two groups of SGA
- Constitutionally small foetus
- growth restricted foetus
risks associated with growth restriction
- Stillbirth
- Birth asphyxia - which could result in Hypoxic Ischaemic Encephalopathy
- Meconium aspiration syndrome
- Meconium aspiration may take place before and during delivery
- latrogenic preterm delivery
- Neonatal complications
Hypothermia due to reduced subcutaneous fat - Hypoglycaemia as a result of depleted glycogen stores
- Polycythaemia due to chronic hypoxia
- Impaired neurodevelopment
Neurological damage manifesting as cerebral palsy, seizures or minimal brain dysfunction - Metabolic syndrome in adulthood (Barker hypothesis) - as a result of genetic imprinting due to gene selection that occurs in utero. The affected fetus has an increased risk of developing many of the metabolic factors associated with an increased risk of vascular disease in later life.
- Obesity
- Type 2 diabetes
- ## Cardiovascular disease
complications of continued placental def in asymmetrical IUGR
Progressive metabolic acidosis -
- Oligohydramnios
- Loss of fetal breathing movements
- Decreased tone
° Worsening cardiac function (and metabolic state) -
- Abnormal fetal heart rate patterns
- Decreased variability
- Decelerations
AT RISK OF BIRTH ASPYREXIA
What is the aetiology of IUGR
Nutrient and oxygen delivery to the placenta
- E.g. decreased oxygen carrying capacity due to maternal cyanotic heart disease, smoking, haemoglobinopathy
- Nutrient and oxygen transfer across the placenta
Maternal vascular disease, e.g. diabetes, hypertension, autoimmune disease - Placental damage resulting from smoking, thrombophilia, autoimmune disease
- Fetal uptake of nutrients and oxygen
- E.g. congenital abnormalities
- Fetal regulation of growth processes
- E.g. inborn errors of metabolism
Maternal causes of IUGR
- Cardiorespiratory disease
- Chronic hypertension
- Pregnancy induced hypertensive disorders
- Diabetes
- Autoimmune disorders
- Thrombophilias
- Haemaglobinopathies
- Renal disease
- Malignancy
- Connective tissue disorders
- Anaemia
- Fever
- Protein energy malnutrition
- Smoking
- Drug abuse
- Alcohol
FETAL CAUSES OF IUGR
- Congenital infections
- Rubella, CMV, Toxoplasmosis, Syphilis
- Structural congenital abnormalities
- Anencephaly, cardiovascular disorders, etc
- Chromosomal abnormalities
- Trisomy (13, 18, 21), Turners syndrome, etc
- Inborn errors of
PLACENTAL CAUSES OF IUGR
- Twin-to-twin transfusion syndrome
- Multiple gestations
- Placenta praevia
- Recurrent antepartum haemorrhage
- Extrauterine pregnancy
- Placental abnormalities
- Circumvallate placenta, placental cysts
- Thrombosis/infarction
- Placental insufficiency - placental bed vasculopathy which is usually (but not always) associated with clinical manifestation of pre-eclampsia
- Failure of the second wave of trophoblastic invasion in the early second trimester
- Spiral arterioles do not transform into low resistance vessels
- This results in under perfusion of the choriodecidual space leading to slow fetal growth and eventual placental infarction
What’s included in the biophysical test
fetal movement count
auscultation of the heart
amniotic fluid volume
doppler studies
antenatal CTG
biophysical profile
test/investigations in IUGR
Biophysical test
biometric test
what do biometric tests measure and what are the examples
they measure size
-SFH
Ultrasound biometry
