Presentation on theme: "Intra Uterine Growth Retardation. What is the definition of IUGR? < 10th centile for age include normal fetuses at the lower ends of the growth curve."— Presentation transcript:
Intra Uterine Growth Retardation
What is the definition of IUGR? < 10th centile for age include normal fetuses at the lower ends of the growth curve + fetuses with IUGR This definition is not helpful clinically < 5th centile for age < 3rd centile for age the most appropriate definition but associated with adverse perinatal outcome
IUGR Failure of the fetus to chieve the expected weight for a given gestation What is the deference between IUGR & SGA? SGA < 10th centile for the population, which means it is at the lower end of the normal distribution ie. Constitutionally small but have reached their full growth potential
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 * AGA -appropriate for gestational age
Incidence % of infants are growth restricted
% of infants conventionally diagnosed to be SGA were in fact AGA when Determinant of birth weight such as maternal * Ethnic group * Parity * Weight * Height
These fetus also had Ê Hypoglycemia Ë hypoinsulinemia Ì glycin/valin Í hypertriglycemia Î thrombocytemia
*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 A previously GR fetus in women with significant risk factors Serial sonography
Definitive diagnosis usually can not be made until delivery.
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.
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.
Such often tolerate labor less than AGA and C/S is indicated for intrapartum fetal compromise. Unfortunately
Importantly Uncertainly about the diagnosis of GR should preclude intervention until fetal lung maturity is assured.
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.
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
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.
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 *uretroplacental thrombosis *placental infarction *idiopathic GR in women with a Hx of recurrent sever GR
LABOR AND DELIVERY
GR is the result of insufficient placental function A.f cord compression breech presentation c/s
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 *Hypothermia *serious hypoglycemia *polycytemia *hyper viscosity
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.
NEUROLOGICAL AND INTELLECTUAL CAPABILITY
A LONG TERM FABORABLE OUT COME MAY BE EXPECTED.
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.
The risk of recurrent FGR is increased in women *Who have previously had this complication *With Hx of FGR &A continuing medical complication