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IUGR (Intrauterine
Growth Restriction)
Putri Mirani
Divisi Fetomaternal
FKUNSRI/RSMH Palembang
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Introduction
Gestational period extraordinary fetal growth
During 1st trimester, embryo grows approx. 1 mm/day
Fetal length continues in a predictable way, growing
approx. 0.5 cm/week troughout pregnancy
Fetus adds much weight during 3rd trimester, approx.
0.5 lb/week
At term, fetuses are relatively standard in length
(mean 51 cm), with > 95 % infants falling within 10%
of the mean
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Sonographic Dating &
Assessment Of Fetal Growth
DATING
Accurate dating of pregnancy cornerstone of
obstetrical management of both normal & abnormal
pregnancies
Dating by menstrual history often unreliable
overestimation GA when compared with US
UShas proved better than calculations based on the
menstrual dates
The earlier the US is performed, the more accurate the
assessment of dates
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Sonographic Dating &
Assessment Of Fetal Growth
FIRST TRIMESTER
GS visible at 4.5 wks, yolk sac (YS) present 95% at 5 wks &
nearly all by 6 wks, fetal heart rate (FHR) is seen beating
86% in 6 wks & always by 7 wks
US evaluation US evaluation
BPD: low growth profile BPD: low flattening pattern
This
ratio helps to differentiate between symmetric IUGR,
asymmetric IUGR and a normally proportioned fetus
Symmetric IUGR - ratio is normal
Asymmetric IUGR - ratio increases as the head size is
maintained at the expense of the AC ("Brain-sparing
effect)
+HC/AC Ratio
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FL/BPD Ratio
Normal ratio = 79 8%
Increased ratio
Microcephaly
Technically
poor measurement of the femur that
erroneously included the distal femoral epiphysis
Decreased ratio
Large head
Skeletal dysplasia (this ratio is a good indicator of fetal
dwarfism) as there is a very low chance that a normal
fetus will have a value that falls outside 4 SD of the
mean
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FL/AC Ratio
Normal = 22 2% (constant after 24
weeks)
When ratio falls <20% or >24%, the AC
should not be used in the assessment
of gestational age
Growth retardation = >24%
Macrosomia = <20%
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Amniotic Fluid Volume
Amniotic fluid tends to reflect fetal size
Chronic fetal hypoxemia often produce
oligohydramnios in addition to growth
restriction supports D/ of IUGR
AF can be normal in some cases of IUGR
indicates that fetus is not compromised
Polyhydramnios distinctly unusual in IUGR
unless fetal anomalies are present
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Umbilical Artery Doppler
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Umbilical & Uterine Artery
Doppler
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Middle Cerebral Artery (MCA)
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MCA Doppler
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Ductus Venosus Doppler
+Ductus Venosus Doppler
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Differential Diagnosis