IUGR

APLA thrombosis at the level of the spiral arteries

IUGR = SGA + growth curve not gaining up

fl = fetal lenght

ac = abdominal cricmference

hc = head circmference

bpd = bi pareital diameter

2 reasons why abdomen is larger in uetro placental insifficiecy and assymetric iugr 1. the fetus priotitises rhe head 2 glycgen and fat deposites are mainly made in the last part so this wont be made

The case of iugr falls under fundus less than dates!! Theres other causes for this apart from iugr.

ultra sound reports for the following ⇒

constituinally small ⇒ all parameters decresed by the same amount

Symmtreic urgr ⇒ head is small

Assymetric igr ⇒ abdomen is small

symmetric iugr vs constitiouonally small?

First see whether AB is disproprionately smaller. If that then assymtreic IUGR. IF everything smaller, then can be constiotuionaly small or can be due to IUGR. To diffeirenciate between the two must take serial ultra sound growth measurement. In constituionally small it will change at the same pace. If symmetric iugr then it will keep getting slower. Must repeat after 4 weeks. because smaller interverals isnt sensitive enough.

Same growth rate as change with abscence of evidence of uetrplacental insufficiency is constituionally small.

Two difs 1. growth rate 2 evidence of uetroplacntal insifficiency.

In fetal doppler we assess the blood flow of the fetus ⇒ primarily the umbilical artery one.

It is different from the routine untrasound grey scan

Intervillous soaces are perfused by the spiral maternal arterioles.

60-70% of placental circulation is compromised (yaing about maternal perfusion) due to teroplacental insufficency then it leads to deranged doppllers

want to dagnose when the umbilical artery changes are only there. Otherwise very late.

Normally always there is a forward flow...even during diastole

decrease in diastolic flow 2. absent end diastolic flow 3 reserved ebd diasoltic flow

(uteroplacental insufficency)

2 and 3 are very bad chances but doesnt show impeding fetal death or preterminal changes whihc is later (reversal + pulsations).cause after 2 and 3 leads to fetal heart failure and then the other changes

Descreased systolic blood flow too THESE ARE IMPORTANT TO TIME THE DELIVERY. Pros of keeping it in because it wil help fetus grow and taking it out before uteropacenta insufficiency kills it.

Because delivering too soon is a double sword...preterm + iugr.

SO ONLY DELIVER WHEN DOPPLER SUGGESTS THAT ITS BECOMING TOO HOSTILE AN ENVIORNMENT FOR THE FETUS TO BE IN. then delvering preterm is okay.

There is other stuff that has been tried but none of that ha been proven to have worked so far. only lateral position rest.

IF ctg is non reactive, then can deliver immeidtely terminating conservative management

even if 32 weeks, just start steroids and immidately deliver.

If very less like 26, 28 then must look case by case. Taking out can be disastrous and even keeping inside can be disastrous. So then intensify monitoring and do doppler of the vein and others?

for this poor obstrectic outcome reason, would preer to deliver ceasrian section.

poor obstrective outcome is about deivery not long term porspects of life

Modified Biophysical Profile = NST + AFI

CDG vs NST

the 34 week cut off for lung maturity differs from region to region. some guidelines usw 35 weeks + 6 days.

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repeated deceleration should be associated with contractions, nothing else.