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Edit Comment Close Premium member Presentation Transcript Slide 1: IUGR Razieh M.Jaafari,MD Ahwaz.u.m.s Dept of ObGyn Intra Uterine Growth Retardation Small for Gestational Age : Small for Gestational Age SGA infants are those with weights below the 10 percentile for their gestational age The neonatal mortality rate of a SGA infant born at 38 weeks 1% compared 0.2% in those with AGA : The neonatal mortality rate of a SGA infant born at 38 weeks 1% compared 0.2% in those with AGA * AGA -appropriate for gestational age Incidence : Incidence 3 -10% of infants are growth restricted 25 -60 % of infants conventionally diagnosed to be SGA were in fact AGA when : 25 -60 % of infants conventionally diagnosed to be SGA were in fact AGA when Slide 6: Ethnic group Parity Weight Height Determinant of birth weight such as maternal MORTALITY & MORBIDITY : MORTALITY & MORBIDITY Fetal demise Birth asphyxia Meconium aspiration Neonatal hypoglycemia Hypothermia Abnormal neurological development Slide 8: ACCELERATED MATURATION Accelerated maturation : Accelerated maturation The fetus resoponses to stressed envirorment by adrenal glucocorticoid Earlier or accelerated maturation SYMMETRICAL VERSUS ASYMMETRICAL GR.. : SYMMETRICAL VERSUS ASYMMETRICAL GR.. Fetal growth has been divided into three phases. : Fetal growth has been divided into three phases. 1-cellular hyperplasia 2- hyperplasy & hypertrophy 3- hypertrophy cell size fat deposition fetal weight as much as 200 G.r. per week. Slide 12: symmetrical An early insult due to : chemical viral aneuploidy Cell size Cell num. Proportionate reduction in head & body Slide 13: A late pregnancy insult such as placental insufficiency would affect cell size. Asymmetrical The ratio of brain weight to liver weight over in the last 12 wk of pregnancy is increased to 5/1 or more : The ratio of brain weight to liver weight over in the last 12 wk of pregnancy is increased to 5/1 or more Growth pattern may potentially reveal the cause : Growth pattern may potentially reveal the cause Slide 16: In practice accurate identification of symmetrical versus asymmetrical fetus has proved difficult. Slide 17: Maternal fetal placental and cord abn. Risk factors for FGR * FGR - fetal growth retardation Slide 18: Constitutionally small mother Poor maternal weight gain & nutrition Social deprivation Maternal causes Slide 19: vascular disease maternal anemia anti phospholipid Ab syn. Extra uterine pregnancy chronic renal disease Slide 20: fetal infections congenital malformations chromosomal abnormalities trisomy 16 multiple fetus FETAL CAUSES Placental and cord abnormalities : Placental and cord abnormalities chromic partial placental sep. extensive infarct. Chorioangioma placenta previa ADDITIONAL INSIGHT OF FGR : ADDITIONAL INSIGHT OF FGR These fetus also had : These fetus also had Hypoglycemia hypoinsulinemia glycin/valin hypertriglycemia thrombocytemia Screening and identification of F.G.R : Early establishment of G.A Attention to maternal weight gain Measurement of uterine height throughout pregnancy Screening and identification of F.G.R Identification of risk factors : Identification of risk factors A previously GR fetus in women with significant risk factors Serial sonography Definitive diagnosis usually can not be made until delivery. : Definitive diagnosis usually can not be made until delivery. MANAGEMENT : MANAGEMENT Once a SGA is suspected , intensive effort should be made to determine if GR is present and if so, its type and etiology. In the presence of sonographically detectable anomalies, cordocentesis may be performed for kariotyping. : In the presence of sonographically detectable anomalies, cordocentesis may be performed for kariotyping. Prompt delivery is likely to afford the best outcome for the GR fetus : Prompt delivery is likely to afford the best outcome for the GR fetus GR. NEAR TERM In the presence of significant oligohydraminos most fetus will be delivered if G.A has reached>34 wk. : In the presence of significant oligohydraminos most fetus will be delivered if G.A has reached>34 wk. Such often tolerate labor less than AGA and C/S is indicated for intrapartum fetal compromise. : Such often tolerate labor less than AGA and C/S is indicated for intrapartum fetal compromise. Unfortunately Slide 32: Importantly Uncertainly about the diagnosis of GR should preclude intervention until fetal lung maturity is assured. GR. REMOTE FROM TERM : GR. REMOTE FROM TERM before 34 wk Normal Amniotic volume Normal fetal surveillance Observation Sono is repeated at interval 2-3 wk Pregnancy is allowed to continue until fetal maturity is achieved. : Pregnancy is allowed to continue until fetal maturity is achieved. At times amniocentesis for assessment of pulmonary maturity may be helpful in clinical decision making. : At times amniocentesis for assessment of pulmonary maturity may be helpful in clinical decision making. There is no specific treatment that will ameliorate the condition : There is no specific treatment that will ameliorate the condition Many clinicians advised a program of modified rest in the lateral recumbent position in which c.o.p and placental perfusion is maximized. : Many clinicians advised a program of modified rest in the lateral recumbent position in which c.o.p and placental perfusion is maximized. Optimal management of the preterm GR fetus remain undefined. : Optimal management of the preterm GR fetus remain undefined. Mortality and morbidity in GR fetuses were determined by GA and birth weight and not by abnormal fetal testing. : Mortality and morbidity in GR fetuses were determined by GA and birth weight and not by abnormal fetal testing. Early anti platelet therapy with low dose aspirin may prevent : Early anti platelet therapy with low dose aspirin may prevent uretroplacental thrombosis placental infarction idiopathic GR in women with a Hx of recurrent sever GR Slide 41: LABOR AND DELIVERY FHR MONITORING : FHR MONITORING Slide 43: GR is the result of insufficient placental function A.f cord compression breech presentation c/s Expert assistance : Expert assistance In making a successful transition to air breathing clear the airway below the vocal cord ventilate the infant as needed The severely GR newborn is susceptible to : The severely GR newborn is susceptible to Hypothermia serious hypoglycemia polycytemia hyper viscosity Prolonged symmetrical FGR is likely to be followed by slow growth after birth. : Prolonged symmetrical FGR is likely to be followed by slow growth after birth. Subsequent development of the GR The asymmetrically GR is more likely to catch up after birth. : The asymmetrically GR is more likely to catch up after birth. Slide 48: NEUROLOGICAL AND INTELLECTUAL CAPABILITY A LONG TERM FABORABLE OUT COME MAY BE EXPECTED. : A LONG TERM FABORABLE OUT COME MAY BE EXPECTED. In a 9-11 year follow up study learning deficit in almost half of GRF : In a 9-11 year follow up study learning deficit in almost half of GRF A significant association between fetal growth restriction and cerebral palsy. : A significant association between fetal growth restriction and cerebral palsy. The risk of recurrent FGR is increased in women : The risk of recurrent FGR is increased in women Who have previously had this complication With Hx of FGR A continuing medical complication In the name of Allah, the beneficent. the merciful : In the name of Allah, the beneficent. the merciful You do not have the permission to view this presentation. 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IUGR SHABARGA Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1036 Category: Entertainment License: All Rights Reserved Like it (3) Dislike it (0) Added: May 14, 2010 This Presentation is Public Favorites: 2 Presentation Description No description available. Comments Posting comment... By: erabaya (16 month(s) ago) thanks alot Saving..... Post Reply Close Saving..... Edit Comment Close By: obanla (23 month(s) ago) when can have my copy of this nice presentation thanks Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Slide 1: IUGR Razieh M.Jaafari,MD Ahwaz.u.m.s Dept of ObGyn Intra Uterine Growth Retardation Small for Gestational Age : Small for Gestational Age SGA infants are those with weights below the 10 percentile for their gestational age The neonatal mortality rate of a SGA infant born at 38 weeks 1% compared 0.2% in those with AGA : The neonatal mortality rate of a SGA infant born at 38 weeks 1% compared 0.2% in those with AGA * AGA -appropriate for gestational age Incidence : Incidence 3 -10% of infants are growth restricted 25 -60 % of infants conventionally diagnosed to be SGA were in fact AGA when : 25 -60 % of infants conventionally diagnosed to be SGA were in fact AGA when Slide 6: Ethnic group Parity Weight Height Determinant of birth weight such as maternal MORTALITY & MORBIDITY : MORTALITY & MORBIDITY Fetal demise Birth asphyxia Meconium aspiration Neonatal hypoglycemia Hypothermia Abnormal neurological development Slide 8: ACCELERATED MATURATION Accelerated maturation : Accelerated maturation The fetus resoponses to stressed envirorment by adrenal glucocorticoid Earlier or accelerated maturation SYMMETRICAL VERSUS ASYMMETRICAL GR.. : SYMMETRICAL VERSUS ASYMMETRICAL GR.. Fetal growth has been divided into three phases. : Fetal growth has been divided into three phases. 1-cellular hyperplasia 2- hyperplasy & hypertrophy 3- hypertrophy cell size fat deposition fetal weight as much as 200 G.r. per week. Slide 12: symmetrical An early insult due to : chemical viral aneuploidy Cell size Cell num. Proportionate reduction in head & body Slide 13: A late pregnancy insult such as placental insufficiency would affect cell size. Asymmetrical The ratio of brain weight to liver weight over in the last 12 wk of pregnancy is increased to 5/1 or more : The ratio of brain weight to liver weight over in the last 12 wk of pregnancy is increased to 5/1 or more Growth pattern may potentially reveal the cause : Growth pattern may potentially reveal the cause Slide 16: In practice accurate identification of symmetrical versus asymmetrical fetus has proved difficult. Slide 17: Maternal fetal placental and cord abn. Risk factors for FGR * FGR - fetal growth retardation Slide 18: Constitutionally small mother Poor maternal weight gain & nutrition Social deprivation Maternal causes Slide 19: vascular disease maternal anemia anti phospholipid Ab syn. Extra uterine pregnancy chronic renal disease Slide 20: fetal infections congenital malformations chromosomal abnormalities trisomy 16 multiple fetus FETAL CAUSES Placental and cord abnormalities : Placental and cord abnormalities chromic partial placental sep. extensive infarct. Chorioangioma placenta previa ADDITIONAL INSIGHT OF FGR : ADDITIONAL INSIGHT OF FGR These fetus also had : These fetus also had Hypoglycemia hypoinsulinemia glycin/valin hypertriglycemia thrombocytemia Screening and identification of F.G.R : Early establishment of G.A Attention to maternal weight gain Measurement of uterine height throughout pregnancy Screening and identification of F.G.R Identification of risk factors : Identification of risk factors A previously GR fetus in women with significant risk factors Serial sonography Definitive diagnosis usually can not be made until delivery. : Definitive diagnosis usually can not be made until delivery. MANAGEMENT : MANAGEMENT Once a SGA is suspected , intensive effort should be made to determine if GR is present and if so, its type and etiology. In the presence of sonographically detectable anomalies, cordocentesis may be performed for kariotyping. : In the presence of sonographically detectable anomalies, cordocentesis may be performed for kariotyping. Prompt delivery is likely to afford the best outcome for the GR fetus : Prompt delivery is likely to afford the best outcome for the GR fetus GR. NEAR TERM In the presence of significant oligohydraminos most fetus will be delivered if G.A has reached>34 wk. : In the presence of significant oligohydraminos most fetus will be delivered if G.A has reached>34 wk. Such often tolerate labor less than AGA and C/S is indicated for intrapartum fetal compromise. : Such often tolerate labor less than AGA and C/S is indicated for intrapartum fetal compromise. Unfortunately Slide 32: Importantly Uncertainly about the diagnosis of GR should preclude intervention until fetal lung maturity is assured. GR. REMOTE FROM TERM : GR. REMOTE FROM TERM before 34 wk Normal Amniotic volume Normal fetal surveillance Observation Sono is repeated at interval 2-3 wk Pregnancy is allowed to continue until fetal maturity is achieved. : Pregnancy is allowed to continue until fetal maturity is achieved. At times amniocentesis for assessment of pulmonary maturity may be helpful in clinical decision making. : At times amniocentesis for assessment of pulmonary maturity may be helpful in clinical decision making. There is no specific treatment that will ameliorate the condition : There is no specific treatment that will ameliorate the condition Many clinicians advised a program of modified rest in the lateral recumbent position in which c.o.p and placental perfusion is maximized. : Many clinicians advised a program of modified rest in the lateral recumbent position in which c.o.p and placental perfusion is maximized. Optimal management of the preterm GR fetus remain undefined. : Optimal management of the preterm GR fetus remain undefined. Mortality and morbidity in GR fetuses were determined by GA and birth weight and not by abnormal fetal testing. : Mortality and morbidity in GR fetuses were determined by GA and birth weight and not by abnormal fetal testing. Early anti platelet therapy with low dose aspirin may prevent : Early anti platelet therapy with low dose aspirin may prevent uretroplacental thrombosis placental infarction idiopathic GR in women with a Hx of recurrent sever GR Slide 41: LABOR AND DELIVERY FHR MONITORING : FHR MONITORING Slide 43: GR is the result of insufficient placental function A.f cord compression breech presentation c/s Expert assistance : Expert assistance In making a successful transition to air breathing clear the airway below the vocal cord ventilate the infant as needed The severely GR newborn is susceptible to : The severely GR newborn is susceptible to Hypothermia serious hypoglycemia polycytemia hyper viscosity Prolonged symmetrical FGR is likely to be followed by slow growth after birth. : Prolonged symmetrical FGR is likely to be followed by slow growth after birth. Subsequent development of the GR The asymmetrically GR is more likely to catch up after birth. : The asymmetrically GR is more likely to catch up after birth. Slide 48: NEUROLOGICAL AND INTELLECTUAL CAPABILITY A LONG TERM FABORABLE OUT COME MAY BE EXPECTED. : A LONG TERM FABORABLE OUT COME MAY BE EXPECTED. In a 9-11 year follow up study learning deficit in almost half of GRF : In a 9-11 year follow up study learning deficit in almost half of GRF A significant association between fetal growth restriction and cerebral palsy. : A significant association between fetal growth restriction and cerebral palsy. The risk of recurrent FGR is increased in women : The risk of recurrent FGR is increased in women Who have previously had this complication With Hx of FGR A continuing medical complication In the name of Allah, the beneficent. the merciful : In the name of Allah, the beneficent. the merciful