1. Dr. Madhavi Karki

7. SYMMETRICAL IUGR
ASYMMETRICAL IUGR
EARLY ONSET. SEEN IN 20% CASES
LATE ONSET. SEEN IN 80% CASES
ETIOLOGY: GENETIC DISEASE/ INFECTION (INTRINSIC TO FETUS)
ETIOLOGY: CHRONIC PLACENTAL INSUFFICIENCY(EXTRINSIC TO FETUS)
TOTAL CELL NUMBER : LESS, CELL SIZE : NORMAL
TOTAL CELL NUMBER : NORMAL, CELL SIZE : SMALLER
USG : ALL PARAMETERS (HC, BPD, AC, FL) SMALLER THAN EXPECTED
USG : HEAD SPARING EFFECT, BUT ABDOMEN IS SMALL
NEONATAL COURSE: COMPLICATED WITH POOR Px
USUALLY UNCOMPLICATED HAVING GOOD Px

10. BIOPHYSICAL TEST : THE FIRST EXAM SHOULD CONFIRM THE CLINICAL
ESTIMATION OF THE GESTATIONAL AGE

12. Fetal distress / death.
Asphyxia & RDS.
Hypoglycemia.
Meconium aspiration syndrome.
Hypothermia.
Pulmonary hemorrhage.
May have retarded growth .
May have cardiac disease, diabetes, in adulthood, if survives.
Long term complications Lower IQ, learning & behavior problems, major neurological handicap seizures, cerebral palsy, mental retardation

13. Adequate bed rest.
Nutritional diet / iron, vitamins, calcium.
No smoking / alcohol allowed.
Aspirin in low dose (50 mg daily).
Ultrasound monitoring of fetus should be done every 4th wks.
Termination of pregnancy – beyond 37 week.
Before 37 week – conservative t/t to increase placental function till fetus becomes viable.

14. Severe degree of IUGR – termination is to be done if lung maturation is achieved.
- If lung maturation has not been achieved corticosteroid therapy (betnasol 12 mg i.m. 24 hrs apart – 2 doses given to reduce the risk of neonatal RDS)
9. CS – to be done in the case of preterm delivery & unfavorable cervix.
10. Baby should be shifted to intensive neonatal care unit.

16. ETIOLOGY 1. Preeclampsia/ eclampsia 2. A.P.H. 3. Diabetes
4. Severe anemia
5. Hyperpyrexia/Malaria
6. TORCH infections
8. Fetal malformations
9. Rh-incompatibility
10.Iatrogenic