YT YouTube2Text

YouTube2Text → Transcripts → Fetal Growth Restriction (FGR, IUGR) | Types, Causes, TORCH Infections, Diagnosis, Treatment

Fetal Growth Restriction (FGR, IUGR) | Types, Causes, TORCH Infections, Diagnosis, Treatment — Transcript

by JJ Medicine · 2,964 words · 456 segments · language en · Watch on YouTube

Open in transcriber Summarize with AI Download SRT/VTT

Full transcript

0:00hi everyone this lesson is on fetal
0:02growth restriction in this list we're
0:04going to talk about what this is some of
0:06the causes of fetal growth restriction
0:08we'll also talk about the types of fetal
0:09growth restriction how it's diagnosed
0:11and how it's treated so fetal growth
0:14restriction is also known as
0:15intrauterine growth restriction or iugr
0:19it is an obstetrical condition involving
0:21significantly low birth weight but more
0:23specifically it's defined as a fetal
0:25weight that is less than the 10th
0:27percentile for gestational age or if it
0:30is a full-term infant that weighs less
0:32than 2500 grams so although this is the
0:35definition for fetal growth restriction
0:37what's more important to recognize here
0:40is that it is where a fetus or infant
0:42does not grow to their genetic potential
0:44because we can also see very small
0:47fetuses or infants with a very low birth
0:50weight in fact they may have less than
0:52the 10th percentile for gestational age
0:53or be less than 2500 grams when they are
0:57full term but that may be normal for
0:59some individuals because that would be
1:01considered small for gestational age but
1:03fetal growth restriction is not the same
1:05as small for gestational age because
1:06when looking at the genetic potential
1:08the potential for growth of the infant
1:10they're not meeting their potential so
1:12there's some cause that is impairing
1:14their ability to grow and that's what's
1:16going to be very key with this condition
1:18so there are some infants that are going
1:21to be constitutionally small for their
1:24age or in relation to other infants but
1:27that is going to be normal for them but
1:28in this Condition it's going to be where
1:30the fetus or infant is going to be very
1:32small for their age they're not growing
1:34to their genetic potential because of
1:36some other cause and we're going to talk
1:37about those causes in the next slide so
1:39fetal growth restriction is estimated to
1:41affect three to seven percent of all
1:43pregnancies it's also going to be more
1:45common in developing nations and in
1:46particular it's even more common in
1:48certain Asian countries in approximately
1:5140 percent of fetal growth restriction
1:53cases are idiopathic meaning that the
1:55underlying cause is not known or not
1:57identified let's talk about those
1:59potential causes of fetal growth
2:02restriction so the causes of fetal
2:04growth restriction are broken down into
2:05three categories of causes one category
2:08is going to be maternal causes the
2:10second category is going to be placental
2:11causes and the third category is going
2:13to be fetal causes so in the category of
2:15maternal causes these are going to
2:17include issues with the mother so so
2:19these are going to include malnutrition
2:21smoking substance abuse alcoholism which
2:24can lead to fetal alcohol syndrome in
2:27the fetus diabetes especially type 1
2:29diabetes chronic hypertension autoimmune
2:32conditions like lupus hematological
2:34disorders like certain thrombophilia
2:36conditions and a previous history of
2:39fetal growth restriction so these are
2:41all going to be potential causes in the
2:43maternal category in the placental
2:44category it's all about placental
2:46insufficiency so not enough exchange of
2:48gases and nutrients across the placenta
2:51so there's some issue with the placenta
2:53and the causes in this category can be
2:56gestational hypertension chronic kidney
2:58disease placenta previous so this is
3:00where the placenta is too close to the
3:01internal cervical loss if there are any
3:04issues with cord insertion or any cord
3:06abnormality so this would be the
3:08umbilical cord if there's an abnormal
3:10umbilical cord insertion or any other
3:12abnormalities with regards to the
3:14umbilical cord there can be issues with
3:15transfer and exchange of nutrients and
3:18gases if there's prolonged gestation and
3:21if there is preeclampsia these can also
3:23be causes within the placental category
3:25and in the fetal category of causes we
3:28have multiple gestation so this is where
3:30there are multiple fetuses so there
3:33could be twins or triplets congenital
3:34disorders these could be different
3:36Trisomy disorders like Trisomy 13 or
3:38Trisomy 18 and then the torch infections
3:41so the torch infections are going to be
3:42a list of important infections that can
3:46cause fetal growth restriction and they
3:48are remembered by the mnemonic porch so
3:51T is for toxoplasmosis O is for other
3:53and this is mostly going to refer to
3:55syphilis R is for rubella C is for
3:58cytomegalovirus or CMV and H is for
4:00herpes simplex virus or HSV so these are
4:03the torch infections that can cause
4:04fetal growth restriction as well so
4:07fetal growth again is going to require
4:09adequate gas exchange in nutrient
4:12delivery so if there's not enough gas
4:13exchange or it's reduced for some reason
4:15or if there's some reduction in nutrient
4:18delivery either of these could be due to
4:21placental insufficiency some of those
4:22causes we talked about before or if the
4:25pregnant patient smokes or has some
4:27other health condition or is using
4:30substances that impair gas exchange or
4:32nutrient delivery this can all lead to
4:34reduced fetal growth or fetal growth
4:37restriction and because of this
4:41reduction in gas exchange and nutrient
4:42delivery we can see what we call the
4:44brain sparing effect so the brain
4:46sparing effect is where blood and along
4:48with the blood gases and nutrients are
4:51shunted to the most important and
4:53critical areas in development and these
4:55include the brain but also the heart the
4:57adrenal glands and the placenta itself
4:59so we can see this brain sparing effect
5:01because of the reduction in gas exchange
5:04and nutrient delivery now let's talk
5:06about the clinical features that can be
5:08seen in a fetus or an infant that has
5:11fetal growth restriction so we actually
5:13break it down into two types type 1 is
5:16going to be known as symmetric and type
5:172 is asymmetric so so in the symmetric
5:20type or type 1 this is going to most
5:23commonly occur early on in gestation
5:25typically in the first trimester type 1
5:28accounts for 25 to 30 percent of cases
5:31and it's more likely to occur from some
5:33Global insult to the developing fetus so
5:36these can include porch infections so
5:38again those congenital infections that
5:40occur early on in development can lead
5:42to type 1 or symmetric fetal growth
5:45restriction we can also see it with
5:47certain congenital disorders so Trisomy
5:4918 is one of those and we can also see
5:51it with certain maternal factors like
5:53malnutrition so something that was
5:54occurring early on in development or
5:56some large or Global insult to the
5:59developing fetus can lead to type 1 or
6:01symmetric fetal growth restriction and
6:03it's named symmetric fetal growth
6:05restriction because the reduction of
6:08body size is symmetrical so this means
6:11that both the head and the abdomen which
6:14would be measured by head circumference
6:16or HC and abdominal circumference or AC
6:19are both less than the 10th percentile
6:21for gestational age so it is symmetric
6:24both the head and the abdomen are
6:26affected
6:27so because the head is affected the
6:29brain is also affected but when we
6:31actually look at the ratio between the
6:33head and the abdomen it's approximately
6:35equal now in type 2 or asymmetric fetal
6:38growth restriction it's most likely or
6:40believed to occur later on in gestation
6:43and this is going to usually be in the
6:45late second to third trimester of
6:47gestation type 2 is going to be the most
6:49common type it accounts for 70 to 75
6:52percent of cases and it's more likely to
6:53occur from some placental insufficiency
6:55cause like preeclampsia
6:58so because it's asymmetric not all
7:01bodily parts are going to be equally
7:03affected so in the asymmetric type it's
7:05going to be the abdomen that is affected
7:07so abdominal circumference is going to
7:09be less than 10th percentile for
7:10gestational age
7:12and because the head is spared the brain
7:14is also spared and we see an increased
7:17head to abdomen ratio so this is going
7:19to be important with regards to type 2.
7:22now there can be other findings in the
7:25fetus or infant depending on the
7:27underlying cause of the fetal growth
7:28restriction so some examples that I'm
7:31just going to briefly talk about here
7:32include the following feedback
7:33alternative is going to be one of them
7:34as mentioned before alcoholism can be a
7:37maternal cause of fetal growth
7:39restriction if the fetal growth
7:41restriction is caused by fetal alcohol
7:43syndrome the infant is going to have
7:44particular characteristics some of these
7:46include a smooth filterum so the
7:49philtrum is the lip Ridge and it's going
7:51to be completely smooth it's going to be
7:52absent a short nose they can also have
7:55small eye openings in a thin upper lip
7:57among other findings as well in
7:59congenital CMV or cytomegalovirus
8:02infections there can be characteristic
8:04findings with regards to this type of
8:06infection including blueberry muffin
8:08spots sensory neural hearing loss choreo
8:10retinitis and hepatomegalior and
8:12enlarged liver in congenital toxic
8:15plasmosis infants can have choreo
8:17retinitis hydrocephalus in intracranial
8:19calcifications and in a potential
8:22congenital disorder one being Trisomy 18
8:25or also known as Edward's syndrome this
8:27is where patients can have a cleft
8:28palate low set ears clenched fists with
8:32overlapping fingers so you can see in
8:34this image here clenched fist with
8:36overlapping fingers can be a Hallmark
8:37finding in Edward syndrome or Trisomy 18
8:40and there can be other features as well
8:42so again these are some potential fetal
8:45or infant findings but it all depends on
8:47the underlying cause now regardless of
8:49what may be the cause of fetal growth
8:51restriction if there is fetal growth
8:53restriction there are complications and
8:55risks that can occur
8:57and these can occur early on and even
9:01throughout life so one of them is going
9:03to be fetal mortality there is increased
9:05risk of fetal mortality in fetal growth
9:07restriction there can also be labor and
9:09delivery issues there's a higher
9:10likelihood that there's going to be a
9:12requirement for a C-section and a higher
9:14likelihood of prematurity meconium
9:16aspiration is also going to be another
9:17risk for fetuses that are growth
9:20restricted some other complications from
9:22fetal growth restrictions include
9:24electrolyte imbalances so we can see
9:26different electrolyte imbalances like
9:27hypokalemia we can also see hypoglycemia
9:30so hypoglycemia is a low glucose level
9:32in the blood this is due to low glycogen
9:35stores within the liver so because of
9:37fetal growth restriction the abdomen is
9:40going to be smaller than usual it's not
9:41going to develop as it should the liver
9:43is not going to develop like it should
9:45and it's not going to store or have
9:47stores of glycogen like it should so
9:50this is going to lead to issues with
9:52neonatal hypoglycemia we can also see
9:55polycythemia and thrombocytopenia we can
9:57also to see an increased risk for
9:59necrotizing enterocolitis and there can
10:01also be increased risk for renal failure
10:03in these newborns
10:05as the patient gets older there can be
10:09developmental delay there can be issues
10:10with cognition and even later in life
10:12these individuals are at a higher risk
10:14for certain conditions and some of these
10:16include metabolic syndrome so they're
10:18more likely to have obesity and type 2
10:20diabetes they're more likely to have
10:21ischemic heart disease and they're more
10:23likely to have psychological impairments
10:25such as mental health disorders and
10:28prolonged and long-lasting cognitive
10:31issues so although a young infant may be
10:34born with fetal growth restriction they
10:35can have long lasting impacts of that
10:38fetal growth restriction even later on
10:40in life so these are important to make
10:43note of with fgr or fetal growth
10:45restriction so how is fetal growth
10:47restriction diagnosed by clinicians so
10:49clinicians are going to use
10:50ultrasonography to diagnose fetal growth
10:53restriction most often there's going to
10:54be serial measurements for at-risk
10:57patients usually every three to four
10:58weeks so what's going to be used for
11:01diagnosis is an estimated fetal weight
11:03or an abdominal circumference of less
11:05than in the 10th percentile for
11:07gestational age and this can be further
11:10broken down into moderate and severe fgr
11:12so moderate fetal growth restriction is
11:15going to be where the estimated fetal
11:17weight is anywhere from the third to the
11:19ninth percentile and in severe cases of
11:22fgr or fetal growth restriction the
11:24estimated fetal weight is going to be
11:26less than the third percentile but as
11:28mentioned earlier on in this lesson it's
11:30important to rule out genetic causes so
11:33perhaps the parents are shorter than
11:36average so even though the fetus is at a
11:39very low weight they may even be less
11:41than the 10th percentile for gestational
11:43age but because their parents are
11:45smaller or shorter they're actually
11:47growing at their potential so they may
11:50be simply small for gestational age and
11:52not considered fetal growth restricted
11:54and another way to actually Define or
11:57determine this is by seeing whether or
11:59not over the course of Serial
12:01measurements are they maintaining growth
12:03along a standard curve if they are or
12:06this is a better indication as well and
12:07if there are no other findings such as
12:10oligohydramnios which would be a low
12:12amniotic fluid volume this is also
12:15another finding that can help rule out
12:17fetal growth restriction so again it's
12:19important to determine is this fetus
12:23growth restricted or are they simply
12:24growing at their growth potential is
12:26this fetus simply constitutionally small
12:29so their parents may be smaller now
12:31although we mentioned that
12:33ultrasonography is a way to diagnose
12:34fetal growth restriction many times it
12:37may be prompted by a decreased synthesis
12:40fundal height measurement so in a family
12:42physician Clinic there are going to be
12:44serial measurements of synthesis final
12:47height throughout pregnancy if it's
12:49found that the symphysis funnel height
12:51is three centimeters or more lower than
12:54it should be this is going to be a
12:56trigger for a potential thought of does
12:58this fetus have fetal growth restriction
13:00and that can often lead to
13:02ultrasonography for that purpose and
13:04then some other body measurements that
13:06can be performed in ultrasonography
13:07include head circumference abdominal
13:09circumference and femur length as well
13:11another part of diagnosing can be
13:14amniotic fluid volume estimates so if
13:17the amniotic fluid index or AFI is less
13:19than five it's more likely that this
13:21fetus is growth restricted and if the
13:24maximum vertical pocket or MVP which is
13:26going to be the largest pocket of
13:29amniotic fluid that is measured if it is
13:31low if that pocket of amniotic fluid is
13:34lower than it should be there's a higher
13:36risk that the fetus is growth restricted
13:39and vice versa so it's inversely related
13:42so if it's a larger maximum vertical
13:45pocket it's less likely that the infant
13:47is growth restricted
13:49and then there are some other methods
13:50that can be used for diagnosis and
13:53management which we'll talk about later
13:54on here and these include uterine artery
13:57Doppler and umbilical artery Doppler
13:59methodologies so again ultrasonography
14:02is going to be very important serial
14:04measurements especially for infants at
14:06risk amniotic fluid volume estimates and
14:09then these other methods uterine artery
14:10Doppler and umbilical artery Doppler so
14:13when a collision has diagnosed fetal
14:15growth restriction how is it treated so
14:18before we get into the treatment it's
14:19important to try to prevent fetal growth
14:22restriction from occurring in the first
14:23place so cessation of illicit substances
14:25cessation of alcohol use and smoking
14:28nutritional Improvement and reduction of
14:30risk of torch infections are all going
14:32to be important in reducing the risk of
14:34fetal growth restriction in the case
14:36that there is fetal growth restriction
14:38already diagnosed umbilical artery
14:40Doppler and a biophysical profile is
14:43going to be important as these help
14:45monitor the fetus so these are often
14:48done weekly so you can see these
14:50biophysical profiles being done weekly
14:52with an ebola artery Doppler and in
14:55doing so the end diastolic flow or EDF
14:57is monitored so these measurements are
14:59going to help determine the next steps
15:01in treatment so if there is reverse and
15:04diastolic flow this is often going to be
15:05a trigger for delivery of the neonate if
15:07there is absent and non-stock flow but
15:10there is
15:11oligohydramnios and that's often also
15:13going to be a trigger for delivery and
15:15if there's absent end diastolic flow but
15:18the gestational age is less than 33
15:20weeks it's often going to require daily
15:22full biophysical profiles and if the
15:25biophysical profile is low that may also
15:28trigger the necessity for delivery as
15:30well so these are some of the outcomes
15:32with some of these measurements but if
15:34you want more information please look up
15:35other more detailed protocols on the
15:38treatment of fetal growth restriction
15:40so although there is no real treatment
15:43for fetal growth restriction the goal of
15:45treatment is to maximize gestational age
15:47so this is going to help reduce certain
15:50complications but if there is a case of
15:52premature delivery then if it is prior
15:55to 34 weeks of gestational age antenatal
15:58steroids will be given this will help
16:00with lung maturation and if it's prior
16:02to 32 weeks of gestational age neural
16:05protection is going to be required with
16:06administration of magnesium sulfate so
16:09although the goal is to maximize
16:10gestational age there are going to be
16:12cases where there is premature delivery
16:14and because certain bodily systems are
16:15not fully developed there may be some
16:17requirement for certain management or
16:20certain treatments like inhale steroids
16:22or magnesium sulfate and then a
16:24C-section may be required in some cases
16:26if there is fetal distress if you want
16:28to learn more about other obstetrical
16:30and gynecological conditions please
16:31check out my playlist on those topics
16:33and if you haven't already please like
16:35And subscribe for more lessons like this
16:36one thanks much for watching and hope
16:37see you next time

About this transcript

This page contains the full transcript of Fetal Growth Restriction (FGR, IUGR) | Types, Causes, TORCH Infections, Diagnosis, Treatment by JJ Medicine, generated from the public captions YouTube serves with the video. The transcript has 2,964 words across 456 segments, with the original timestamps preserved so you can click any line to jump to that moment in the embedded player.

What you can do with it

Use the transcript to take notes, quote the speaker, build a study guide, generate a summary with ChatGPT or Claude via the YouTube Summary tool, or export it as a timed subtitle file with YouTube to SRT. You can also re-open it in the transcriber to translate the transcript into 100+ languages.

Free YouTube transcript tool

YouTube2Text is a free YouTube transcript generator — no signup, no daily limit. Paste any YouTube link and get the full transcript instantly, with timestamps, click-to-jump, translation to 100+ languages, AI prompts for ChatGPT, Claude, and Gemini, and exports to TXT, SRT, VTT, or Markdown.