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Intra uterine growth retardation

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are those with weights below the 10 percentile for their gestational age ... Meconium aspiration. Neonatal hypoglycemia. Hypothermia. Abnormal neurological development ... – PowerPoint PPT presentation

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Title: Intra uterine growth retardation


1
IUGR
Intra Uterine Growth Retardation
Razieh M.Jaafari,MD Ahwaz.u.m.s Dept of ObGyn
2
Small for Gestational Age
  • SGA infants are those with weights below the 10
    percentile for their gestational age

3
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
4
Incidence
  • 3 -10 of infants are growth restricted

5
25 -60 of infants conventionally diagnosed to
be SGA were in fact AGA when
6
Determinant of birth weight such as maternal
  • Ethnic group
  • Parity
  • Weight
  • Height

7
MORTALITY MORBIDITY
  • Hypothermia
  • Abnormal neurological development
  • Fetal demise
  • Birth asphyxia
  • Meconium aspiration
  • Neonatal hypoglycemia

8
  • ACCELERATED MATURATION

9
Accelerated maturation
  • The fetus resoponses to stressed envirorment by
    adrenal glucocorticoid

Earlier or accelerated maturation
10
SYMMETRICAL VERSUS ASYMMETRICAL GR..
11
Fetal growth has been divided into three phases.
  • cell size
  • fat deposition
  • fetal weight as much as 200 G.r. per week.
  • 1-cellular hyperplasia
  • 2- hyperplasy hypertrophy
  • 3- hypertrophy

12
symmetrical
  • An early insult
  • due to
  • chemical
  • viral
  • aneuploidy
  • Cell size
  • Cell num.

Proportionate reduction in head body
13
Asymmetrical
A late pregnancy insult such as placental
insufficiency would affect cell size.
14
The ratio of brain weight to liver weight over in
the last 12 wk of pregnancy is increased to 5/1
or more
15
Growth pattern may potentially reveal the cause
16
  • In practice accurate identification of
    symmetrical versus asymmetrical fetus has proved
    difficult.

17
Risk factors for FGR
  • Maternal
  • fetal
  • placental and cord abn.

FGR - fetal growth retardation
18
Maternal causes
  • Constitutionally small mother
  • Poor maternal weight gain nutrition
  • Social deprivation

19
  • vascular disease
  • maternal anemia
  • anti phospholipid Ab syn.
  • Extra uterine pregnancy
  • chronic renal disease

20
FETAL CAUSES
  • fetal infections
  • congenital malformations
  • chromosomal abnormalities
  • trisomy 16
  • multiple fetus

21
Placental and cord abnormalities
  • chromic partial placental sep.
  • extensive infarct.
  • Chorioangioma
  • placenta previa

22
ADDITIONAL INSIGHT OF FGR
23
These fetus also had
  • Hypoglycemia
  • hypoinsulinemia
  • glycin/valin
  • hypertriglycemia
  • thrombocytemia

24
Screening and identification of F.G.R
  • Early establishment of G.A
  • Attention to maternal weight gain
  • Measurement of uterine height throughout pregnancy

25
Identification of risk factors
  • A previously GR fetus in women with
  • significant risk factors

Serial sonography
26
Definitive diagnosis usually can not be made
until delivery.
27
MANAGEMENT
  • Once a SGA is suspected , intensive effort should
    be made to determine if GR is present and if so,
    its type and etiology.

28
In the presence of sonographically detectable
anomalies, cordocentesis may be performed for
kariotyping.
29
Prompt delivery is likely to afford the best
outcome for the GR fetus
GR. NEAR TERM
30
In the presence of significant oligohydraminos
most fetus will be delivered if G.A has
reachedgt34 wk.
31
Such often tolerate labor less than AGA and C/S
is indicated for intrapartum fetal compromise.
Unfortunately
32
Importantly
Uncertainly about the diagnosis of GR should
preclude intervention until fetal lung maturity
is assured.
33
GR. REMOTE FROM TERM
before 34 wk Normal Amniotic
volume Normal fetal surveillance
Observation
Sono is repeated at interval 2-3 wk
34
Pregnancy is allowed to continue until fetal
maturity is achieved.
35
At times amniocentesis for assessment of
pulmonary maturity may be helpful in clinical
decision making.
36
There is no specific treatment that will
ameliorate the condition
37
Many clinicians advised a program of modified
rest in the lateral recumbent position in which
c.o.p and placental perfusion is maximized.
38
Optimal management of the preterm GR fetus remain
undefined.
39
Mortality and morbidity in GR fetuses were
determined by GA and birth weight and not by
abnormal fetal testing.
40
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

41
LABOR AND DELIVERY

42
FHR MONITORING

43
  • GR is the result of insufficient
  • placental function
  • c/s
  • A.f cord
  • compression
  • breech presentation

44
Expert assistance
  • In making a successful transition to air
    breathing
  • clear the airway below the vocal cord
  • ventilate the infant as needed

45
The severely GR newborn is susceptible to
  • Hypothermia
  • serious hypoglycemia
  • polycytemia
  • hyper viscosity

46
Prolonged symmetrical FGR is likely to be
followed by slow growth after birth.
Subsequent development of the GR
47
The asymmetrically GR is more likely to catch up
after birth.
48
  • NEUROLOGICAL AND INTELLECTUAL CAPABILITY

49
A LONG TERM FABORABLE OUT COME MAY BE EXPECTED.

50
In a 9-11 year follow up study learning deficit
in almost half of GRF
51
A significant association between fetal growth
restriction and cerebral palsy.
52
The risk of recurrent FGR is increased in women
  • Who have previously had this complication
  • With Hx of FGR
  • A continuing medical complication

53
In the name of Allah, the beneficent. the
merciful
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