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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
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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
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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
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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
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Pola Pertumbuhan
• hyperplasiaTrimester1
• Hyperplasia
• hypertrophyTrimester
2
• hypertrophyTrimester3
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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!!
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Etiologi
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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
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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
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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
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Fetal Decompensat ion
Multiple-organ failureMetabolic
abnormalitiesacidemiaworsens
↑ risks ofintrauterine
damage
perinatal deathincrease
LOSS OF CARDIOVASCULARHOMEOSTASIS
Placental dysfunction progressive and sustained
Exhausted Decompensation
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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
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Klasifikasi
IUGR
Symmetric
< 20 minggu
Hyperplasia
asymmetric
>20 minggu
Hypertrophy
decreasednutrition and
oxygen
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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
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Diagnosis dan Evaluasi
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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
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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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