INTRA- UTERINE GROWTH RESTRICTION AND
FOETAL MONITORING.
The foetus grows in 3 phases: 1st 16
weeks – increase in cell no ( hyperplasia)
2nd
16 weeks – hyperplasia of hypertrophy
3rd
16 week- Hypertrophy
studies
have also shown that there is a slowing down of growth at about 38weeks. This
does not occur in other species ( growth
continues). Early in pregnane, the foetal genoma determine the growth rate, but later, environment of
nutritional factors become important.
GROWTH RESTRICTED BABY: one that has been prevented by certain factors
from achieving the optimal growth
potential.
Why
study them. Because they are at increased risk of IUD and morbidity. In 1963, intra-uterine
death. In 1963, a research
lenchenka to his collegues did a
lot of study on foetal growth rate. SGA.
Howere, may of those indant were appropriately grow when consideration was taken of ethnic factors, parity, weight
and height of mother. Therefore, SGA is
not the same as IUG restriction.
However,
various definitions have been used to classity IUGR. When using the 3rd
percentile 3% of babies are growth
restricted.
When
2 SD2 are used (statistics),
incidence is 3%.
RISK FACTORS:
Constitutionally
small mothers weighty of loss then 100 pounds
for a women doubles the risk of IUGR.
A
treatment of IUGR of the mother.
Poor
maternal nutrition.
Social
deprivation (low socio- economic class,
drunkard, smokers, drug abuses).
Foctal
infections (Rubella, Toxophsmosis, CVIN) congenital abnormalities, chromosomal
aneuploidies
Pre-pedantic
taxonomic
Anocmia
esp SCD
Multiple gestation.
Chronic hypoxia
Teratogens
( cigaretle, coconia, alcohol)
Renal
dz Via HTN
Placental
abnormalities
IDENTIFICATION
Weight
gain in anle-natal clinic, symplysiotundal height oncesarement ( b/w 18 weeks
of 30 weeks, the gestation age should c correspond to symphysiotundal height
measurement. It a difference of > 2-3cm exists, IUGR should be suspected).
Serial
sonograms.
Doppler
venosymactry (Reside flow pattern or absent end diastolic flow is
abnormal)
TYPES OF IUGR – 2 types
Asymmetrical:
Head is big; abdomen is small.
Symmetrical:
Baby is general small
Generally,
symmetrical GR is due to an early insult, affecting the all no of size. Could
be due to viruses, chromosomal abnormalities or chemical explosive. Both Head
circumference to abnormal circumference are reduces.
In
asynetrial GR, the insult occurs later to effect fractal size eg pre-eclampsia
the theory is that when the insult occurs, to protect the head, blood or nutrients are diverted to the head of ad these expense of the liver
to other organs. However, this is a simplistic view as since observation show
that this is not always the case. A scientist Dashe et al showed that
asymmetrical GR babies have on increase
in intrapartum & neoratal complication of concluded that asymmetrical GR
babies have on increase in intropartum & neoriatal complication of
concluded that asymmetrical GR babies
represent fretuses with significantly disordered growth, while symetiral GR
babies more likely represented genetic small sized babies.
METABOLIC ABNORMALITIES SEEN IN IUGR.
Hypoplycamisea
Hypoxemia
Increased
trigylyceride levels became they burn fat for energy ( Ration of nonessential:
essential AAS in increased, (Ze in Koashioker).
MANAGEMENT
It discover near tern, confirm the diagnosis,
assesses factual condition evaluate for abnonalities. It every this other
things is okey, deliver at 34 wks vaginally if foctal heart assessment is reassuring Otherwise, do a C/s.
If
discovered far away from term (eg <
32 weeks).
Excludes
anomalies.
Assess
amniotic fluid
Fetal
surveitance by USS:- Co
Give
bedrest.
Nutrient
supplementation.
02
Heparin
Volume
expansion
Aspirin
Anti-hypertensive
Manage
conservatively
Do
stress tests
Doppler
Studies
show that morbidity to mortality depend on birth weight and on the result
precautions in labour. Intensive monitoring.
Inoased
rate of C/S
Pediatricians
should alwaysbe informal so as to receive the baby fetus comdly soffer:
hypoxic, mecorium, aspiration, hypothermia, pohycytheamia, Namibia
If
there no gente abnormally, most babies anlogo catch-up growth.
IMPLICATION FOR MOTHER
Adult
HTN
Atheroselerosis
Increased
risk of ischaemic heart dz showing flat some gmatic factors are working in both
paties).
ANTE- PARTUM FOETAL
The
goal is to present focted death. If we test is reassuring because it is unlikely.
For the tocts to dis with 7 days.
METHOD.
Sonicaid
Rnnard
Stethoscope
Foctal
mout of breathing
Stress
test
Non-
Stress test.
Biophysical
profile
Amniotic
fluid vol
Inbilical
venosymnetry.
Foctal
heard with pinard stethos cepie) : university applicable, low costy tells that
foctus is alive, but not how well, measured every 15 mins.
Foctal mort may be used. Where a women
has HTN , she should be asked to
count the no of tones a baby moves in a
cortain period at time. More considered 10 moots in 2 hrs a normal. However, in
ante-natals severance, movement/hr is
normal.
Foetal
breathing may be used: Needs as
ultrasured of a lot of time. Stress test: 2 types for the foetus. It measure
the response of the foetal heart to
contractions, in duced by oxytocin ( oxytocin challenge test). Or nipple stimulation (which cause oxytions
release, which causes uterine
contractions). With contractions, myometrial pressure exceeds collapsing
pressure of the foetal ussel, there is
disease in bld flow in intravenous space, resulting in short period of 02
defienecy if utero- parented
pathology is present, it elicits foctal heart deceleration. If not present, no
significant heart deceleration occur. The stress tests have largely been abandoned in most
places.
Non- stress tests measure, response at
foctal heart rate to foctal movement as a sign of total health. The
foctal HR is constrained by the sym :- presage (e autonomic). The non- stress
test is based in the hypothesis that a non- aciditie (health) foctal with temporally accelerat on movement of these movements are identified by the
mother, of the tiabatl HR is recorded
electronically.
INTERPRETATION: Normal
Accelerations that occur without
movement are also corded as normal.
DISADVANTAGES: Time consuming.
Interpellation is difficult (prompting
interpretations, which are more reliable). Acoustic stimulation test (external
source of sound of sound is used to strith the foctus, proverbs acceleration).
BIOPHYSICAL PROFILE: for assessing babies veror 5 paranets are used (
scoral zero to 2).
1. Foctal bredhing
2. Foctal movement
3. foctal tone
4. Nonstress tests
5. amniotic fluid volume.
Seores
of 8- 10 are very, good
Seores
of 6 are poor
Seores
of 0 indicated death.
AMNIOTIC FUND VOLUME
Used
to asses foctal health. Based on the fact that decreased utero-placental
perfusion, there is decreased renal flow, causing decrease urine production & reduced amniotic fluid (which
is usually a bed sign).
Measurement
of Amniotic fluid volume: Measure height of deepest packed: Normal
<
2 is oligohydramnions
<
8 is Polyhydramnions
UMBILICAL ARTERY DOPPLER
Abnormal
patterns: Absent diastolic or reversed diastolic flow
INTRA-PARTUM: ASSESSMENT.
Poniard
stath.
External
electronic
Factual
scale electrodes
Others
(scalp stimulation, accust stimulation, fetal ECG, intra-patum Doppler
Uewsynety in labour, observe once every is miniutes- poniard.
External
monitor: A sensor which commit ultrasound waves is strapped to the abdomen the
weight hits the foctal heard, because of Dapper principle, these is a shift in frequency.
The
pattern and priated out
continuously on a monitor this an be
used even when the membrane have not ruptured.
Internal
monitor;: when membranes rupture, use FSC
(attached to scalp or breach). I t monitors focted ECG, which is
amplified of converted tectonically to a chart.
Although the maternal ECG, which at electrodes to scalp. Problem may
arises base of mother dies, the electrode will pick of that of mother.
Foctal
scalp sampling 9 when there is an inconclusive bal sign, user this) . An
ithemuipted is inserted via dilated cervix
after membrane rupture. Places on foctal scalp. Skin is wiped with silica gol
of a drop of blood is collected fro Ph.
pH
7.2-7.25 repeat in 30 mins
pH
of 7.25- repeats.
pH < 7.2- organic for immediate CS
OBSERVATIONS IN FOCTAL HEART MONITORING
Bradycardia.
Caused by head compression, foctal distresa heart black, abruption, maternal
hypothermia, sever pydonephritis.
Tachycardia:
maternal fever of infections, Foctal
compromise (distress) , drugs (
e,g. atropine & Terbutaline).
Loss
of beast to – beast variation can ominous- bat sign) is the single most reliable evidence of foctal compromise. Can be due to foctal distress, academies drugs (anaglesica,
phenothiazens, barbiturates) prescribed in labour.
Periodic foctal heart changes: change related to contraction.
Acceleration
could be due to movement, uterine contractile, foctal blood sampling, acoustic stimulation. It is
generally reassuring.
Decelerations:
there are 3 types.
a.
Early ( type I)
desideration: Deceleration starts just as contraptions starts – not a bed sign
.
b.
Late (type II).
Deceleration. Deceleration starts
Type
I is not associated with hypoxia,
academia or low types scores.
Type
II decelerations are consequence at utero- planted induced hypoxial cause., include placental
dysfunction, material H.T.N, Dm to chronic Anoemia.
Variable
(type III) deceleration: not related to contraction. It is a bed sign caused by
card compression.
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July 08, 2015
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