A lady of 150 cm height with Hb of 11gm%, BP of 160/110 mm Hg and 12 kg gain during her pregnancy delivered an IUGR baby, the causes in this cases are:
Correct Answer: HTN
Description: Ans. is c, i.e. HTN (hypertension)Ref. Dutta Obs. 7/e, p 97, p 260, 51Friends, It is a tricky question which needs only common sense. Answer is hidden in the question itself. So, lets read the question once again and rule out each option one by one.The lady in our question is of 150 cm height ( 5 feet)."While an arbitrary measurement of 5 ft. is considered as short stature in western countries, it is 4' 7" in India considered the low average height" --Dutta Obs. 6/e, p 98So, the lady is not constitutionally small, i.e. options 'b' is ruled out.Her Hb is 11 gm%."According to the standards laid down by WHO. anemia in pregnancy is present when the hemoglobin concentration in the peripheral blood is 11gm% or less". --Dutta Obs. 6/e, p 262So, according to the WHO standard 11gm% is borderline for anemia.Anemia leads to IUGR when it is moderately severe i.e. Hb<8 gm% or if it is sickle cell anemia (Fernando arias, 3/e, p 41)So, option 'e' is ruled out.Her BP is 160/110 mm HgHypertension is an absolute rise of BP of at least 140/90 mm Hg, if the previous BP is not known. So, there is no doubt that the patient is hypertensive.Prolonged hypertension leads to placental insufficiency which ultimately results in IUGR.So, option 'c' is correct.Her weight gain is 12 kg."Ideally weight gain should depend on prepregnancy body mass index (BMI) level. Weight gain for a woman with normal BMI (20-26) is 11 to 16 kg" --Dutta Obs. 6/e, p 51So, the weight gain comes under normal range, option 'd' ruled out.Though maternal infection during pregnancy also causes IUGR, here in our question no such history has been mentioned.So, option 'a' is also ruled out. Hence the answer of this question is, IUGR is due to hypertension.
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Gynaecology & Obstetrics
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