPECTED

USG : HEAD SPARING EFFECT, BUT ABDOMEN IS SMALL

NEONATAL COURSE: COMPLICATED WITH POOR Px USUALLY UNCOMPLICATED HAVING GOOD Px

BIOPHYSICAL TEST : THE FIRST EXAM SHOULD CONFIRM THE CLINICAL ESTIMATION OF THE GESTATIONAL AGE

1. Fetal distress / death.2. Asphyxia & RDS.3. Hypoglycemia. 4. Meconium aspiration syndrome.5. Hypothermia.6. Pulmonary hemorrhage.7. May have retarded growth .8. May have cardiac disease, diabetes, in adulthood, if

survives.Long term complications Lower IQ, learning & behavior problems, major neurological handicap seizures, cerebral palsy, mental retardation

Increased meconium aspirationDecreased surfactant deficiency

Adequate bed rest.

Nutritional diet / iron, vitamins, calcium.

No smoking / alcohol allowed.

Aspirin in low dose (50 mg daily).

Ultrasound monitoring of fetus should be done every 4th wks.

Termination of pregnancy – beyond 37 week.

Before 37 week – conservative t/t to increase placental function till fetus becomes viable.

Severe degree of IUGR – termination is to be done if lung maturation is achieved.

- If lung maturation has not been achieved corticosteroid therapy (betnasol 12 mg i.m. 24 hrs apart – 2 doses given to reduce the risk of neonatal RDS)

9. CS – to be done in the case of preterm delivery & unfavorable cervix.

10. Baby should be shifted to intensive neonatal care unit.