RCIU

IUGR VS SGA

Epidemiology

The incidence of IUGR is six times higher in underdeveloped/developing countries when compared to that in developed countries, and this incidence can be further high in lower- and middle-income countries, as many infants are born in home with NO BIRTH RECORDS!

SGA

It refers to a weight below the 10th percentile for gestational age as per the population growth charts. It can be further classified as follows:

Moderate: Birth weight from third to tenth percentile

Severe: Birth weight less than the third percentile

Clinical features at birth

Causes of IUGR

Various maternal factors such as

- Age of the mother

- Inter-pregnancy interval (less than 6 months or 120 months or more)

- Maternal health

- Behavioral habits

- Maternal infection

Endocrine Basis of IUGR

Insulin controls the cell number because it has direct mitogenic effects on cellular development.

Fetal insulin acts as a signal of nutrient availability for growth

Fetal hypothyroxinaemia leads to developmental abnormalities such as decreased oxygen consumption and oxidation of glucose, leading to decreased fetal energy supply for growth.

The glucocorticoid hormone does not have any significant effects on the fetal growth but has an important role in the development and maturation of fetal organs.

Growth hormone, which is the major hormonal regulator of postnatal growth, has no demonstrable effect on fetal growth.

Traditional screening methods for fetal growth using abdominal palpation or measurement of symphysis–fundal height (SFH) have poor detection rates for IUGR, and therefore they should not be performed routinely

A few studies have shown that an abnormal HC/AC ratio is more specific and have negative predictive value in detecting asymmetric IUGR when compared with symmetrical IUGR

Abdominal circumference has a specificity and negative predictive value close to 90% for diagnosing IUGR.

The Cochrane meta-analysis reported that there was insufficient evidence from various randomized controlled trials to support the use of BPP as a test of fetal well-being in high-risk pregnancies.

Doppler velocities are helpful as a clinical tool specifically in the case of placental insufficiency that leads to IUGR.

Once maternal risk factors and IUGR are identified, the mother is evaluated with fetal karyotype for chromosomal abnormalities, maternal infection including TORCH (Toxoplasma, others, rubella, cytomegalovirus, and herpes), syphilis, and malaria especially in high endemic areas.

ESTUDIOS COMPLEMETARIOS

1.Poblacion General

A. Clasificar edad gestacional

B. Investigar factores de riesgo para definir subgrupos de manejo:

1. Sin FR y Ayudas Dx concordantes para edad gestacional

2. Sin FR y Ayudas Dx discordantes para edad gestacional

3. Con FR y Ayudas Dx concordantes para edad gestacional.

MANEJO DE FACTORES DE RIESGO

4. Con FR y Ayudas Dx discordantes para edad gestacional

SOSPECHA DE RCIU

1.Poblacion

General

RCIU DE INICIO TEMPRANO:

Hospitalizar si:

- ILA Disminuido por debajo percentil 2.5 con Doppler umbilical normal

- Ausencia de flujo de

fin de diastole en Art. Umb.

- Flujo de

fin de diastole en Art. Umb. revertido.

Antes de la semana 32

1. control por medicina materno-fetal

2. Clasificacion etiologica del RCIU: Cariotipo (Si RCIU severo antes de 20 Sem), Infeccion (Titulos TORCH), Disfuncion uteroplacentaria

3. Determinar el tipo de RCIU

4. Tratamiento de condiciones maternas

5. Rercomendar reposo en decubito lateral

6. Ecografia y velocimetria doppler cada 3 semanas hasta la sem 36 o hasta llegar a oligohidramnios severo.

7. Perfil biofisico bisemanal

Considerar parto si:

- Anhidramnios a las 30 sem o posterior

- Monitoria fetal con desaceleraciones fetales persistentes

-Detencion de crecimiento x 3 sem

-Doppler Art. umb anormal

POSTNATAL

LONG TERM COMPLICATIONS

Step 2

TARDIAS

Step 1