16 - intrauterine growth retardation ( IUGR )

1. Definitions
1. Intrauterine Growth Retardation (IUGR)
1. Estimated fetal weight less than 10% per gestational age
2. Some suggest cutoff of 5% to reduce false positives
2. Small for Gestational Age (SGA)
1. Normal small infants without adverse risks
2. Evaluation
1. Indicators of IUGR
1. Poor Maternal Weight gain
1. Most sensitive indicator for IUGR
2. Fundal Height less than expected for gestational age
2. Consider environmental and comorbid factors
1. Tobacco abuse (most significant individual risk)
2. Poor Nutrition
3. Illicit Drug Use
4. Alcohol Abuse
5. Minimal to no prenatal care
6. Traumatic stress
3. Fetal Assessment
1. Follow Fetal Movement Counts (kick) counts
2. Follow Non-Stress Test
3. Serial Obstetric Ultrasounds for growth
4. Biophysical Profile
3. Diagnosis
1. Detection rate in-utero: 70%
2. Indications for Obstetric Ultrasound
1. Low risk fetus smaller than expected size
2. High risk monitoring
3. Ultrasound interpretation
1. Head Circumference to Abdominal Circumference ratio
1. Most useful in assessing Asymmetric IUGR
4. Management
1. Address risk factors
1. Tobacco Cessation
2. Eliminate other negative habits
3. Ensure adequate maternal weight gain
4. Maximize prenatal care
5. Reduce environmental stressors
2. Perinatology Consultation Indications
1. Poor Nonstress Test
2. Decreasing Biparietal diameter
3. Oligohydramnios
4. Abdominal circumference 4 weeks less than BPD
3. Early Delivery Indications
1. Doppler diastolic flow 0 mmHg in umbilical artery
5. Peripartum Risks of IUGR
1. Meconium aspiration
2. Intrauterine Asphyxia
3. Polycythemia
4. Hypoglycemia
6. Causes of IUGR
1. Symmetric IUGR (Head and body growth retarded)
2. Asymmetric IUGR (head growth spared)
7. References
1. Gabbe (1996) Obstetrics, Churchill, p. 863-886
2. Ahluwalia (2001) Obstet Gynecol 97:649

3 - post-term pregnancy

1. Epidemiology
1. True Prevalence of post-dates pregnancy: 2-3%
2. Pseudoprevalence (misdated pregnancy): 10-14%
2. Definition
1. Post-Term
1. Over 294 days (42 weeks) beyond first day of LMP
2. Post-Mature Infant
1. Truly post-term by objective criteria
3. Signs: Physical Characteristics of a post-dates infant
1. Underweight due to loss of subcutaneous fat
2. Long and thin in girth
3. Skin with patchy areas of Desquamation
4. Skin, long nails may be covered with meconium
5. Wrinkled hands and feet on ventral surfaces
4. Management: Antenatal Monitoring
1. Weekly Biophysical Profile
2. Amniotic Fluid Index
1. Demonstrate single 3 cm vertical fluid pocket
2. Lack of pocket associated with fetal asphyxia
3. Lack of pocket associated with perinatal mortality
3. Fetal heart monitoring
1. Biweekly Nonstress Test or
2. Weekly Contraction Stress Test
5. Management: Induction at 42 weeks
1. Induction at 41 weeks no recommended
1. No benefit to infant
2. Higher risk of labor complications
2. References
1. Alexander (2000) Obstet Gynecol 96:291