IUGR & IUFD

Adrian Goenawan, M.D.

References
Cunningham, F. Gary, et al. Williams Obstetrics,
24th Edition. McGraw Hill Education, 2014.

Callen, Peter W. Ultrasonography in Obstetrics and

Gynecology, 6th ed. Saunders Elsevier, 2016
IUGR
 Fetal Growth
1. ~16 weeks -­‐> hyperplasia
2. 16 – 32 weeks  hyperplasia and
hypertrophy
3. >32 weeks -­‐> hypertrophy
 Fetal Growth
1. 5 g/day at 15 weeks
2. 15 – 20 g/day at 24 weeks
3. 30 – 35 g/day at 34 weeks
 EFW
• Johnson’s formula
• Ultrasound
 Fetal Growth
• Example:
Fetal Growth
 Definition

IUGR SGA
 IUGR
• Symmetrical IUGR  chronic or normal???
• Asymmetrical IUGR  acute onset
Risk Factor
 Recognition of Suspected IUGR
• Uterine Fundal Height
• Fetal biometry
– BPD
– HC
– AC
– FL
– HC/AC ratio
• Doppler velocimetry
• Amniotic Fluid Index  Oligohydramnios
 Umbilical Artery
• Reflects the status of placental circulation
Umbilical Artery
Middle Cerebral Artery
 Uterine Artery
• Reflects the uterine circulation
Uterine Artery
 Middle Cerebral Artery
• Most accessible cerebral vessel
• Carrying 80% of cerebral blood flow
Middle Cerebral Artery
Middle Cerebral Artery
 Ductus Venosus
• Reflects the status of oxygenated blood
carried to the right ventricle
Ductus Venosus
 Brain sparring
• Preferential shutting of oxygen and nutrients
to the brain
• MCA / UA < 1
IUFD
 IUFD
• Death prior to complete expulsion or extraction
from the mother of a product of human
conception irrespective of the duration of
pregnancy and which is not an induced
termination of pregnancy
• The death is indicated by the fact that after such
expulsion or extraction, the fetus does not
breathe or show any other evidence of life such
as beating of the heart, pulsation of the umbilical
cord, or definite movement of voluntary muscles
 IUFD
• 0.5 – 1% of pregnancies (1 : 1.000 term births)
• Risk factors:
– Advance maternal age
– Smoking / illicit drug use
– Maternal disease
– ART
– Nulliparity
– Obesity
– Previous adverse pregnancy outcomes
Cause
 IUFD
• Retained IUFD >3-­‐4 weeks 
hypofibrinogenemia, sometimes lead to DIC
Documentation

2 Clinicians
Documentation
Investigation
 Investigation
• Bullae in epidermis (leading to peeling):
appear at about 24 hours
• Hemoglobin staining of internal viscera (loss
of normal color): 24-­‐48 hours
• Separation of dura from calvarium bone: 5+
days
 Investigation
• Hematology and coagulation testing
• Biochemistry, including liver function
• Thrombophilia screening, including
antiphospholipid antibodies
• Infection and serological testing
• Blood group and antibody
screening
• Parental karyotyping (when
indicated)
Investigation
 Delivery
• Discuss with the patient for mode of delivery