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INTRA-UTERINE GROWTH RESTRICTION

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Definition

  1. infants whose weight is < 10th %ile for a particular GA
  2. weight not associated with any constitutional or familial cause
  3. prone to problems such as meconium aspiration, asphyxia, polycythemia, hypoglycemia, and mental retardation
  4. greater risk of perinatal morbidity and mortality



Etiology

Maternal causes
  1. poor nutrition,
  2. cigarette smoking,
  3. drug abuse, alcoholism,
  4. cyanotic heart disease,
  5. severe DM,
  6. SLE,
  7. pulmonary insufficiency

Maternal-fetal
  1. any disease which causes placental insufficiency leading to inadequate transfer of substrate across the placenta
  2. includes PIH, chronic HTN, chronic renal disease, gross placental morphological abnormalities (infarction, hemangiomas)

Fetal causes
  1. TORCH infections,
  2. multiple gestation,
  3. congenital anomalies
Clinical Features

Symmetric/Type I (20%)
  1. occurs early in pregnancy
  2. inadequate growth of head and body although the head:abdomen ratio may be normal
  3. usually associated with congenital anomalies or TORCH

Asymmetric/Type II (80%)
  1. occurs late in pregnancy
  2. brain is spared therefore the head:abdomen ratio is increased
  3. usually associated with placental insufficiency
  4. more favorable prognosis than Type I
Diagnosis

  1. clinical suspicion
  2. SFH measurements at every antepartum visit
  3. more thorough assessment if mother is in high risk category or if SFH lags > 2 cm behind GA
  4. U/S exam should include assessment of BPD, head and abdomen circumference, head:body ratio, femur length and fetal weight
  5. doppler analysis of umbilical cord blood flow
Management

  1. prevention via risk modification prior to pregnancy ideal
  2. most important consideration is accurate menstrual history and GA in which to assess the above data
  3. modify controllable factors: smoking, alcohol, nutrition
  4. bed rest (in LLD position)
  5. serial BPP (monitor fetal growth)
  6. delivery when extrauterine existence is less dangerous than continued intrauterine existence or if GA > 34 weeks with significant oligohydramnios
  7. liberal use of C-section since IUGR fetus withstands labour poorly

PLEZ watch this until the end
INTRA-UTERINE GROWTH RESTRICTION INTRA-UTERINE GROWTH RESTRICTION Reviewed by Radiology Madeeasy on December 25, 2010 Rating: 5
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