intrauterine growth restriction and intrauterine death

Define IUFR

Inability of fetus to attain full genetic potential

Small for gestational age & low birth weight babies fall under which percentile?

<10th percentile for GA

Usually weight for low birth weight?

<2.5kg

Usually weight for very low birth weight ?

<1.5kg

Clinical signs of IUGR?(7)

1. Inadequate fundal growth

2. Fetal head hard & larger than expected

3. Decreased amniotic fluid index (oligohydramnios)

4. Increased flexion of fetal body

5. Decreased fetal movement

6. Cedric more favourable than expected for GA

7. Increased variable decelerations on CTG

How do we diagnosis IUGR clinically?(3)

1. Two successive SFH <10th centile

2. Any 3 values <10th centile

3. 3 values forming a plateau irrespective of whether it’s below 10th centile

   
   

When IUGR is suspected what can we confirm and evaluate?(4)

1. Confirm GA

2. Confirm FH present

3. Evaluate the abdomen and cervix

4. Exam signs of chronic disease

On ultrasound what will we look for? (3)

1. Fetal growth > symmetrical vs asymmetrical

2. Amniotic fluid index

3. Doppler > umbilical artery, middle cerebral artery

*consider customised growth charts

What are the causes of IUGR?(4)

1. Genetic factors

2. Placental factors

3. Fetal factors

4. Maternal factors

What are the pre-placental causes of IUGR (maternal) ? (7)

1. Living at high altitude

2. Maternal cyanotic heart lesions

3. Severe maternal respiratory distress

4. Chronic malnutrition

5. Renal disease

6. Maternal sickle cell anemia

7. Tobacco, alcohol, cocaine

What are placental causes of IUGR?(4)

1. Inadequate trophoblastic invasion > hpt disease

2. Chronic partial placental separation

3. Extensive placental infarction

4. Chorioamgioma

What is the post-placental (fetal) causes?

1. Post-term pregnancies > placenta cannot adequately supply foetuses needs

What investigations can be done to diagnose IUGR?(2)

Amniocentesis

TORCH

Maternal management for IUGR?(3)

Monitor for pre-eclampsia toxaemia (PET)

Quit smoking

Aspirin

What are the fetal managements of IUGR ? (3)

1. U/S > amniotic fluid index + Doppler

2. If growth plateaus <34 weeks > steroids 2x weeks, consider admission

3. If >34 weeks normal Doppler consider weekly surveillance

What are the consequences of poor placental function during labour & delivery?(2)

1. Fetal distress

2. Meconium stained liquor

What are the consequences of oligohydramnios during labour & delivery?(3)

1. Fetal lung hypoplasia

2. Fetal pressure abnormalities

3. Variable decelerations on CTG

What are the consequences of meconium leaking during labour & delivery?(2)

1. Meconium aspiration and asphyxia

2. Intrauterine infection

Define IUFD

Death of baby in utero >- 500g presents with decreased/ absent fetal movements confirmed on ultrasound

Causes of IUFD?(7)

1. Placental dysfunction > fetal growth restriction

2. Placental abruption and other disorders

3. Genetic abnormalities

4. Congenital birth defects

5. Umbilical cord complications

6. Uterine rupture

7. Unexplained

What are the risk factors for IUGR?(4)

1. Underling medical conditions

2. Complicated pregnancies/ history e.g. PTB

3. Domestic violence

4. Multiple pregnancies

What is the management of IUFD?(7)

1. Inducing labour with medication

2. Wait for labour to occur naturally within a week / 2

3. Grief counselling

4. Look fir cause (X-ray baby, examine placenta)

5. Print pictures of baby

6. Postnatal follow-up appointment

7. Plan for future pregnancies