Fetal Growth Restriction

Front 1

Symmetric fetal growth restriction

Back 1

if fetus is normal, then consitutionally small,
may be result of intrinsic insult such as chromosomal abnormalities and congenital malformations
growth is symmetrical b/c insult happens when fetal growth occus by cell division
worse prognosis than asymmetric fetal growth restriction

Front 2

Asymmetric fetal growth restriction

Back 2

consequence of extrinsinc factors-inadequate substrate for growth and fetal metabolism (maternal vascular disease, decreased uteroplacental perfusion)
presents later in pregnancy

Front 3

Etiologies of fetal growth restriction

Back 3

maternal vascular disease (HTN, early severe pre-eclampsia)
DM
Collagen vascular disease
severe pulmonary disease
sickle cell disease
Maternal tx-chemotherapy
inflammatory bowl disease,
low maternal gain
substance abuse
magernal age<16, >35
low SES

Front 4

Fetal complications of growth restriction

Back 4

perinatal morbidity and mortality
variable decels in labor
increase c/s
sudden fetal death
polycythemia, hyperbilirubinemia, hypgoglycemia, hypothermia, apneic episode, sepsis

Front 5

Midwifery plan for suspected or documented FGR

Back 5

Diagnostic tests:
1)REview dating criteria for accurate GA
2)Serial u/s at least 3 weeks apart (BPD and abdominal growth most helpful)
3)Urine dip to r/o pre-eclampsia
Tx: 1)high protein diet
2)smoking cessation
Ed: 1)kick counts
2)nutritional counseling
F/U -consult with MD
q week in clinic,
Antenatal testing 2x week
Induction at term
Doppler flow studies q2-4 weeks
social work to address psychosocial factors