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    Intrauterine Growth Restriction: Diagnosis - No Consensus EFW (Effective Fetal Weight) 10th Centile For Gestational Age

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    dr_ashutosh756078
    This document discusses intrauterine growth restriction (IUGR), including its diagnosis, types (symmetrical vs asymmetrical), accuracy of ultrasound dating, and management. Key points include: 1) IUGR is diagnosed when a fetus's estimated fetal weight is below the 10th percentile for gestational age. It can be symmetrical, affecting all parameters equally, or asymmetrical, with abdominal growth most restricted. 2) Dating accuracy declines in the third trimester, making diagnosis difficult when most IUGR cases present. Ossification centers can help determine gestational age past certain points. 3) Asymmetrical IUGR carries higher risks, including abnormal Doppler flows, and fetuses need careful monitoring and

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    Intrauterine Growth Restriction: Diagnosis - No Consensus EFW (Effective Fetal Weight) 10th Centile For Gestational Age

    Uploaded by

    dr_ashutosh756078
    30 views22 pages
    This document discusses intrauterine growth restriction (IUGR), including its diagnosis, types (symmetrical vs asymmetrical), accuracy of ultrasound dating, and management. Key points include: 1) IUGR is diagnosed when a fetus's estimated fetal weight is below the 10th percentile for gestational age. It can be symmetrical, affecting all parameters equally, or asymmetrical, with abdominal growth most restricted. 2) Dating accuracy declines in the third trimester, making diagnosis difficult when most IUGR cases present. Ossification centers can help determine gestational age past certain points. 3) Asymmetrical IUGR carries higher risks, including abnormal Doppler flows, and fetuses need careful monitoring and

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    IUGR PPT

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    IUGR

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    This document discusses intrauterine growth restriction (IUGR), including its diagnosis, types (symmetrical vs asymmetrical), accuracy of ultrasound dating, and management. Key points include: 1) IUGR is diagnosed when a fetus's estimated fetal weight is below the 10th percentile for gestational age. It can be symmetrical, affecting all parameters equally, or asymmetrical, with abdominal growth most restricted. 2) Dating accuracy declines in the third trimester, making diagnosis difficult when most IUGR cases present. Ossification centers can help determine gestational age past certain points. 3) Asymmetrical IUGR carries higher risks, including abnormal Doppler flows, and fetuses need careful monitoring and

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    30 views22 pages

    Intrauterine Growth Restriction: Diagnosis - No Consensus EFW (Effective Fetal Weight) 10th Centile For Gestational Age

    Uploaded by

    dr_ashutosh756078
    This document discusses intrauterine growth restriction (IUGR), including its diagnosis, types (symmetrical vs asymmetrical), accuracy of ultrasound dating, and management. Key points include: 1) IUGR is diagnosed when a fetus's estimated fetal weight is below the 10th percentile for gestational age. It can be symmetrical, affecting all parameters equally, or asymmetrical, with abdominal growth most restricted. 2) Dating accuracy declines in the third trimester, making diagnosis difficult when most IUGR cases present. Ossification centers can help determine gestational age past certain points. 3) Asymmetrical IUGR carries higher risks, including abnormal Doppler flows, and fetuses need careful monitoring and

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    © All Rights Reserved
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    of 22

    Intrauterine Growth Restriction

    Diagnosis – No consensus
    EFW (Effective fetal weight) < 10th centile for Gestational age
    Symmetrical IUGR

    • EFW < 10 th centile for Gestational age


    • Uniformly small for gestational age
    • All biometric parameters equally affected
    • Multiple anomalies
    • Aneuploidy
    • Echogenic Bowel
    • Doppler – usually normal
    • NO Brian sparing flow
    Symmetrical IUGR

    • Accurate dating – Essential


    • Early USG more accurate than LMP
    • CRL more accurate than G sac diameter
    • Biological variations don’t manifest untill 13 weeks of
    gestation
    Symmetrical IUGR

    • Accuracy – USG
    • I trimester - ± 0.7 week
    • II trimester - ± 1.5 week
    • III trimester - ± 3-4 week

    • Difficulty –
    • Patient usually presents in III trimester
    • At 34 weeks; fetus can be normal in range of 31-37 weeks
    • Biological variation has maximum effect in III trimester
    Symmetrical IUGR

    • Ossification centre
    • Distal Femoral - ≥ 32 weeks
    • Proximal Tibial - ≥ 35 weeks

    • Management
    • Karyotype – 5 – 27% babies may have chromosomal
    abnormality
    • Infection screen
    Constitutional Small fetuses

    • By Definition – 10% of pregnancies will be “Too Small”


    • Constitutional – Examine Parents
    • Ask “Birth-weight” of previous babies
    • Interval Growth - Normal
    Asymmetrical IUGR

    • EFW < 10 th centile for Gestational age


    • Abdomen < other biometric parameters
    • HC, BPD – Preserved
    • AC – Small; Poor interval growth
    • Echogenic bowel – 10 – 20%
    • Multiple Gestation – Placental cord insertion
    – Significantly increase in Marginal / Velamentous cord insertion
    • Oligohydramnios
    • Abnormal Doppler
    Asymmetrical IUGR

    • Monitor growth –
    • Ideal minimum interval 3 weeks
    • Biophysical profile
    • Acute Hypoxia – Abnormalities of movement and tone
    • Chronic Hypoxia – Decrease in amniotic fluid
    Asymmetrical IUGR

    • Presentation in late II / early III trimester


    • Earlier presentation – Triploidy; Twins or High order gestation
    • 4 fold increase in adverse perinatal outcome
    • Additional 4 – 8 fold with abnormal Doppler
    • Neurodevelopmental morbidity in survivors
    • IUGR babies – Higher risk of Hypertension, Diabetes, Stroke
    as adults
    Asymmetrical IUGR

    • Management
    • Infection screen
    • Thrombophilia screen ( especially with h/o IUGR fetuses and
    Pre – Eclampsia)

    • Recurrence –
    • Risk of IUGR – upto 25% if past history of IUGR fetus ±
    Maternal risk factors
    Management

    • Early recognition of Small for gestational age


    • Diagnosis of factor inducing delay in growth
    • Monitoring
    • Determining the time of delivery
    Pathophysiology

    • Uteroplacental Insufficiency
    • Maternal (Hypertension, Diabetes mellitus, Collagen Vascular disease,
    Drugs, Alcohol, Cigarette, Malnutrition)
    • Uterine
    • Placental (Vascular endothelial growth factor, Leptin, Resistin)
    • Fetal Abnormality

    • Most Accepted – Failure of trophoblast invasion; Increased


    impedance to umbilical artery
    Persistence of Nutritional Deprivation

    • Progressive Deterioration
    • Hemodynamic changes affecting cardiofuctioning
    • Abnormalities in venous system
    • Abnormalities in Fetal motor behaviour and Fetal
    heart rate patterns
    • If NOT delivered in due course- Fetal DEATH
    Determining TIME of delivery

    • Based on Biophysical profile or uncontrolled maternal disease


    (Pre-Eclampsia)
    • Time interval between FIRST doppler abnormality in
    umbilical / Fetal circulation (Brain sparing) and delivery is
    wide (May Range from 1-9 weeks)
    • Ultrasound Obstet Gynecol 18; 564-570; 2001
    • After establishment of Brain Sparing; IUGR fetuses with
    abnormal heart rate tracings may be Acidotic and exhibit poor
    neurologic development at 2 years
    • Am J Obstet Gynecol 167; 66-71. 1992
    • IUGR babies must be delivered before the onset of abnormal
    Fetal heart rate patterns
    • Eur J Obstet Gynecol Reprod Bio 42; 573-587, 1991
    Hemodynamic changes and Doppler patterns in
    Deteriorating fetus
    Hemodynamic Changes Doppler Findings

    Brain sparing Increase UA / MCA

    Change of Cardiac Afterload Increase Pulmonary artery TPV


    Decreased Aortic TPV
    Redistribution of Cardiac output Decreased RCO/LCO

    Decreased cardiac output Decreased Aortic PV


    Decreased Pulmonary PV
    Increased venous pressure Increased precent Reversal flow in IVC
    Increased S/A in Umbilical artery
    UV pulsations
    Decompensation Abnormal fetal heart patterns
    Maternal weight at booking and fetal growth.
    Fetuses of heavier mothers display accelerated growth after 26 week
    Maternal height and fetal growth
    Fetuses of taller mothers display accelerated growth after 32 weeks
    Parity and fetal growth
    Growth is similar untill 36 weeks, then primipare have a slight decelerative course.
    Ethinicity and fetal growth
    Growth is slower in Indian fetuses from about 30 weeks
    Effect of smoking in fetal growth
    Statistically significant difference noted from 36 weeks.
    Preterm delivery and Fetal growth
    Birth Weight prediction errors – Customised v/s Non- Customised charts

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