IUGR BY PROFESSOR DR HUMAIRA AKRAM DEFINITION SGA

IUGR BY PROFESSOR DR HUMAIRA AKRAM

DEFINITION SGA “ A baby whose growth paramaters are below 10 th centile for a given gestational age is known as small for gestation” e: g �The fetus with physiologically lower genetic growth control �Babies with IUGR “Failure of a fetus to reach its genetic growth potential due to an underlying pathology” ALL SGA FETUSES ARE NOT IUGR

SIGNIFICANCE USG OF SGA: �Small fetus �Normal umbilical artery doppler study �Normal liquor volume �No structural abnormality USG OF IUGR: �Small fetus �Small sized placenta �Reduced amount of liquor

RISKS FOR IUGR BABY �IUD prior to onset of labour �Meconium aspiration & fetal distress during labour �Increased incidence of instrumental & operative delivery �Post natal risk of hypothermia, hypoglycemia, infection, pulmonary haemrrhage, necrotizing enterocolitis & encephalopathy, multiorgan thrombosis, heart failure, hyperbilirubinaemia. �Perinatal mortality 6 -8 times higher than in normal pregnancy. �Babies remain physically small during first yr of life �Risk of CVS disorder & DM in later life

PATHOPHYSIOLOGY �SYMETRICAL �ASYMETRICAL

CAUSES �MATERNAL �FETAL �PLACENTAL

MATERNAL: �Nutrition �Drugs �Chronic ailments �Antibodies FETAL: �Anomaly �Infection PLACENTAL: �Circulation �Size IDIOPATHIC:

CLINICAL FEATURES �Feeling of small baby in relation to gestational age �Reduced fetal movements �Decreased weight gain �Failure of fundal height to grow in proportion with the duration of gestation

MANAGEMENT �HISTORY �EXAMINATION Ø GPE Ø ABDOMINAL EXAMINATION Ø PELVIC EXAMINATION

INVESTIGATION USG ( Diagnostic ): � Growth parameters � Structural abnormality � Liquor volume ___ MVP (2 -8 cm) ___ AFI (10 -24 cm) DOPPLER: � Umbilical artery flow __ end diastolic flow appear 5 wks before fetal demise __reversed end diastolic flow precedes fetal demise by 1 -2 days � Fetal venous flow __pulsatile flow in umbilical vein is sign of severe fetal compromise BIOPHYSICAL PROFILE: CTG

SUBSEQUENT MANAGEMENT Depends upon �Duration of gestation �Fetal normality �Umbilical artery flow �Doppler �Biophysical profile

TERM PREGNANCY: FETAL ABNORMALITY: PREGNANCY WITH NORMAL FETUS: Ø CONSERVATIVE: �General measures �Monitoring _DAILY: Maternal vitals 4 hrly, FKCC _ALTERNATE DAY: CTG _WEEKLY: USG for liquor volume Umbilical artery Doppler study Biophysical profile _TWO WEEKLY: USG for fetal growth

INDICATION FOR URGENT DELIVERY: �Abnormal fetus �Reverse end diastolic flow �Biophysical profile < 4 INDICATION FOR CONSERVATIVE MANAGEMENT: �Absent diastolic flow �Biophysical profile 8/10

DELIVERY AND LABOUR MODE OF DELIVERY: �Elective C/Sec in case of severe IUGR but with good chances of survival according to gestation �SVD case of abnormal, too premature baby & baby with normal doppler study LABOUR: �Trial with low threshhold of C/Sec �Electronic Fetal heart monitoring �Avoid the use of oxytocin �Patient should be kept fasting �Second stage should be shortened �No contraindication of epidural analgesia

PREVENTION IUGR can be prevented by controlling the causative factors

THANKS