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2 FGR

Fetal growth restriction (FGR) is defined as an estimated fetal weight below the 10th percentile for gestational age, with severe cases being below the 3rd percentile. Factors influencing fetal growth include race, sex, and parental characteristics, while distinguishing between constitutionally small fetuses (SGA) and pathological FGR is crucial for management. Monitoring and management strategies include ultrasound assessments, Doppler velocimetry, and timely delivery based on fetal condition and gestational age.

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6 views30 pages

2 FGR

Fetal growth restriction (FGR) is defined as an estimated fetal weight below the 10th percentile for gestational age, with severe cases being below the 3rd percentile. Factors influencing fetal growth include race, sex, and parental characteristics, while distinguishing between constitutionally small fetuses (SGA) and pathological FGR is crucial for management. Monitoring and management strategies include ultrasound assessments, Doppler velocimetry, and timely delivery based on fetal condition and gestational age.

Uploaded by

mehari michael
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Fetal growth restriction/Fetal

growth restriction{IUGR/FGR}
Successful Fetal Growth
• Normal fetal growth requires successful devt of
placental interface b/n maternal and fetal
compartment.
• Fetal sidecontinuous branching of
villous12m sq surface area
• Maternal side Extravillous troph invasion of
spiral arterieslow resistance600ml/min of
maternal CO.
• Fetal side 200-300ml/kg/min
definition
• Estimated Fetal Weight (EFW)<10th percentile
for the Gestational Age (GA).
• <3rd percentile severe IUGR
• 5th -10th percentileModest IUGR
• 70 percent of those <10th percentile
constitutionally small
• An abdominal circumference below the 10th
percentile for gestational age can also be used
to define FGR .
definition
 Characteristics that support a diagnosis of a
constitutionally small fetus include:
●Modest smallness (ie, estimated weight between the 5th
and 10th percentiles)
●Normal growth velocity across gestation
●Normal physiology (ie, normal amniotic fluid volume and
umbilical artery Doppler)
●Abdominal circumference growth velocity above the 10th
percentile
●Appropriate size in relation to maternal characteristics
(height, weight, race/ethnicity)
Copyrights apply
Figures
• IUGR is the second(next to prematurity) in
causing perinatal death.
• 120 per 1000 PMR in all cases of IUGR.
• 80 per 1000 PMR after excluding congenital
anomalies.
• 53 % of Preterm babies are IUGR.
• 26% of term babies are IUGR.
Fetal growth xics
• Less than <16 weeksof GA :
cellular hyperplasia
• 16-32 weeks:
cellular hyperplasia & hypertrophy
• >32 weeks:
Cellular hypertrophy
Factors affecting fetal growth
• Race
• Sex
• Socioeconomic status
• Parental height and weight
• Birth order
Birthwt %ile vs PMR/morbidity
Causes
SGA vs FGR
• SGA(Small for Gestational Age):
 <10th percentile for GA but constitutionally small.
 Not pathological.
 70% of those less than 10th percentile
 Small and healthy
 Normal ponderal index
 Normal Sc fat
 Non-eventful perinatal outcome
SGA vs FGR/IUGR
• FGR(Fetal Growth Restriction) OR
IUGR(Intrauterine Growth Restriction)
30% of those less than 10th percentile
Pathological
Some FGR might have normal weight but
couldn’t achieve growth potential.
Symmetrical and Non-symmetrical FGR
Signs of FGR
• Big head and anxious
• Old man face
• Loose and peeled off skin
• Poorly developed breast
bud
• Scaphoid abdomen
• Long thin lower and
upper limbs
• Thin cord and meconium
stained
Ponderal index
• PI=wt(gm) *100/length 3(cms)
• Assymetric FGR low PI
• Symmetricnormal PI
• Normal weight(10th %ile-90th %ile) but IUGR low PI
• Decreased growth of adipose tissue and skeletal
muscle a reduced PI.
• PI of less than 10th percentile reflects fetal
malnutrition.
• PI of less than 3 rd percentile indicates severe wasting .
Screening IUGR or FGR
using SFH
 >or= 2cms mild IUGR
 >or=4cmssevere IUGR
Screening using maternal weight
• Weighing the mother 11.5KG -16KG
• OBESE :7-11.5KG
• PER WEEK:0.4kg
Management
• IUGR due to uteroplacental insufficiency is
monitored by:
●Fetal growth velocity
●Fetal behavior (biophysical profile [BPP])
●Impedance to blood flow in fetal arterial and
venous vessels (Doppler velocimetry)
Management
Management
• B mode Ultrasound
Serial measurement of EFW and biometry q 2-
3weeks
Amniotic fluid
Anatomic scan

• Doppler velocimetry is very useful!!!


Management
• Doppler velocimetry
Abnormal doppler velocimetry
 In normal pregnancy as gestational age advances
diastolic flow in umbilical artery increases and S/D ratio
decreases.
BUT in IUGR/FGR
 S/D ratio increases.
 Diastolic flow absentAEDV
 Diastolic flowreducedRedEDV
 Diastolic flowreversedREDV
Principles
• In FGR placental invasion
is poor .
• Umbilical artery is the
blood flow towards the
placenta.
• Resistance is
highdiastolic flow is low.
• Initially S/D ratio
increasesb/c of
decreased diastolic flow
• Finally AEDVREDV
Principles
• In advanced IUGR after
REDV(blood flow in
umbilical vein….Flow
towards the heart affected)
reversed flow in ductus
venosus

Pulsations in umbilical veins


This is due to fetal heart
failure
Timing of delivery
• Delivery time is dependent on fetal condition and
gestational age.
 Generally if the risk of fetal death outweighs the
neonatal deathdelivery is recommended.
 Late preterm(>34wks)delivery is recommended if:
o Arrest of growth over 3weeks
o REDV or AEDV in Umbilical A.
o Maternal medical problems
 In the absence of the above delivery at 39-40weeks
TIME OF DELIVERY
• <34 weeks delivery is indicated:
REDV
Pulsations in veins
Oligohydramnios
Reversed flow in ductus venosus
Long term prognosis
• Most assymetric IUGR(type 2) catch up in
weight in 6 months.

• Symmetric IUGR(type 1)
 Remain shorter,and have small HC.
Lower IQ,learning and behavioral problems
Prevention
• Nutritional
 Balanced protein and energy supplementation
 Treat malabsorption
 Treat intestinal parasitosis
• Infection
 Avoid contact with CMV and Rubella infected person
 Check for immunity (rubella and Toxo)
 If Negative immunity for rubella vaccine before conception
 If Negative immunity for Toxoavoid cats and uncooked meat
• Treat anemia,treat hypertension
• Low dose ASA in a mother previously conceived IUGR baby.

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