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Intrauterine growth restriction (IUGR) (Complications (Cerebral palsy,…
Intrauterine growth
restriction (IUGR)
Definition
Reduced growth of the foetus
compared to that expected for
gestation or prev trajectory
Types
Symmetrical
Entire body is proportionally small
Often early onset IUGR and/or Chr abnormalities
Asymmetrical
Undernourished foetus e.g. placental insufficiency compensating by directing energy to vital organs (brain, heart) at expense of fat, muscle, liver
See normal head size and small abdomen, thin limbs
Pathophysiology
Maternal causes
Chronic disease, substance abuse,
poor nutrition
Foetal causes
Genetic/congenital abnormalities,
infections, multiple pregnancy
Uteroplacental insufficiency
Commonest cause
Abnormal placenta/cord development, infarction,
abruption, tumours
Becomes more critical as foetus gets bigger (exponential growth in last few weeks of pregnancy)
No treatment, may need to deliver child early to prevent adverse outcomes
Aetiology
Child
Genetic/congenital
Trisomy 13/18/21, Turners, triploidy
Cardiac (ToF, transposition), gastroschisis
Developmental
Multiple pregnancy
Infection
CMV, rubella
Placenta*
Developmental
Accreta, praeva
Abnormal cord/insertion
Neoplastic
Chorioangiomas
Vascular
Infarction, pre-eclampsia
Mother
Vascular
HTN, cardiac disease
Genetics
Genetic disorders
Idiopathic
SEC, nutrition
Autoimmune
Antiphospholipid syndrome, SLE
Metabolic
Renal disease
Drugs
Smoking, alcohol,
substance misuse
Diagnosis
Examination
Abdomen: small for gestational age
Investigations
Bedside
Symphysis-fundal height (small)
Maternal obs (infection, HTN)
Foetal obs (HR hand Doppler/Pinard)
Customised growth charts (maternal height,
weight, parity, ethnicity, foetal gender)
Bloods
Immune screen, virology
Foetal anomaly screen
Urine
Dipstick (infection, pre-eclampsia)
Imaging
USS: IUGR, structural abnormalities,
multiple pregnancies, neoplasms
Uterine artery Doppler: resistance in placenta (pre-eclampsia)
History
PMH
Cardiac/renal disease, autoimmune disease,
genetic disorders
FH
Cardiac/renal disease, autoimmune disease,
congenital abnomalities
POH
Previous IUGR, chromosomal/developmental abormalities,
placental abnormalities, pre-eclampsia, delivery, complications
Current pregnancy
Scans, bloods, USS to date,
growth charts, foetal movement
DH
Current meds, allergies
SH
Occupation, smoking, alcohol, drugs
Complications
Cerebral palsy
Foetal distress/asphyxia
Mortality
Perinatal/stillborn
Meconium aspiration
Necrotising enterocolitis
Medical illnesses
Hypoglycaemia/hypocalcaemia
cardiac disease, hypercholesterolemia, HTN
Emergency CS
Management
Surgical
Delivery
Indication: baby old enough to survive outside (>24wk)
Method: often CS, as IUGR babies have
little reserve so often go into distress with NVD
Conservative
Information
Advice, support
Monitoring
Dopplers (Umbilical artery, MCA Ductus venous), CTG
Growth charts (USS regularly)