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IUGR/SGA (risk factors (smoking, maternal age >35, Hx of SGA, 2 or more…
IUGR/SGA
risk factors
smoking
maternal age >35
Hx of SGA
2 or more miscarriages
chronic HTN
renal disease
antiphospholipid syndrome
aetiology
asymmetric (70%)
HC slower than weight/AC/length
extrinsic factors affecting fetus at later stages
preeclampsia
maternal systemic disease
multiple gestation
malnutrition
symmetric (20-25%)
more worrisome
TORCH infections
toxoplasmosis
other
syphillis
varicella-zoster
parovirus b19
Rubella
Herpes
CMV
chromosomal abnormalities
poor nutrition
alcohol/drugs
placental
preeclampsia
multiple births
uterine malformations
maternal
smoking
recent pregnancy
previous IUGR
diabetes
alcohol/drugs
lung, heart, or kidney disease
HTN
fetal
chromosomal
infection
management
refer to specialist (if GP)
start on aspirin 100mg OD before 16/40 until 36/40
high risk of preeclampsia
weekly USS (liquor volume and growth) and umbilical doppler and biophysical profile
fundal height falling at 37/40 --> need to mention preeclampsia
BP
Urinanalysis
risk factors
post 32w
DM
HTN
G1
personal hx
family hx
lupus or other AI disease
thrombophilias
multiple gestation
CTG monitoring at delivery
clinical
signs
growth charts
X = fundal height
large
LGA
increased BMI
gestational diabetes
polyhydramnios
breech position
small
fetal descent
SGA
oligohydramnios
O = fetal weight
symptoms
ask about FM
Hx of HTN
previous preeclampsia?
FHx?
symptoms?
headache
blurry vision
examination
abdo
biophysical profile (USS)
FM
FHR
amniotic fluid volume
fetal breathing
fetal tone
Manning's score 2-10
8-10 = reassuring
definition
SGA
infants with a birth weight <10th percentile for GA
IUGR
pathological
asymmetrical growth
HC>AC
symmetrical
HC=AC
fetus does not reach growth potential in utero
may be "small" (<10th centile) or "normal"
less than 10th centile EFBW or AC <5th centile
complications
perinatal
intrauterine death/still birth
hypothermia
hypoxia in labour
premature delivery
infant/paediatric
short stature
neurological developmental delay
adult
HTN
DM