Term
| Define small for gestational age |
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Definition
| ACOG: Infants with a birth weight at the lower extreme of the normal birth weight distribution. In the United States, the most commonly used definition is a birth weight below the 10th percentile for gestational age. |
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Term
| Define intrauterine growth restriction |
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Definition
ACOG: A fetus whose estimated weight appears to be less than expected, usually less than the 10th percentile.
Includes normal fetuses at the lower end of the growth spectrum, as well as those with specific clinical conditions in which the fetus fails to achieve its inherent growth potential as a consequence of either pathologic extrinsic influences or intrinsic genetic defects.
SFGH:
Sonographic evidence of EFW less than the 10th%tile for gestational age. However, the 5-10th percentile range is associated with constitutionally small vs real IUGR, so some people choose to use less than the 5th percentile as their definition |
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Term
| Below what percentile of growth do most problems occur |
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Definition
| Below the 5th percentile, maybe even below the 3rd percentile. |
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Term
| When a baby is compromised, what is more likely to decrease in size/interval growth -- head or abdomen? |
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Definition
| With ongoing compromise (usually nutritional/blood flow), a fetus is more likly to have shunting of blood flow to brain and away from the abdomen (abdominal wasting, head sparing) |
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Term
| Describe symmetric growth restriction in terms of HC/AC |
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Definition
| head circumference equal to abdominal circumference, with overall growth restriction |
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Term
| Describe asymmetric growth restriction in terms of HC/AC |
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Definition
| High HC/AC ratio. Head circumference typically increasing with decreasing or steady abdominal size. |
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Term
| What might be two causes of symmetric growth restriction? |
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Definition
| early intrinsic insult impairing overall number of cells (CMV, aneuploidy, drugs) or constitutionally small baby |
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Term
| What is the pathophysiology of asymmetric growth restriction? |
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Definition
| Consequence of fetus not getting enough nutrients/oxygen for growth--so they have enough cells, but cells can’t grow to full potential. In this case, resources are shunted to head (“head sparing”) and abdomen shrinks--poor nutrtition means fetus needs glycogen stores and the liver shrinks (as well as increased use of sub-q fat) so then AC<HC. |
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Term
| 4 potential causes of early onset FGR |
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Definition
- constitutionally small mom and dad
- teratogenic exposure:anticonvulsants, chemotherapy, radiation, organic solvents, pesticides.
- TORCH infections:toxoplasmosis, other(varicella,syphilis, malaria), rubella, cytomegalovirus, herpes.
- congenital anomalies/aneuploidy (20%)
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Term
| 4 potential cause of intermediate onset FGR |
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Definition
- Nutrition:adequate calories and macronutrients.
- Malabsorption e.g. inflammatory bowel dz.
- Smoking
- Drugs: alcohol, cocaine, heroin
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Term
| Potential cause of late onset FGR |
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Definition
Late onset:Maternal vascular disease
- Hypertension e.g. chronic and preeclempsia
- Chronic renal dz
- Diabetes
- Antiphospholipid syndrome and other clotting disorders
- Collagen vascular disease: systemic lupus, rheumatoid arthritis, scleroderma
Late Onset: Maternal hypoxic disease
- Chronic hypoxia
- severe pulmonary dz
- cyanotic heart dz
- altitude-extreme
- sickle cell dz or other hemoglobinopathies
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Term
| How is a IUGR diagnosis made? |
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Definition
Suspect based on S<D, risk factors
Confirm with ultrasound measuring: est. fetal wt, AFI, head/abd circ ratio, and possibly doppler criteria
Best diagnosis made with 2 ultrasounds at least 2 weeks apart |
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Term
| Management for IUGR > 32 weeks |
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Definition
- 32 week IUGR diagnosis -->
- Umbilical artery doppler flow & BPP weekly
- If normal EDF, deliver at term
- If normal EDF + oligo --> daily full BPP, delivery if <=6
- If reverse EDF ---> immediate delivery
- If absent EDF -->
- >33 weeks --> delivery
- Oligo --> delivery
- <33 weeks -->
- daily BPP and delivery if BPP <=6
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Term
How much is perinatal mortality increased in FGR babies? What percentage of stillborn babies are FGR? |
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Definition
- Perinatal mortality increased 10 fold over normally grown infants
- 30% of stillbirths are growth restricted
- Second leading risk factor for perinatal mortality
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Term
| What perinatal morbidities are associated with IUGR? |
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Definition
- Morbidity ↑7 fold to 5-10%
- Hypoxemia/asphyxia
- Hypoglycemia
- Hypothermia
- Polycythemia
- Hypocalcemia
- Meconium aspiration
- Congenital anomalies and infections
- Long-term: increased mortality vs AGA
- preterm infants
- ↑ dz as adults of HTN, CVD, type 2
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Term
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Definition
Diagnostic:
1. Dx-review dating criteria to accurately assess GA
2. Serial US to monitor fetal growth
3. Abnormal HC/AC or FL/AC ratios are particularly helpful in diagnosis of asymmetric vs. symmetric fetal growth
4. Assess for s/sx of pre-eclampsia
5. Monitor weight gain closely
6. do TORCH labs if earlier in pregnancy
Therapeutic:
1. Encourage high-protein diet
2. Encourage smoking cessation
Education:
1. Kick counts
2. Nutritional counseling
Follow-Up:
1. Consult with attending (co-management)
2. Weekly office visits
3. Antenatal testing 2 x week
4. Induction at 37 weeks
5. Doppler flow studies weekly
6. Consider social work to address poss psychosocial stressors, eating disorder, food insecurity, etc. |
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Term
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Definition
| low AFI < 5cm, one pocket less than 2cm |
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Term
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Definition
| excess AFI >25cm, one pocket >8cm |
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