iugr

Presented by:Anup ShresthaDalian medical UniversityIntern ,WRH : 

Presented by:Anup ShresthaDalian medical UniversityIntern ,WRH IUGR

Slide 2: 

IUGR (Intra-Uterine Growth Restriction)

Definition of IUGR : 

Definition of IUGR Fetus whose estimated weight is: less than 10th percentile for its gestational age. Abdominal circumference is less than 2.5th percentile.

Birth Weight and gestational age in percentile : 

Birth Weight and gestational age in percentile

Intra-uterine growth restriction is also known as : 

Intra-uterine growth restriction is also known as Intra-uterine growth retardation Dysmaturity Small for Date Chronic Placenta Insufficiency

Incidence : : 

Incidence : 1/3 of the low birth weight babies 5 % in term babies 15 % in post term babies

Etiology – Maternal= reduced availibility of nutrients in the mother : 

Etiology – Maternal= reduced availibility of nutrients in the mother Small women ,maternal genetic , racial background Maternal nutrition before and during pregnancy Maternal disease- Anaemia , HTN, Thrombophilia ,Heart disease ,Chronic renal disease Toxins – alcohol, smoking, cocaine, heroin

Fetal: substrate in the maternal blood crosses the placenta but is not utilized by the fetus : 

Fetal: substrate in the maternal blood crosses the placenta but is not utilized by the fetus *Structural anomalies either Cardio-vascular disease or renal disease . *Chromosomal abnormality - Trisomy (13, 18, 21) and Turner’s syndrome *Infection- TORCH TO- Toxoplasmosis R - Rubella C - Cytomegalovirus H - Herpes Simplex and malaria

Placenta= due to poor uterine blood flow to the placenta for long time : 

Placenta= due to poor uterine blood flow to the placenta for long time Placenta Previa Placenta Abruption Placenta circumvallete Placenta Infarction Placenta Mosaicism

Types : Depending upon the size of their head, abdomen and femur IUGR is divided into : : 

Types : Depending upon the size of their head, abdomen and femur IUGR is divided into : # Symmetrical : affected from the noxious effect very early in the phase of cellular hypertophy. - total cell less - all the organs including head is affected # Asymmetrical : fetus affected in later months during the phase of cellular hypertrophy. - total cell remains same but the size of cell is smaller

Feature of IUGR : 

Feature of IUGR

Features : 

Features

Diagnosis : 

Diagnosis Clinical Palpation Symphysis fundal height A lag of 4 cm or more Suggest IUGR Maternal Weight gain : Remains stationary or at times fall during 2nd half of pregnancy

Ultrasonography.Commonly used predictive values are : 

Ultrasonography.Commonly used predictive values are HC (Head Circumference) and AC ( Abdominal Circumferece) ratio Normal 1. Before 32 weeks > 1 2. 32 – 34 weeks almost 1 3. After 34 weeks < 1 In asymmetrical IUGR ,HC remain large so HC:AC is always elevated In symmetrical IUGR , Both HC and AC is reduced So HC:AC is normal

Doppler velocimetry:Reduced ,absent or reversed diastolic flow in umbilical artery indicate IUGR : 

Doppler velocimetry:Reduced ,absent or reversed diastolic flow in umbilical artery indicate IUGR

Reverse diastolic flow : 

Reverse diastolic flow

Physical features at Birth : 

Physical features at Birth Weight deficit at birth is about 600 gm than estimated weight Length is unaffected HC larger than the body in asymmetrical varaiety Dry and wrinkled skin which give baby “ Old Man Look”. The baby is alert, active and having normal cry. Reflexes are normal including Moro-reflex

Old Man Look : 

Old Man Look

Complication : 

Complication Fetal complication Asphyxia and RDS MAS DIC Hypothermia Pulmonary Haemorrhage Polycythaemia Maternal Complication Pre-eclampsia Heart disease Malnutrition

Management :General : 

Management :General Adequate bed rest Correct Malnutrition Avoid smoking and alcohol Maternal hyperoxygenation Low dose of Aspirin may help with the history of recurrence Repeat USG in every 3-4 weeks

Termination of Pregnancy : 

Termination of Pregnancy Beyond 37 weeks – Should be done Before 37 weeks- a) Uncomplicated mild IUGR – General management to improve placental function b) Severe degree IUGR – i) If lung maturation is achieved – termination is done ii) If lung maturation has not been achieved - Dexamathasone therapy

Reference : 

Reference Text Book of Obstetrics – D.C. Dutta Essential Pediatrics – O.P. Ghai www.fetal.com www.IUGR.com www.wikipedia.org