Intrauterine Growth

Retardation
Ira Ong
RSP Oktober 2013

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation
Doppler
studies of
IUGR

Constitution
al SGA

pathological
process
decrease in fetal
growth rate that
prevents an infant
from obtaining his or
her complete
growth
IUGR
potential

SGA
estimated fetal weight < 10th
percentile

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation
Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation
Doppler
studies of
IUGR

Definition

Risk
Factors
Diagnose
Physiology
of normal
fetal
circulation
Doppler
studies of
IUGR

Definition

Risk
Factors
Diagnose
Physiology
of normal
fetal
circulation
Doppler
studies of
IUGR

Previous pregnancy with SGA or IUGR

Constitutionally small mother or low pre-pregnancy
weight
Poor maternal weight gain and nutrition (< 1500
cal/day)
Low socioeconomic status
Smoking, alcohol, illicit drugs
Extremes of maternal age: < 16 years, > 35 years
Assisted reproductive technology
New partner for subsequent pregnancy
Teratogens: anticonvulsants, methotrexate,
warfarin
Vascular disease: chronic hypertension, pregestational diabetes, antiphospholipid antibody
syndrome, collagen vascular disease (e .g .,
systemic lupus erythematosus, thrombophilia,
renal disease, Crohns disease, ulcerative colitis)
Hypoxiahigh altitude (> 10 000 ft)
Anemia including hemoglobinopathies

Maternal

Placental

Fetal

Definition

Risk
Factors

Maternal

Placental

Fetal

Diagnose
Physiology
of normal
fetal
circulation
Doppler
studies of
IUGR

Congenital infections: cytomegalovirus,

syphilis, rubella, varicella,
toxoplasmosis, tuberculosis, HIV,
congenital malaria
Aneuploidies: triploidy, trisomy 13, 18,
21
Microdeletions: 4pImprinting:
Russell-Silver syndrome
Genetic syndromes or fetal anomalies
Discordant growth in multiple gestation

Definition

Risk
Factors
Diagnose
Physiology
of normal
fetal
circulation
Doppler
studies of
IUGR

Maternal

Placental

Uteroplacental vascular
insufficiency
Chorionic separation (partial
abruption, hematoma)
Extensive villous infarction
Marginal or velamentous cord
insertion (chorion regression)
Major uterine malformations
(unicornuate uterus)
Confined placental mosaicism
Advanced placental maturation

Fetal

Definition

Risk
Factors
Diagnose
Physiology
of normal
fetal
circulation
Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose

Physiolog
y of
normal
fetal
circulatio
n
Doppler

Definition
Risk Factors
Diagnose

Physiolog
y of
normal
fetal
circulatio
n
Doppler

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Uterine
artery
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Uterine
artery
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Uterine
artery
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Uterine
artery
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Uterine
artery
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Uterine
artery
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Uterine
artery
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Uterine
artery
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Uterine
artery
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Uterine
artery
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Uterine
artery
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Umbilical
artery
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Umbilical
artery
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Maternal or placental conditions

that obliterate small muscular
arteries in
the placental tertiary stem villi
result in
a progressive decrease in enddiastolic
ow in the umbilical artery
Doppler
waveform until absent (Figure 1,
B) and
then reversed (Figure 1, C) ow
during
diastole are evident.
Reversed end-diastolic
ow in the umbilical arterial circulation represents an advanced
stage
of placental compromise and

Umbilical
artery
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

MCA
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

MCA
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

MCA
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

MCA
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

MCA
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

MCA
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

MCA
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

DV
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

DV
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

DV
Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation

Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation
Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation
Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation
Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation
Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation
Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation
Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation
Doppler
studies of
IUGR

Definition
Risk Factors
Diagnose
Physiology
of normal
fetal
circulation
Doppler
studies of
IUGR

THANK YOU