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Old 05-26-2011
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ObGyn What is the cause of IUGR in this case?

A 23-year-old G1P0 woman at 28 weeks’ gestation presents to her obstetrician for a prenatal examination. She has received poor prenatal care up to this point, but is confident about dating the pregnancy. She denies use of alcohol and illicit drugs but has continued to smoke during the pregnancy. The mother has gained only 9 kg (20 lb) during the course of the pregnancy. The mother’s temperature is 36.8°C (98.2°F), pulse is 94/min, blood pressure is 138/84 mm Hg, and respiratory rate is 12/min. The fundal height is 23 cm above the pubic symphysis. Further examination with ultrasound reveals the fetus is <10% of the expected weight for the gestational age with symmetric growth anomalies. What is the most likely cause for the intrauterine growth restriction of this fetus?

A. Maternal smoking
B. Inadequate maternal weight gain during pregnancy
C. Maternal hypertension
D. In utero infection
E. Singleton pregnancy
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Old 05-26-2011
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Two good answers: smoking and IU infections. Not mention about infection, and so the answer must be smoking. NB. her BP is high though, but I'll stick to smoking as the most likely cause.


See below.


Many different things can lead to intrauterine growth restriction (IUGR). An unborn baby may not get enough oxygen and nutrition from the placenta during pregnancy because of:
  • High altitudes
  • Multiple pregnancy (twins, triplets, etc.)
  • Placenta problems
  • Preeclampsia or eclampsia
Congenital or chromosomal abnormalities are often associated with below-normal weight. Infections during pregnancy that affect the developing baby, such as rubella, cytomegalovirus, toxoplasmosis, and syphilis may also affect the weight of the developing baby.
Risk factors in the mother that may contribute to IUGR include:
  • Alcohol abuse
  • Clotting disorders
  • Drug addiction
  • High blood pressure or heart disease
  • Kidney disease
  • Poor nutrition
  • Smoking
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Old 05-26-2011
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Quote:
Originally Posted by Hohepa View Post
A 23-year-old G1P0 woman at 28 weeks’ gestation presents to her obstetrician for a prenatal examination. She has received poor prenatal care up to this point, but is confident about dating the pregnancy. She denies use of alcohol and illicit drugs but has continued to smoke during the pregnancy. The mother has gained only 9 kg (20 lb) during the course of the pregnancy. The mother’s temperature is 36.8°C (98.2°F), pulse is 94/min, blood pressure is 138/84 mm Hg, and respiratory rate is 12/min. The fundal height is 23 cm above the pubic symphysis. Further examination with ultrasound reveals the fetus is <10% of the expected weight for the gestational age with symmetric growth anomalies. What is the most likely cause for the intrauterine growth restriction of this fetus?

A. Maternal smoking
B. Inadequate maternal weight gain during pregnancy
C. Maternal hypertension
D. In utero infection
E. Singleton pregnancy
She is pregnant...then, 138/84 mm Hg = Hypertension = symmetric IUGR
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Old 05-27-2011
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I'd go with A. smoking
@bebix: Shouldn't BP be >140/90 to label her as having Gestational HTN?
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Quote:
Originally Posted by amu87 View Post
I'd go with A. smoking
@bebix: Shouldn't BP be >140/90 to label her as having Gestational HTN?
Yes, you are right, but my problem is that Smoking is a risk factor for asymmetric IUGR, and not symmetric
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Old 05-27-2011
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Thanks Bebix. I didn't notice symmetric/non-symmetric IUGR before!

Hohepa, could you confirm the answer?
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Old 05-27-2011
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same Question on this link
http://firstaidteam.com/2011/05/25/u...uestion-21134/

The correct answer is D. Causes of symmetric intrauterine growth restriction (IUGR) include in utero infection, multiple pregnancies, and maternal disease. Asymmetric IUGR is more often due to uteroplacental insufficiency from maternal hypertension, smoking, and poor nutrition. Since this fetus demonstrates symmetric growth restriction, the most likely cause of the IUGR is an early in-utero infection.

A is incorrect. Maternal smoking affects fetal growth by causing a relative uteroplacental insufficiency. The fetal nutritional requirements exceed the placenta’s ability to provide nutrients, especially later in pregnancy. Thus smoking is more likely to cause asymmetric IUGR.

B is incorrect. Inadequate weight gain inhibits growth by cellular hyperplasia, and causes asymmetric IUGR. However, because nutritional deficiency only affects cellular hyperplasia rather than division, it is more amenable to reversal if the nutritional deficit is corrected.

C is incorrect. Maternal hypertension, like smoking, causes IUGR through uteroplacental insufficiency. This is likely to cause asymmetric IUGR rather than the symmetric IUGR demonstrated in this child.

E is incorrect. Singleton pregnancy has not been shown to be a risk factor for IUGR. Rather, multiple gestations can lead to IUGR through decreased relative amount of nutrients available to each fetus.
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Old 05-28-2011
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Quote:
Originally Posted by amu87 View Post
same Question on this link
http://firstaidteam.com/2011/05/25/u...uestion-21134/

The correct answer is D. Causes of symmetric intrauterine growth restriction (IUGR) include in utero infection, multiple pregnancies, and maternal disease. Asymmetric IUGR is more often due to uteroplacental insufficiency from maternal hypertension, smoking, and poor nutrition. Since this fetus demonstrates symmetric growth restriction, the most likely cause of the IUGR is an early in-utero infection.

A is incorrect. Maternal smoking affects fetal growth by causing a relative uteroplacental insufficiency. The fetal nutritional requirements exceed the placenta’s ability to provide nutrients, especially later in pregnancy. Thus smoking is more likely to cause asymmetric IUGR.

B is incorrect. Inadequate weight gain inhibits growth by cellular hyperplasia, and causes asymmetric IUGR. However, because nutritional deficiency only affects cellular hyperplasia rather than division, it is more amenable to reversal if the nutritional deficit is corrected.

C is incorrect. Maternal hypertension, like smoking, causes IUGR through uteroplacental insufficiency. This is likely to cause asymmetric IUGR rather than the symmetric IUGR demonstrated in this child.

E is incorrect. Singleton pregnancy has not been shown to be a risk factor for IUGR. Rather, multiple gestations can lead to IUGR through decreased relative amount of nutrients available to each fetus.
perfect! thanks.
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Old 05-28-2011
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Thanks AMU87. Useful!

Useful link too!

Have a look guys!

http://firstaidteam.com/category/step-2-wed/
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