IUGR Babies whose birth weight is below the 10th percentile for their gestational age-SGA SGA-1.CONSTITUTIONALLY SMALL BUT HEALTHY 2.TRUE IUGR Growth restriction can occur in preterm,term or post term babies. IUGR-symmetrical/asymmetrical

IUGR symmetrical IUGR –uniform growth retardation-propotionally small.due to insult early in pregnancy-chemichal exposure,viral infection,inherent cellular developmental abnormality-aneuploidy. assymetric IUGR-dispropotionately lagging abdominal growth,defeciency of nutrients due to chr.placental insufficiency-pre eclampsia,malnutrition.placental insufficiency-marginal/velamentous insertion of cord,circumvallate/placenta previa Intrinsic IUGR ,extrinsic IUGR,combined IUGR, idiopathic IUGR. Incidence of IUGR is 2%-5%.

History Age-teenage and elderly gravidas-malnutrition,chronic vascular disease. Increased matenal age-^ risk of chromosomal abnormalities High altitudes-chronic hypoxia h/o consanguinity-since iugr is seen in congenital anomalies-cvs,renal and in familial chondrodystrophies,osteogenesis imperfecta. possibility of fetal congenital disorder should always be considered in idiopathic/unexplained IUGR. h/o loss of wt/absence of wt gain during pregnancy-lack of wt gain in 2nd trimester is strongly associated with decreased BW and iugr.

History h/o symptoms of malabsorption-steatorrhoea h/o drug intake-warfarin/phenytoin h/o symptoms of anaemia-fatigue,breathlessness,palpitations In most cases anemia does not cause IUGR.exception-sickle cell anemia.

History h/o symptoms of pre-eclampsia-before 37 weeks h/o symptoms suggestive of APLA syndrome-recurrent thrombotic events,recurrent pregnancy loss h/o infections-TORCH,parvovirus-direct infection of the fetus and placenta,chronic villitis,accelerated fetal metabolism-IUGR.infection with hepatitis A/B,congenital malaria,TB,syphilis CMV-cytolysis,loss of functional cells,rubella-vascular insufficiency due to endothelial damage

OBSTETRIC HISTORY- h/o iugr/stillbirths with small fetus/h/o IUD in previous pregnancy ^ incidence of stillbirth in IUGR.20-25% of stillbirths show IUGR. Fetal death in IUGR may occur at any time-more frequent >35 weeks h/o chromosomal abnormalities in previous pregnancy-chromosomal abnormalities cause altered placental function-fetal malnutrition.also affects fetal growth potential

PAST HISTORY h/o any chronic maternal vascular diseases-chronic hypertension,chronic renal disease,diabetes,connective tissue disorders(SLE),IDDM,sickle cell anaemia,heart disease -especially with superimposed pre eclampsia h/o congenital cyanotic heart disases-chronic hypoxia h/o tuberculosis,syphilis,malaria

h/o consumption of alcohol,IUGR found in 91% of fetal alcohol syndrome h/o Smoking -reduced intervillous blood flow,effect of carbon monoxide & thiocyanate on fetus-decreased prostacyclin synthesis. tobacco chewing gravidas,passive smokers also affected. reduction in BW by 150-400 gm at term H/o heroin,morphine ,cocaine use-direct effect on fetus,maternal malnutrition

Examination Small built women-racial,genetic factors-small babies-not worrisome. Look for maternal malnutrition-major cause in developing countries Maternal weight during pregnancy remains stationary or falls. Look for anemia,cyanosis,icterus, Signs of pre-eclampsia-edema,hypertension There is absence of normal trophoblastic invasion of the spiral arteries in cases of IUGR-similar to pre-eclampsia.the extent of this abnormality and the maternal compensatory mechanisms will determine manifestation as pre-eclampsia,IUGR,or both. CVS-evidence of heart disease

Examination Early establishment of gestational age-careful mesurement of uterine fundal height throughout pregnancy. Fundal ht is a reasonably accurate screening method to detect SGA fetuses-40% of such fetuses are identified. b/w 18-30 weeks-symphysiofundal ht jn cm coincides with weeks of gestation.if measurement is 2-3 cm less than expected-IUGR may be suspected. P/A-reduction in fundal ht - fundal ht falls below the 10th percentile

Examination Abdominal girth measurement shows stationary or falling values Oligohydramnios due to chronic placental insufficiency-uterus full of fetus. Cause of oligohydramnios-decreased urinary output caused by redistribution of bloodflow with preferential shunting to the brain and decreased renal perfusion Mild iugr-amniotic fluid may be normal. When AFI is normal,incidence of iugr-5%.when AFI was decreased incidence of iugr-40% Look for evidence of IUGR in multiple pregnancy-iugr of 1 or more fetuses is seen in 21% of the cases.reasons-abnormal placentation,abnormal placental vascular anastomoses.more seen in monochorionic placentation.