Dr K.

Waqanisau Pre examination workshop 2013

 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

Serial scan with the normal chart or using the

customized chart Weight discordance of 20 to 25% (may differ with chorinicity)

 Biochemical marker HCG, inhibin A, and AFP is associated but their

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

It is more useful when used a serial plotting in a

graph Using the graph improved SGA detection from 29% to 54%
Growth

scan

Routine scan is not supported by evidence

Rather for pregnancy at high risk should have

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