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It
is associated with SB, NND, Perinatal morbidity and CP are not detected antenatal New tool for the screening for growth restriction
Is the customized weight for gestation It is a computer program It adjust for parity, ethnic origin and BMI
Risk
factors
Previous history of IUGR or SB Previous Iugr has 50% on this current pregnancy History of SB before 32 weeks is strongly associated with IUGR Will need close fetal monitoring Diabetes 15% of DM T1 are found to have SGA (using the customized growth chart)
Obesity
It was once thought that it is protective of SGA Using the new tool it is associated with 50% Even PMR is associated
Multiple
gestation
sensitivity, specificity and predictive value dosnt support their use, even in combination
Early growth restriction A slow growth between the first and second trimester Associated with increase PMR before 34 weeks Needs more intensive monitoring during pregnancy UA doppler It is not a good screening tool but useful in triaging
high risk cases More associated with early IUGR then Late IUGR
SFH
graph Using the graph improved SGA detection from 29% to 54%
Growth
scan
serial scan
Aim
is fetal well being and timing of delivery Assessment of a fetus (chronic and acute)
Chronic test UA
Absent and reverse diastolic pattern 40% is found with acidosis 1 weeks before acute deterioration
MCA
Progressively vasodilatation of the vessel show that 50 to 80% will have acute deteriotion in 2 weeks
AFI
<5 is associated with abnormal APGAR but not acidosis
Acute markers DV This has a strong association with acidosis Absent or reverse has about 70% sensitivity of perinatal mortality FHR It has a false positive of 50% It failed to show any benefit in high risk pregancy and iugr patient BPP Because of the high false positive it not recommended to be used in preterm IUGR
It
need to balance the iatrogenic morbidities and the continued exposure to the intrauterine factors Once fetal lung maturity can be proven that is little benefit in waiting Or 36 weeks of gestation