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INTRAUTERINE GROWTH RESTRICTION

INTRAUTERINE GROWTH RESTRICTION. DEFINITION. Intra uterine growth restriction is said to be present in those babies whose birth weight is below the tenth percentile of the average for gestational age. INCIDENCE. 2 -8%. TYPES. SYMMETRICAL OR TYPE – I

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INTRAUTERINE GROWTH RESTRICTION

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  1. INTRAUTERINE GROWTH RESTRICTION

  2. DEFINITION • Intra uterine growth restriction is said to be present in those babies whose birth weight is below the tenth percentile of the average for gestational age

  3. INCIDENCE • 2 -8%

  4. TYPES • SYMMETRICAL OR TYPE – I • Affected from the very early phase of cellular hyperplasia • Slow rate of growth • A reduction in absolute size • The pathological process is intrinsic to the fetus • All the organs including the head is affected • ASYMMETRICAL OR TYPE – II • Affected in the later months • Phase of cellular hypertrophy is affected • Pathological process is extrinsic to the fetus • Fetal size is reduced

  5. ETIOLOGY • MATERNAL FACTORS • Constitutional – Small women, racial back ground and genetic • Maternal nutrition before and during pregnancy • Maternal diseases • Decreased blood supply due to high altitude,hemoglobinopathies and cyanotic heart disease • Smocking and tobaco chewing • Ingestion of drugs like etanol,cocaine,hydantoin and coumarin

  6. Contd… • FETAL FACTORS • Congenital infections • Congenital malformation • Chromosomal abnormalities • Infections - TORCH • Multiple pregnancy

  7. Contd… • PLACENTAL FACTORS • Abruptio placenta • Placental infarction • Small placenta • Post term pregnancy • Placental insufficiency due to maternal vascular diseases • Poor implantation of the placenta • Circumvallate placenta

  8. DIAGNOSIS • HISTORY • Previous medical or obstetric problems • Prior delivery of an IUGR baby • WEIGHT GAIN • Not a reliable indicator • Remains stationary or at times falling • UTERINE FUNDAL HEIGHT • Stationary or may fall • FETAL KICK COUNT • Dimnished fetal movement

  9. MANAGEMENT • GENERAL • Adequate bed rest especially in the left lateral position • Balanced diet +300 extra calorie to be taken • Management of associated complicating factors that cause IUGR • Avoidance of smocking and alcohol • Maternal hyperoxygenation for short term prolongation of pregnancy • Low dose aspirin (50mg daily)

  10. Contd… • ANTEPARTUM EVALUATION • Clinical examination • USG • Fetal kick counts • Doppler velocimetry • NST • Cord blood for blood gas analysis

  11. Contd… • TERMINATION OF PREGNANCY • Beyond37 weeks :Termination of pregnancy should be done • Before 37 weeks : • Uncomplicated mild IUGR • Treatment to improve placental function • Severe degree of IUGR • Attained lung maturity – Terminate pregnancy • Not attained lung maturity – Dexamethasone therapy

  12. Methods of termination • LRM followed by oxytocin

  13. INTRAPARTUM MANAGEMENT • INTRAPARTUM MONITORING • Continuous electronic fetal heart monitoring and scalp blood sampling • CARE DURING VAGINAL DELIVERY • Delivery in equipped hospital • Intensive intranatal monitoring • Facility for intensive neonatal care • In – Utero transfer of baby to equipped hospital • Precautions as for pre term labour • INDICATIONS FOR LSCS • Fetal distress • Malpresentation • Very low fetal weight • Failed induction • Arrest of progress • Previous cesarean section

  14. PHYSICAL FEATURES AT BIRTH • Weight 600 gm below the minimum in percentile standard • Length is unaffected • Head circumference is relatively larger in assymetric variety • Wrinkled skin • Scaphoid abdomen • Thin meconium stained vernix caseosa • Thin umbilical cord • Plantar creases are well developed • The baby is alert ,active with normal cry • Reflexes are normal

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