宫内胎儿发育迟缓.pdf

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1、2/13/2014FetalGrowthRestrictionHishamArabConsultantOb/Gyn&PerinatologistJeddah,KSADEFINITIONS:a)Lowbirthweight(LBW)b)Verylowbirthweight(VLBW)c)Extremelylowbirthweight(ELBW)d)Prematuree)LargeforGestationalAge(LGA)f)SmallforGestationalAge(SGA)g)IntrauterineGrowthRetardation(IUGR)1

2、2/13/2014VariablesbehindNormalVariationofB.Wt.SexParityRacialandEthnicgroupAltitudeMaternalsizeNumberoffetusesFetalgrowthoccursin3phases:1.4-20weeks–rapidcellulardevelopmentwithmitosis2.20-28weeks–increaseincellularsizecombinedwithongoingmitosis.3.28-40weeks–cellsrapidlyin

3、creasinginsize,withpeakat33weeks.Inaddition,rapidaccumulationoffat,muscleandconnectivetissueoccurs.22/13/2014GrowthRestrictionGrowthinhibitionofAll3stagescausesSymmetricIUGRGrowthinhibitionduringstageII&IIIcauses•Decreaseofcellsize,i.e•Decreasedfetalweight•Lesseffectontotalcelln

4、umber,i.e•LowNormalfetallength•LowNormalheadcircumference•LeadingtoAsymmetricIUGR.SymmetricvsAsymmetricRelativelygreaterAllorgansdecreaseindecreasedabdominalproportionallysize(liverduetovolume/sqfat)hyperplasiathanhead(division)circumferenceimpairment(Redistributionofbloodflowto

5、head)32/13/2014CausesSymmetric:ConstitutionallysmallAneuploidy/congenitalanomaliesEarlyinfectionAsymmetric:SubstrateDeficiencyConditionsassociatedwithsymmetricIUGR:•Genetic-constitutional,chromosomalandsinglegenedefects,anddeletiondisordersandinbornerrorsofmetabolism.•Cong

6、enitalanomalies,•Intrauterineinfections•Others:substanceabuse,cigarettesmokingandtherapeuticirradiation42/13/2014ConditionsassociatedwithAsymmetricIUGR:Uteroplacentalinsufficiency-chronichypertension,-preeclampsia,-placentalinfarction,abruptioplacenta-velamentousinsertionoftheum

7、bilicalcordandcircumvallateplacentaMaternalillnesses-chronicrenaldisease,-cyanoticheartdisease,-hemoglobinopathies-substanceabuseandcigarettesmoking.GrowthvelocitySmallvsintroubleFalling%ilesshouldraisealarm52/13/2014GradesofIUGR<10thpercentileConstitutionallysmall(50–70%)J

8、ustmalnourishedIUGR<5thpercentile<3rdpercent