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Definitions
IUGR: Failure of a pregnancy to reach
expected fetal growth and manifest as a
deviation of fetal growth from normal
pattern.
SGA: Infant with wt < 10 % for GA, or > 2
SDs below mean for GA.
Low birth weight (LBW) means a baby with a
birth weight of less than 2500 g, which could be
due to IUGR or Prematurity
Easiest way to think about these
terms are
5 - 8 % of all pregnancies.
20 % of stillborns are growth retarded.
30 % of infants with SIDS were IUGR.
1/3 of infants with BW < 2800 gms are growth
retarded and not premature.
9 - 27 % have anatomic and/or genetic
abnormalities.
Perinatal mortality is 8 - 10 times higher for
these fetuses.
Types of IUGR
Symmetric IUGR: weight,length and head
circumference are all below the 10 th
percentile. (33 % of IUGR Infants)
Asymmetric IUGR: weight is below the 10 th
percentile and head circumference and
length are preserved. (55 % of IUGR)
Combined type IUGR: Infant may have
skeletal shortening, some reduction o soft
tissue mass. (12 % of IUGR)
Symmetrical Asymmetrical
In a normal infant, the brain weighs about three times more than the liver. In
asymmetrical IUGR, the brain can weigh five or six times more than the liver.
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Classification
Newer Classification: -
1. Normal small fetuses- have no structural abnormality,
normal umbilical artery & liquor but wt., is less.They are
not at risk and do not need any special care.
2. Abnormal small fetuses- have chromosomal anomalies
or structural malformations. They are lost cases and
deserve termination as nothing can be done.
3. Growth restricted fetuses- are due to impaired
placental function.Appropriate & timely treatment or
termination can improve prospects.
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Diagnosis
Intrauterine -
IUGR can be difficult to diagnose.
Presence of risk factors.
Inadequate growth detected by serial
measurement of Wt., abdominal girth and
fundal .
Ultrasound to evaluate the foetal growth.
Inadequate foetal growth.
Placental calcification.
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Diagnosis,
cont...
Neonatal -
Low ponderal index (Wt./Fl).
Decreased subcutaneous fat.
Presence / appearance of –
Hypoglycemia,
Hyperbilirubinemia,
Narcotizing enterocolitis,
Hyper viscosity syndrome
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Neonate and Placenta in IUGR
3) Placental Factors:
Placental insufficiency ( most imp in 3rd trimester)
Anatomic problems:
Multiple infarcts
Aberrant cord insertions
Umbilical vascular thrombosis & hemangiomas
Premature placental separation
Small Placenta
Postnatal Assessment
Hypoxia
- Perinatal asphyxia
- Persistent pulmonary hypertension
- meconium aspiration
Thermoregulation
- Hypothermia due to diminished subcutaneous
fat and elevated surface/volume ratio
Complications
Metabolic
- Hypoglycemia
- result from inadequate glycogen stores.
- diminished gluconeogenesis.
- increased BMR
- Hypocalcemia
- due to high serum glucagon level, which
stimulate calcitonin excretion
Complications
Hematologic
- hyperviscosity and polycythemia due to
increase erythropoietin level sec. to hypoxia
Immunologic
- IUGR have increased protein catabolism and
decreased in protein, prealbumin and
immunoglobulins, which decreased
humoral and cellular immunity.
Management
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Short Term Risks of IUGR
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Long term Prognosis
IUGR infants are more likely to remain small
than those of normal birth weight. They will
need the special attention of primary health,
nutrition and social services during infancy and
early childhood.
Implication of IUGR can be life long affecting:
Body size growth, composition and physical
performance.
Immunocompetence.
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Long term Prognosis
It appears to predispose to adult adult-onset,
degenerative diseases like maturity onset
diabetes , obesity, and cardiovascular diseases.
Impaired Neurodevelopment
Long term neuromotor dysfunction
Poor school performance
Deficits in academic achievements