Questions and Answers
Which of the following investigations are essential for diagnosing intrauterine growth restriction (IUGR)?
What is the significance of measuring symphiso-fundal height (SFH) in the management of fetal growth?
In terms of antenatal care for IUGR, how often should fetal weight estimation be performed?
Which immediate short-term complication is associated with intrauterine growth restriction (IUGR) in newborns?
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Which factor influences the decision for delivery in cases of intrauterine growth restriction?
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Which factor has the least influence on determining birth weight?
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What is a common complication associated with IUGR?
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Which maternal condition can notably lead to reduced utero-placental flow?
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Which infection is particularly notable for its impact on abnormal fetal growth?
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What type of placental abnormality can lead to IUGR?
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Study Notes
Determinants of Birth Weight
- Influenced by gestational age, maternal size, fetal gender, parity, and ethnicity.
Intrauterine Growth Restriction (IUGR)
- Defined as fetal weight below the 10th percentile or abdominal circumference below the 2.5th percentile.
- Causes include:
- Fetal Factors: Genetic, chromosomal abnormalities, congenital malformations, multiple pregnancies.
- Placental Factors: Ischemic placental diseases, multiple infarcts, abnormal cord insertion, chorioangioma.
- Maternal Factors: Reduced utero-placental flow, hypoxemia, malnutrition, substance abuse, certain medications, infections (e.g., TORCH), and other conditions (e.g., vitamin D deficiency).
Management of IUGR
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Screening:
- Fetal size estimation through palpation and symphiso-fundal height (SFH) measurement.
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Investigations:
- Diagnosis via ultrasound (USS) for fetal biometry and amniotic fluid index (AFI).
- Doppler studies of umbilical arteries and cardiotocography (CTG).
- Fetal karyotyping and relevant laboratory tests.
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Antenatal Care:
- Regular USS every two weeks, CTG assessments, and administration of steroids.
- Delivery usually not beyond 37 weeks gestational age (GA).
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Delivery Considerations:
- Induce labor if GA is near term without fetal distress; otherwise, elective cesarean section (CS) is indicated.
Complications of IUGR
- Short-term: Risk of hypoglycemia, respiratory distress syndrome, and birth asphyxia.
- Long-term: Potential for cerebral palsy, reduced IQ, increased Adult hypertension, ischemic heart disease, and hypercholesterolemia.
Prevention of IUGR
- Lifestyle modifications: cessation of smoking, avoidance of drugs/alcohol, and management of pre-existing conditions (thrombophilias, vitamin D deficiency).
- Effective pre-conception counseling.
- Ineffective measures include bed rest and certain medications.
Macrosomia
- Defined as a birth weight exceeding 4kg.
- Causes include genetic disorders (e.g., Beckwith-Wiedemann syndrome), gestational diabetes mellitus (DM), and hyper-insulinemia.
Risk Factors for Macrosomia
- High body mass index (BMI), excess weight gain during pregnancy, multiparity, advanced maternal age, and previous delivery of a macrosomic infant.
Management of Macrosomia
- Screening: Fetal size estimation using palpation and SFH measurement.
- Diagnosis: Fetal biometry using ultrasound; less accurate for larger infants.
- Delivery: Preferentially cesarean section due to associated risks.
Complications of Macrosomia
- Short-term: Birth injuries, neonatal hypoglycemia, and increased maternal trauma during delivery.
- Long-term: Risk of neurodevelopmental delays, obesity, and type 2 diabetes.
Prevention of Macrosomia
- Prioritize normalization of BMI, early detection of gestational diabetes, and encourage moderate exercise during pregnancy.
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Description
Explore the factors influencing birth weight and delve into the intricacies of intrauterine growth restriction (IUGR). This quiz covers the fetal, placental, and maternal factors leading to IUGR, as well as its screening and management. Test your knowledge on this important topic in maternal-fetal medicine.
