IUGR for 4th year med.students

SGA
Intra Uterine Growth Restriction (IUGR)
or
Small for Gestational Age (SGA)
 Weight of the Fetus
is <10th percentile for
the gestational age.
 Some consider 5th or
3rd percentile as cut
off.
28 August 2017 2May All Be Happy & Healthy.
GA
(weeks)
Weight
(Kg)
10th
percen
1.2 0.828
2.2 1.532
3 2.336
3.3 2.738
IUGR

Constitutional SGA
(Healthy small fetus)
Genetic cause:
• Race, Sex
• Maternal weight
• Paternal height

Incidence:
IUGR: 5 to 8 %

Complications
 Short term:
1. Chronic Fetal hypoxia (distress).
2. Oligohydramnios with its complications.
3. Meconium Aspiration & RDS.
4. Problems of prematurity.
5. Neonatal Hypoglycemia, hypocalcaemia,
polycythemia, hypothermia.
6. LBW: Causes 60% of neonatal death.

Complications
 Long term:
 Malnutrition in childhood & adulthood
 Low IQ, neurological handicaps
 Learning deficits

Abdominal circumference AC
Head circumference AC

Types:
 Symmetrical:
 Less common 25%
Fetus is proportionately small.
Usually fetal genetic cause
Bad prognosis with slow growth after
birth
HC ÷ AC: WNL

Symmetrical IUGR
HC & AC both lagging behind:

Types:
 Asymmetrical
 More common 70%
Occurs late in pregnancy
Fetus has lagging abdominal growth.
Maternal & Uteroplacental cause.
Good prognosis with rapid growth
after delivery.
HC ÷ AC: ↑

Asymmetrical IUGR
HC WNL while AC Falling to 10th %

Etiology:

Fetal Causes of IUGR:
1. Genetic
 Chromosomal, genetic, CFMF
 Vertically transmitted infection
(TORCHS infection)
2. Multiple pregnancy: TTT
28 August 2017 14May All Be Happ& Healthy.

Uteroplacental Causes:
 Uteroplacental insufficiency:
1. Preeclampsia
2. Anti Phospholipid antibody
Syndrome
3. Chronic abruptio placenta.
4. Placenta previa.
5. Uterine malformation

Maternal Causes
 Smoking & drug abuse.
 Anemia & malnutrition.
 Medical disorders:
 Hypertension, renal disease, DM.
 Heart diseases, COPD.
 Celiac disease
 Infections: Malaria & Viral infections.

Risk factors for IUGR
 Hypertension, Anemia, diabetes, infections.
 Past H/O IUGR.
 Smoking & drug abuse
 Poor weight gain during pregnancy
 Multiple pregnancy
 Fundal Height less than expected as per GA.

Diagnosis &
management:

Diagnosis:
 History
 High risk factor should alert clinician.
 Poor weight gain.
 Reduced fetal kick

Diagnosis:
 General examination
 Look for sign of maternal
cause
 Abdominal examination
 Fundal height < expected.
 Oligohydroamnios

Diagnosis:
1. Investigation to confirm the Dx
 Serial USS
 AC, FL, HC/AC ratio
 Other finding: oligohydramnios, CFMF
 Doppler USS-

Diagnosis:
2. Investigation to detect a cause
 Maternal: OGTT, ECHO for heart
 Fetal: prenatal diagnosis of CFMF
3. Tests to evaluate fetal wellbeing
4. Tests to evaluate fetal maturity

Uterine Artery Doppler velocimetry:

Umbilical artery
Doppler velocimetry:
Absent Diastolic
Flow in
Umbilical Artery
Normal Diastolic
Flow in
Umbilical Artery
Reversed
Diastolic Flow in
Umbilical Artery

Management
 Prophylactic:
 Proper ANC for early diagnosis of any
RF with proper management.
 Active management
 During pregnancy
 During labor

Management
 During pregnancy
 If the baby is mature (> 34 weeks)
TOP (Best CS)
 If the baby is not mature (<34 weeks)
conservative management
 Bed rest, left lateral position
 Proper maternal nutrition
 Low dose Aspirin + LMWH
 Induction of lung maturity- corticosteroid

Management
 During labor
 Best by CS
 Vaginal delivery is possible under close fetal
monitoring, shortening of the 2nd stage by
forceps
 Management of neonate
 In NICU
 Early feeding, warming, care of RDS

IUGR for 4th year med.students

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