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Intrauterine Growth Restriction (IUGR) - Coggle Diagram
Intrauterine Growth Restriction (IUGR)
Definition: Fetus is pathologically small.
Physiological factors known to affect growth & birth weight include:
Maternal & paternal (less) height
Maternal weight in early pregnancy
Parity
Ethnic origin
Gender of the fetus
Importance of IUGR:
For IUGR fetuses compared w/ normally grown population:
a) Perinatal mortality is 6-10x higher
b) Incidence of cerebral palsy is 4x higher
c) 30% of all stillborn infants are growth restricted
IUGR fetuses are also more likely to have:
a) Intrapartum fetal distress and asphyxia
b) Meconium aspiration
c) Emergency CS
d) Necrotizing enterocolitis
e) Hypoglycaemia & hypocalcaemia
Causes of IUGR:
Maternal:
a) Chronic maternal disease:
i. Hypertension
ii. Cardiac disease
iii. Chronic renal failure
b) Substance abuse:
i. Alcohol
ii. Recreational drug use
c) Smoking
d) Autoimmune diseases, including antiphospholipid antibody syndrome
e) Genetic disorders, including phenylketonuria
f) Poor nutrition
g) Low socio-economic status
Placental (placental insufficiency):
a) Abnormal trophoblastic invasion:
i. Pre-eclampsia
ii. Placenta accreta
b) Infarction
c) Abruption
d) Placental location (placenta praevia)
e) Tumours (chorioangiomas - placental haemangiomas)
f) Abnormal umbilical cord or cord insertion: two-vessel cord
Fetal:
a) Genetic abnormalities:
i. Trisomy 13, 18, 21
ii. Turner's syndrome
iii. Triploidy
b) Congenital abnormalities:
i. Cardiac (e.g.: tetralogy of Fallot, transposition of great vessels)
ii. Gastroschisis
c) Congenital infection:
i. CMV
ii. Rubella
iii. Toxoplasmosis
d) Multiple pregnancy
Management & Outcome:
Symmetric & asymmetric IUGR:
a) Symmetric IUGR:
Entire body is proportionately small & tends to be seen w/ very early onset IUGR & also w/ chromosomal abnormalities.
b) Asymmetric IUGR:
Undernourished fetus compensates by directing most of its energy to maintaining growth of vital organs at the expense of liver, fat and muscle.
This "head-sparing effect" results in a normal head size with small abdominal circumference & thin limbs (most often seen w/ IUGR secondary to placental insufficiency)
Management:
a)
Early identification & intensive fetal monitoring
are key to managing IUGR
b) Aim: To continue the pregnancy safely for as long as possible to decrease problems associated w/ prematurity but deliver fetus before it is excessively compromised.
Long-term outcome:
a) Most will grown normally in infancy and childhood but 1/3 children will not reach their predicted adult height and have childhood attention and performance deficits.
b) People who were small or disproportionate (thin or short) at birth have been found to have higher rates of coronary heart disease, high BP, high cholesterol concentrations and abnormal glucose-insulin metabolism (Barker Hypothesis).