refrat iugr

8/13/2019 Refrat IUGR

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DEFINISI

IUGR

• terjadi apabila janin yang belum lahirmemiliki berat pada atau dibawah 10persentil di usia kehamilan saat itu (dalam

minggu). Janin tersebut dipengaruhi olehkeadaan patologi sehingga untukkemampuan berkembang terhambat

•

Berat badan lahir rendah (BBLR): bayidengan berat lahir kurang dari 2500 gramyang dapat berarti mengalami IUGR atauprematuritas



Pendahuluan

↑ Perinatal mortalitas and short- and long-termMorbiditas

Fetal Growth Disorder

Intrauterine Growth Restriction(IUGR)

Macrosomia

Disturbance of normal fetal growth Abnormal

Weight Body massbody proportion at

birth

www.themegallery.com



Pendahuluan

Sebelum ada ANTENATAL ULTRASOUND PertumbuhanJanin Diklasifikasikan dengan BERAT BADAN BAYI

• Macrosomia (>4000 g),

• BBLR <2500 g

• BBLSR <1500 g

•

BBLASR

<1000 g

Lubchenco and colleagues

• Sangat Kecil Masa Kehamilan (SKMK), very small for gestational age(VSGA) : < 3 persentil

• Kecil Masa kehamilan (KMK), Small for gestaational age (SGA) : < 10persentil

• Sesuai Masa Kehamilan (SMK), Appropiate for gestaational age (AGA) :10 – 90 persentil

• Besar Masa kehamilan (BMK), Large for gestaational age (LGA) : > 90persentil




REGULASI Pertumbuhan Janin

Coordinate Placental and Fetal Growth

Trimester 1 blastocyst adherence and implantation placental vascular development

Transport Nutrients and Oxygen growing trophoblast

differentiation of placentatransport mechanisms

activation of paracrine and endocrinesignaling pathways between the mother,the placenta, and the fetus

Successful Placentation

development of maternal andfetal vascular supply

synthetic activity of the placenta establishment of transplacentalcarrier proteins for substrates

Pertumbuhan Janin

Maternal Placental Fetal compartments




Pola Pertumbuhan

• hyperplasiaTrimester1

• Hyperplasia

• hypertrophyTrimester

2

• hypertrophyTrimester3




KECEPATAN PERTUMBUHAN

BERAT BADAN

1. 0-15 minggu : 10 gr/minggu2. 16-27 minggu : 85 gr/minggu

3. 28-37 minggu : 200 gr/minggu

4. 38-42 minggu : 70 gr/minggu

• 20 minggu – berat 10%

• 28 minggu – kecepatan tumbuh maksimal,

berat badan 1.000 gr

• Mempertahankan partus prematurus meskipun

hanya beberapa minggu penting!!



Etiologi




Patofisiologi

www.themegallery.comand nutrient exchange decreases

Which is the metabolically active placental mass

fetoplacental flow resistance is increased throughout the vascular bed,

With progressive vascular occlusion

↓effective exchange area

producing a maternal-fetal placental perfusion mismatch

obliteration and fibrosis increase placental blood flow resistance

Maternal placental floor infarcts and fetal villous

placental autoregulation becomes deficient

hypoxia-stimulated angiogenesis is inadequate

increases vascular reactivity

expression of vasoactive substances

Mechanism s of Placenta l Dysfunct ion



Metabo l ic and Cel lular Effects o f

Placental Dys funct ion

and affects cellular and functional differentiation in many target organs.

limits fetal growth

Placenta and fetus do not reach their size potential

Fetal hypoxemia and protein energy malnutrition

Inability to establish essential adipose stores

Proteins are catabolized to gluconeogenic amino acids

Nutrient supply worsens

Fetal hypoglycemia

fetal oxygen uptake is reduced

↓(0.6 mmol/min/kg fetal body weight)

Oxygen delivery + Substrate Delivery




Fetal Response in Major Organ

Systems

Delayed maturation of several fetal behaviorsappearance of movement, to

coupling and cyclicity of behavior

integration of movement patterns

into stable behavioral states

autonomic reflexessuperimposed on intrinsic

cardiac activity fetal heart rate

Progressive degrees of placental

vascular damage

Mild placental dysfunction

Cardiovascular and central nervous system functionsplacentalresistance

fetaloxygenation

organautoregulation

Vascularreactivity




Fetal Decompensat ion

Multiple-organ failureMetabolic

abnormalitiesacidemiaworsens

↑ risks ofintrauterine

damage

perinatal deathincrease

LOSS OF CARDIOVASCULARHOMEOSTASIS

Placental dysfunction progressive and sustained

Exhausted Decompensation




Screening

•

Pengukuran TFUKlinis

• estriol

• human placental lactogen (hPL)

• human chorionic gonadotropin (hCG)

• α-fetoprotein (AFP)

Biokimia

• Placental and Fetal Doppler Studies

• Pada usia kehamilan 22 dan 23 mingguUterine Artery

Doppler

• BIPARIETAL DIAMETER

• Lingkar Kepala

• Lingkar Abdominal

• Sonographic Estimate of Fetal Weight

Pengukuran




Klasifikasi

IUGR

Symmetric

< 20 minggu

Hyperplasia

asymmetric

>20 minggu

Hypertrophy

decreasednutrition and

oxygen




Diagnosis Dan Evaluasi

Maternal History and Examination

• Maternal medical

• Medication

• Obstetric histories

Two-Dimensional Ultrasound

• Assessment of Fetal Size

Doppler Velocimetry of Arterial and Venous Circulation

Computerized Cardiotocography and Biophysical ProfileScore




Diagnosis dan Evaluasi




Terapi

↓ potential external contributors• stress

• Smoking

maternal rest

• Lateral position

↑ Fetal oxygen and substrate delivery

• Maternal hyperoxygenation

• Intravascular volume expansion

Pharmacology

• low-dose aspirin therapy (81 mg/day) Mild IUGR

• Antenatal corticosteroids any fetus with IUGR when

delivery is anticipated before 34 weeks www.themegallery.com



Tim ing and Mode o f Del ivery

High RISKfetal acidemia

spontaneous latedecelerations

late decelerations withminimal uterine activity

SC

Low RISKfetal testing lessserious conditions

Gestational age ismore advanced

Per Vaginam


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