iuggr

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Pathophysiology Pathophysiology 3) Placental Factors: Placental insufficiency ( most imp in 3 rd trimester) Anatomic problems: Multiple infarcts Aberrant cord insertions Umbilical vascular thrombosis & hemangiomas Premature placental separation Small Placenta

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iugr

Transcript of iuggr

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PathophysiologyPathophysiology

3) Placental Factors: Placental insufficiency ( most imp in 3rd trimester) Anatomic problems:

– Multiple infarcts– Aberrant cord insertions– Umbilical vascular thrombosis & hemangiomas– Premature placental separation– Small Placenta

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Postnatal AssessmentPostnatal Assessment

Growth parameters: weight, height, HCAssess GA with Ballard score.Plotted growth parameters in growth chart

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Physical AppearancePhysical Appearance

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Physical appearance:Physical appearance:

• Heads are disproportionately large for their trunks and extremities

• Facial appearance has been likened to that of a “wizened old man”.

• Long nails.• Scaphoid abdomen

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• Signs of recent wasting - soft tissue wasting - diminished skin fold thickness - decrease breast tissue - reduced thigh circumference

• Signs of long term growth failure - Widened skull sutures, large fontanelles - shortened crown – heel length - delayed development of epiphyses

• Comparison to premature infants,IUGR has brain and heart larger in proportion to the body weight, in contrast the liver, spleen, adrenals and thymus are smaller.

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ComplicationComplicationHypoxia

- Perinatal asphyxia- Persistent pulmonary hypertension- meconium aspiration

Thermoregulation- Hypothermia due to diminished subcutaneous fat and elevated surface/volume ratio

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ComplicationsComplications

Metabolic - Hypoglycemia

- result from inadequate glycogen stores.- diminished gluconeogenesis.- increased BMR

- Hypocalcemia- due to high serum glucagon level, which

stimulate calcitonin excretion

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ComplicationsComplicationsHematologic

- hyperviscosity and polycythemia due to increase erythropoietin level sec. to hypoxia

Immunologic- IUGR have increased protein catabolism and decreased in protein, prealbumin and immunoglobulins, which decreased humoral and cellular immunity.

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ManagementManagementAntenatal diagnosis and management is the

key to proper management of IUGRDelivery and Resuscitation

- appropriate timing of delivery- skilled resuscitation should be available- prevention of heat loss

Hypoglycemia- close monitoring of blood glucose- early treatment ( IV dextrose, early feeding )

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ManagementManagement Hematological Disorder

- central Hct to detect polycythemia- CBC with diff to r/o leukopenia or thrombocytopenia

Congenital infection- infant should be examined for signs of congenital infection (eg.rash, microcephaly hepatosplenomegaly, lymphadenopathy, cardiac anomalies etc….)- TORCH titer screening- Viral cx of urine, nasopharynx- Head CT to r/o calcification

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ManagementManagementGenetic anomalies

- screening as indicated by physical exam- chromosomal analysis (infant with dysmorphic features)

Others- serum calcium to r/o hypocalcemia- fractionated bilirubin sec to polycythmia, congenital infection- urine, meconium tox for substance abuse

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ManagementManagement

Early feeding and caloric intake should be 100-120 kcal/kg/d

Developmental and growth f/u in all IUGR infants

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OutcomeOutcome

Symmetric vs. Asymmetric IUGR- symmetric has poor outcome compare to asymmetric

Preterm IUGR has high incidence of abnormalities IUGR with chromosomal disease has 100%

incidence of handicap Congenital infection has poor outcome - handicap

rate > 50% IUGR has higher rate of learning disability.

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Thank YouThank You