IUGR vs SGA

Which parameters if found to be abnormal, will classify IUGR? (3)

1. Growth velocity over time

2. Umbilical artery doppler

3. Amniotic fluid index

What are the short term risks of significant morbidity and mortality in IUGR?(8)

1. Hypoglycaemia

2. Temperature instability

3. Chrombocytopenia

4. Polycythemia

5. Acute kidney injury

6. Persistent pulmonary hypertension of the newborn

7. Necrotising enterocolitis

8. Asphyxia

What are the long term risks of significant morbidity and mortality in IUGR?(5)

1. Hypertension

2. Hyperlipidemia

3. Coronary artery disease

4. Type 2 diabetes

5. Obesity (Baker hypothesis)

Define small for gestation age

A birth weight less than the 10th centile

What may SGA be associated with ?

IUGR > if associated with IUGR parameters)

If the infant has normal AF, normal growth velocity over time + Doppler, and their appropriate size in terms of maternal characteristics then they are… ?

Constitutional small > not at risk for adverse outcomes

Define symmetry IUGR?

When the weight, length, head circumference are proportionally small

What are the early onset causes of symmetrical IUGR?(3)

1. Inherent genetic growth restriction

2. Chromosomal disorders

3. Congenital infections

Who is the cause of symmetrical IUGR?

The fetus

Define asymmetrical IUGR?

Weight reduced (growth failure) while the head circumference is spared

What is the late onset cause of IUGR?

Foetal growth rate exceeds provision of nutrients or oxygen or both

Who/ what is the cause of asymmetrical IUGR?(2)

1. Maternal

2. Placental

What is the outcome of asymmetry IUGR?

High risk > potentially prevalence perinatal death

What are the classifications of IUGR?(3)

1. Inherent foetal

2. Utero-placental function

3. Maternal environmental

What are placental causes of IUGR?(6)

1. Ischemic placental disease

2. Chronic abruptio

3. Placenta praevia

4. Abnormal cord insertion

5. Twin-to-twin transfusion syndrome

6. Multiple gestations

What are maternal causes of IUGR?(8)

1. Chronic hypertension

2. Pregnancy-induced hypertension

3. Cyanotic heart disease

4. Diabetes

5. Malnutrition

6. Smoking

7. Substance abuse

8. Uterine malformation

   
   

What are the methods of investigation to determine the cause of IUGR?(3)

1. Amniocentesis

2. QF-PCR > if high risk of aneuploidy

3. Screen for congenital infections

What else should you do when screening for congenital infection? (2)

Maternal history

Physical exam

What are the signs & symptoms on the baby that can indicate a congenital infection?(3)

1. Blue-berry muffin rash

2. Petechia

3. Heptosplenomegaly