265861058-iugr-and-iufd

8/9/2019 265861058-Iugr-and-Iufd

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IUGR & IUFDDR. SALWA NEYAZICONSULTANT OBSTETRICIAN GYNECOLOGISTPEDIATRIC & ADOLESCENT GYNECOLOGIST

IUGRWhat is the definition of IUGR!" #$th %enti&e fo' a(e in%&)de no'*a& fet)ses at the&o+e' ends of the ('o+th %)',e - fet)ses +ith IUGRThis definition is not he&.f)& %&ini%a&&/!" 0th %enti&e fo' a(e !" 1'd %enti&e fo' a(e the *ost a..'o.'iate definition 2)tasso%iated +ith ad,e'se .e'inata& o)t%o*e

What is the defe'en%e 2et+een IUGR & SGASGA " #$th %enti&e fo' the .o.)&ation3 +hi%h *eans it isat the &o+e' end of the no'*a& dist'i2)tion ie.Constit)tiona&&/ s*a&& 2)t ha,e 'ea%hed thei' f)&& ('o+th.otentia&IUGR 4ai&)'e of the fet)s to %hie,e the e5.e%ted +ei(htfo' a (i,en (estation What a'e the %a)ses of IUGR!6ate'na& *edi%a& %onditions!Ch'o*oso*a& ano*a&ies &

ane).&oid/!Geneti% & St')%t)'a& ano*a&ies!E5.os)'e to d')(s & to5ins!#'/ .&a%enta& disease!E5t'e*es of *ate'na& a(e!Lo+ so%ioe%ono*i%stat)s

!Infe%tions!6)&ti.&e (estation

Whi%h *ate'na& *edi%a& %onditions 'es)&t in IUGR!7PT!PET!D6 +ith ,as%)&a' in,o&,e*ent!

SLE!Ane*ia

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!Si%8&e %e&& disease!Anti.hos.ho&i.id s/nd'o*e!Rena& disease!

6a&n)t'ition!Inf&a**ato'/ 2o+e& disease!Intestina& .a'asites!C/anoti% .)&*ona'/ disease 7o+ does the .&a%enta .&a/ a 'o&e in the de,e&o.*ent of IUGR!A2no'*a&ities in .&a%enta& de,e&o.*ent & t'o.ho2&ast in,asion Idio.athi% o' d)e to *ate'na& disease e(

SLE3 PET3 D63 7PT!Ch'oni% .a'tia& a2').tion!P&a%enta& infa'%ts!P&a%enta .'e,ia!Cho'ioan(io*a!Ci'%)*,a&&ate .&a%enta!P&a%enta& *osai%is*

!T+in to t+in t'ansf)sion S/nd'o*e What infe%tions 'es)&t in IUGRCon(enita& infe%tions9!C6:!R)2e&&a!7e'.es!:e'i%e&&a ;oste'!To5o.&as*osis!6a&a'ia!Liste'iosis0<#$= of IUGR Whi%h d')(s %an 'es)&t in IUGR!A&%oho&!

Ci(a'ette s*o8in( 1<>?!7e'oin & %o%%aine

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!6ethot'e5ate!Anti%on,)&sants!Wa'fa'in!

Antih/.e'tensi,es @A<2&o%8e's!C/%&os.o'in

What a'e the (eneti% diso'de's that %an 'es)&t in IUGR!Do+nBs s/nd'o*e TC#!T'iso*/ #13#D!T)'ne' s/nd'o*e!

Ne)'a& t)2e defe%ts!A%hond'o.&asia!Osteo(enisis i*.e'fe%ta!A2do*ina& +a&& defe%ts!D)odena& at'esia!Rena& a(enesis@ Pote'Bs S#0= of IUGR!

S/**et'i% IUGR!A4:@ Do..&e' N!St')%t)'a& a2no'*a&ities!6ate'na& a(e!N)%ha& t'ans&)%en%/!Bio%he*i%a& s%'eenin( 'es)&ts4eat)'es s)s.i%io)s of t'iso*/ Wh/ does *)&ti.&e .'e(nan%/ 'es)&t in IUGR!P&a%enta& ins)ffi%ien%/ @inadeE)ate .&a%enta&'ese',e to s)stain N ('o+th of F one fet)s!T+in to t+in t'ansf)sion s/nd'o*e!Ano*a&ies +ith hi(he' o'de' (estations *ono;/(oti% t+ins

What are the types of IUGR ?#<S/**et'i% GC$=

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!P'o.o'tionate de%'ease in *an/ o'(an +ei(hts in%&)din(the 2'ain!De.'i,ation o%%)'s ea'&/!The fet)s is *o'e &i8e&/ to ha,e an endo(eno)s defe%t that

.'e%&)de N de,e&o.*ent !U@S 2io*et'/ A&& *eas)'e*ents BPD3 4L3 AC

Types of IUGRC<As/**et'i% IUGRHD$=!Re&ati,e s.a'in( of the 2'ain!De.'i,ation o%%)''es in the &ate' ha&f of .'e(nan%/!

The infant is *o'e &i8e&/ to 2e N 2)t s*a&& in si;e d)e toint'a)te'ine de.'i,ation!U@S 2io*et'/ BPD3 4& N3 AC

Why IUGR often associated with olighydramnios ? 2&ood f&o+ to the &)n(s .)&*ona'/%ont'i2)tion to a*nioti% f&)id ,o&)*e2&ood f&o+ to the 8idne/s G4R

)'ine o)t.)t

It is .'esent in D$<I$= of IUGR fet)ses 7o+ to e,a&)ate a %ase of IUGR#<7isto'/9!C)''ent .'e( L6P3 .'e( test3 E)i%8enin(

AP73 a2').tio .&a%entae3 & feta& *o,e*ents!P'e,io)s o2stet'i% 75 .a'ti%)&a'&/ &oo8in( fo' IUGR3& ad,e'seo)t%o*e!6edi%a& 759 %onne%ti,e tiss)e diseases3 th'o*2oti% e,ents &endo%'ine diso'de's!75 of 'e%ent ,i'a& i&&ness!D')( 75!4a*i&/ 75 of %on(enita& a2no'*a&ities & th'o*2o.hi&ias E?A6INATION!S/*.h/sis f)nda& hei(ht in %* J (est a(e in +8s afte' C> +8!

Sensiti,it/ >K<DK= in dete%tin( IUGR!A diffe'en%e of *o'e than C%* 'eE)i'es feta& assess*ent

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!O&i(oh/d'a*nio)s *a/ 2e dete%ted on .a&.ationU@S!4eta& 2io*et'/ fo' datin( then se'ia& *eas)'e*ents!Ano*a&/ s%an

!A4 inde5!Do..&e' )*2i&i%a& a'te'/ 'esistan%e inde53 6CA!Re.eat tests e,e'/#<C +8s In,asi,e feta& testin(!A*nio%entesis o' .&a%enta& 2io.s/@ feta& 2&ood sa*.&in(fo' 8a'/ot/.in( if ane).&oid/ is s)s.e%tedfo' ,i'a& st)dies if infe%tions s)s.e%ted

!Ca'ies the 'is8s of infe%tion3 PRO63 P'ete'* &a2o'Ret'os.e%ti,e tests!6ate'na& 2&ood tests fo' C6:3 R)2e&&a3 To5o 6eta2o&i% diso'de's th'o*2o.hi&ia!P&a%enta sho)&d 2e sent fo' 7P!Post*o'te* e5a*ination The %onstit)tiona&&/ s*a&& fet)s

!A fet)s ('o+in( .a'a&&e& to the &o+e' %enti&es th'o)(h o)t .'e(!Anato*i%a&&/ N!A4: N!Do..&e' N!S&i* .etite +o*en Co*.&i%ations of IUGR!6ate'na& %o*.&i%ations d)e to )nde'&/in( disease 'is8 of CS!4eta& %o*.&i%ations Sti&&2i'th3 h/.o5ia@a%idosis3

*a&fo'*ations!Neonata& %o*.&i%ations 7/.o(&/%e*ia3 h/.o%a&%e*ia37/.o5ia & a%idosis3 h/.othe'*ia3 *e%oni)* as.i'ation 3Po&/%/the*ia3 h/.e'2i&i')2ine*ia3 se.sis3 &o+ APGAR s%o'e%on(enita& *a&fo'*ations3 a.nei% s.e&&s3 int)2ation s)dden infant death s/nd'o*e!

Lon( te'* %o*.&i%ations Lo+e' IL3 &ea'nin( & 2eha,io'P'o2&e*s3 *aMo' ne)'o&o(i%a& handi%a. sei;)'es3 %e'e2'a&Pa&s/3 *enta& 'eta'dation3 7PT

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!Pe'inata& *o'ta&i&it/ #.0<C?

T'eat*ent!Sto. s*o8in( @ a&%oho&!

Bed 'est )te'ine 2&ood f&o+ fo' .t +ith as/**et'i% IUGR!Lo+ dose as.i'in!Wee8&/ ,isits attention to 9 463 S473 *ate'na& +t3 BP3 CTG3 A4:!U@S e,e'/ C<> +8s!BPP!Cont'a%tion st'ess test

!De&i,e'/ 1D +8s o' ea'&ie' if the'e is feta& %o*.'o*ise!G&)%o%o'ti%oids if .&anin( de&i,e'/ 2efo'e 1> +8s!C&ose *onito'in( in &a2o'@ %ontin)o)s *onito'in( @s%a&. P7!CS *a/ 2e ne%essa'/ IU4DDia(nosisA2sen%e of )te'ine ('o+th

Se'ia& A<h%(Loss of feta& *o,e*entA2sen%e of feta& hea'tDisa..ea'an%e of the si(ns & s/*.to*s of .'e(nan%/?<'a/ S.a&din( si(n Ro2e'tBs si(nU@S #$$= a%%)'ate D5Definition9 dead fet)ses o' ne+2o'ns +ei(hin( F 0$$(*O' F C$ +8s (estation>.0 @ #$$$ tota& 2i'ths 4eta& %a)ses C0<>$=!Ch'o*oso*a& ano*a&ies!Bi'th defe%ts!Non i**)ne h/d'o.s!Infe%tionsP&a%enta& C0<10=!A2').tion!Co'd a%%idents

!P&a%enta& ins)ffi%ien%/!

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Int'a.a't)* as.h/5ia!P P'e,ia!T+in to t+in t'ansf)sion S!Ch'ioa*nionitis

6ate'na& 0<#$=!Anti.hos.ho&i.id anti2od/!D6!7PT!T'a)*a!A2no'*a& &a2o'!

Se.sis!A%idosis@ 7/.o5ia!Ute'ine ').t)'e!Postte'* .'e(nan%/!D')(s!Th'o*2o.hi&ia!C/anoti% hea't disease

!E.i&e.s/!Se,e'e ane*iaUne5.&ained C0<10=Ca)ses O4 IU4D A s/ste*ati% a..'oa%h to feta& death is ,a&)a2&e indete'*inin( the etio&o(/# < 7isto'/A<4a*i&/ histo'/!Re%)''ent a2o'tions!:TE@ PE!Con(enita& ano*a&ies!A2no'*a& 8a'/.t/.e!7e'edita'/ %onditions!De,e&o.*enta& de&a/B<6ate'na& 7isto'/I<6ate'na& *edi%a& %onditions!:TE@ PE!D6!7PT!Th'o*2o.hi&ia!SLE!A)toi**)ne disease

!Se,e'e Ane*ia!E.i&e.s/!Consan()init/

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!Co&o'<*e%oni)*3 2&ood!:o&)*eP&a%enta!Wei(ht

!Stainin(!Adhe'ent %&ots!St')%t)'a& a2no'*a&it/!:e&a*ento)s inse'tion!Ede*a@ h/d'o.i% %han(es6e*2'anes!

Stained!Thi%8enin( 1 < In,esti(ations6ate'na& in,esti(ations!CBC!B& G. & anti2od/ s%'een!7B A# C!N&eiha)e' Bat8e test!Se'o&o(i%a& s%'eenin( fo' R)2e&&a!C6:3 To5o3 S.h/&is3 7e'.es &Pa'o,i')s

!Na'/ot/.in( of 2oth .a'ents OR4L3Ba2/ +ith *a&fo'*ation!72 e&e%t'o.ho'e'sis!Anti.&ate&et an2in ti2odies!Th'o2o.hi&ia s%'eenin( Oantith'o*2inP'otein C & S 3 fa%to' I: &eiden3 4a%to' II *)tation3 3 &).)santi%oa()&ant3anti%a'do&i.in anti2odiesP!DIC4eta& in,es+ti(ations!4eta& a)to.s/!Na'/ot/.eO s.%i*en ta8en f'o* %o'd2&ood3 int'a%a'dia% 2&ood 32od/ f&)id3 s8in3 s.&een 3P&a%enta& +ed(e3 o' a*nioti%4&)id P!4eto('a.h/!Radio('a.h/P&a%enta& in,esti(ations!Cho'iono%it/ of .&a%enta in t+ins!Co'd th'o*2osis o' 8nots!Infa'%ts3 th'o*2osis3a2').tion3

!:as%)&a' *a&fo'*ations!Si(ns of infe%tion!Ba%te'ia& %)&t)'e fo' E%o&i3

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Liste'ia3 (. B st'.t . IU4D %o*.&i%ations!7/.ofi2'ino(ene*ia ><0 +8s afte' IU4D!Coa()&ation st)dies *)st 2e sta'ted C +8s afte' IU4D

!De&i,e'/ 2/ > +8s o' if fi2'ino(en " C$$*(@*& Ps/%ho&o(i%a& as.e%t & %o)nse&in(!A t'a)*eti% e,ent!Post<.a't)* de.'ession!An5iet/!Ps/%hothe'a./

!Re%)''en%e $<D= de.endin( on the %a)se of IU4D

265861058-iugr-and-iufd

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