6. Stages
• Stage I (Hyperplasia)
- 4 to 20 weeks
- Rapid mitosis
- Increase of DNA content
7. Stages
• Stage II (Hyperplasia & Hypertrophy)
- 20 to 28 weeks
- Declining mitosis.
- Increase in cell size.
8. Stages
• Stage III ( Hypertrophy)
- 28 to 40 weeks
- Rapid increase in cell size.
- Rapid accumulation of fat, muscle and
connective tissue.
• 95% of fetal weight gain occurs during last
20 weeks of gestations.
13. FETAL FACTORS
• A Chromosome Defect In second trimester 20% SGA fetuses have
chromosomal abnormality
Triploid is most common under 26 wks.
Trisomy-18 is common after 26 wks .
Other are 21(Down’s syndrome), 16, 13, xo
(turner’s syndrome).
14. FETAL FACTORS
• Exposure to an infection• German measles (rubella),
cytomegalovirus, herpes simplex,
tuberculosis, syphilis, or toxoplasmosis,
TB, Malaria, Parvo virus
15. FETAL FACTORS
• birth defects
• (cardiovascular, renal, anencephally, limb
defect, etc).
• A primary disorder of bone or cartilage.
• A chronic lack of oxygen during
development (hypoxia
• Placenta or umbilical cord defects.
16. PLACENTAL FACTORS
• Uteroplacental Insufficiency
Resulting From -.
– Improper / inadequate trophoblastic
invasion and placentation in the first
trimester.
– Lateral insertion of placenta.
– Reduced maternal blood flow to the
placental bed.
17. PLACENTAL FACTORS
• Fetoplacetal Insufficiency Due To-.
– Vascular anomalies of placenta and
cord.
– Decreased placental functioning mass-.
• Small placenta, abruptio placenta,
placenta previa, post term pregnancy
20. Environmental Causes of IUGR
• High altitude - lower environmental oxygen
saturation
• Toxins
21. Types of IUGR
• Symmetric IUGR:
(33 % of IUGR Infants)
• Asymmetric IUGR
(55 % of IUGR)
• Combined type IUGR:
(12 % of IUGR)
22. SYMMETRICAL
• height, weight, head circ proportional
• early pregnancy insult:
• commonly due to congenital infection,
genetic disorder, or intrinsic factors
• Reduced no of cells in fetus
• normal ponderal index
• low risk of perinatal asphyxia
• low risk of hypoglycemia
23. PONDERAL INDEX
• The ponderal index is used determine
those infants whose soft tissue mass is
below normal for their stage of skeletal
development.
Ponderal Index =
birth weight x 100
crown-heel length
24. PONDERAL INDEX
• Typical values are 20 to 25.
• Those who have a ponderal index below
the 10th % can be classified as SGA
• PI is normal in symmetric IUGR.
• PI is low in asymmetric IUGR
25. ASSYMETRICAL
• later in pregnancy:
• commonly due to utero placental
insufficiency, maternal malnutrition,
hypoxia, or extrinsic factors
• low ponderal index
• Cell number remains same but size is
small
• increased risk of asphyxia
• increased risk of hypoglycemia
26. • Growth restriction in the stage of
hypertrophy
• Brain sparing effect
• Head growth remains normal but
abdominal girth slows down
27.
28.
29.
30. Newer Classification: 1. Normal Small Fetuses-
Have no structural abnormality,
normal umbilical artery & liquor but
wt., is less.
They are not at risk and do not need any
special care.
31. Abnormal Small Fetuses- have
chromosomal anomalies or structural
malformations. They are lost cases and
deserve termination as nothing can be
done.
Growth Restricted Fetuses- are due to
impaired placental function. Appropriate &
timely treatment or termination can
improve prospects.
36. • 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
37. PREDICTION OF IUGR
• History
risk factors
last menstrual period - most precise
size of uterus
time of quickening (detection of
fetal movements)
• Examination /
38. MATERNAL SERUM
SCREENING
• AFP
• more for gestation in the absence of fetal
anomaly, there is a 5-10 fold increase in
the risk of FGR
39. • Uterine Artery Doppler Velocimetry
- Notching of the waveform /reduce
EDF
associated 3-fold increase in risk of
FGR.
• Bright or echogenic fetal bowel in the
second trimester is associated with
increase risk of FGR.
40. • Combination of un-explain elevated
maternal AFP is powerful predictor of
adverse perinatal outcome (FGR)
• Increase AFP combine with echogenic
bowel is strong predictor of FGR
41.
42. • DOPPLER OF THE UMBILICAL ARTERY
• Reduced end diastolic flow.
•
Absent end diastolic flow
•
Reversed end diastolic flow( severe
cases)
43.
44. Problems
• Hypoxia
- Perinatal asphyxia
- Persistent pulmonary hypertension
- meconium aspiration
• Thermoregulation
- Hypothermia due to diminished
subcutaneous fat and elevated
surface/volume ratio
45. Metabolic
- Hypoglycemia
- result from inadequate glycogen
stores.
- diminished gluconeogenesis.
- increased BMR
- Hypocalcemia
- due to high serum glucagon level,
which stimulate calcitonin excretion
46. • Hematologic
- 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.
47. • Fetal distress,
• Hypoxia, Acidosis and Low Apgar Score
at birth.
Increased perinatal morbidity and mortality
•
Grade 3-4 intraventricular haemorrhage
•
Necrotizing enterocolitis
57. MEDICAL
• ASPIRIN THERAPY
• Other forms of treatment that have been
studied are
• nutritional supplementation,
• zinc supplementation,
• fish oil,
• hormones and
• oxygen therapy