Dr. Madhavi Karki

SYMMETRICAL IUGR ASYMMETRICAL IUGR

EARLY ONSET. SEEN IN 20% CASES

LATE ONSET. SEEN IN 80% CASES

ETIOLOGY: GENETIC DISEASE/ INFECTION (INTRINSIC TO FETUS)

ETIOLOGY: CHRONIC PLACENTAL INSUFFICIENCY(EXTRINSIC TO FETUS)

TOTAL CELL NUMBER : LESS, CELL SIZE : NORMAL

TOTAL CELL NUMBER : NORMAL, CELL SIZE : SMALLER

USG : ALL PARAMETERS (HC, BPD, AC, FL) SMALLER THAN EXPECTED

USG : HEAD SPARING EFFECT, BUT ABDOMEN IS SMALL

NEONATAL COURSE: COMPLICATED WITH POOR Px

USUALLY UNCOMPLICATED HAVING GOOD Px

BIOPHYSICAL TEST : THE FIRST EXAM SHOULD CONFIRM THE CLINICAL ESTIMATION OF THE GESTATIONAL AGE

1. Fetal distress / death.2. Asphyxia & RDS.3. Hypoglycemia. 4. Meconium aspiration syndrome.5. Hypothermia.6. Pulmonary hemorrhage.7. May have retarded growth .8. May have cardiac disease, diabetes, in

adulthood, if survives.• Long term complications Lower IQ, learning

& behavior problems, major neurological handicap seizures, cerebral palsy, mental retardation

1. Adequate bed rest. 2. Nutritional diet / iron, vitamins, calcium.3. No smoking / alcohol allowed.4. Aspirin in low dose (50 mg daily).5. Ultrasound monitoring of fetus should be

done every 4th wks.6. Termination of pregnancy – beyond 37

week.7. Before 37 week – conservative t/t to

increase placental function till fetus becomes viable.

Severe degree of IUGR – termination is to be done if lung maturation is achieved.

- If lung maturation has not been achieved corticosteroid therapy (betnasol 12 mg i.m. 24 hrs apart – 2 doses given to reduce the risk of neonatal RDS)

9. CS – to be done in the case of preterm delivery & unfavorable cervix.

10. Baby should be shifted to intensive neonatal care unit.

ETIOLOGY

1. Preeclampsia/ eclampsia2. A.P.H.3. Diabetes4. Severe anemia 5. Hyperpyrexia/Malaria6. TORCH infections8. Fetal malformations9. Rh-incompatibility10.Iatrogenic