Intrauterine growth restriction (IUGR)
Intrauterine growth restriction or IUGR means poor fetal growth while still in the uterus, while small for gestational age is a description of an overly small baby once it is born. The most common definition of small for gestational age is a birthweight below the 10th percentile. It may be argued that fully 10% of infants will fall below the 10th percentile by definition. Most of these babies are going to be normal. However the 10th percentile is a legitimate point when concern arises and extra surveillance begins. Adverse outcomes are generally confined to babies with weight below the 5th percentile, all other things being equal.
What are the risk factors for IUGR ?
Maternal medical conditions :
Diabetes with microvascular disease heart disease Antiphospholipid antibody syndrome
Collagen vascular or autoimmune disease like Lupus
Hemoglobinopathies such as Sickle Cell disease
Smoking, alcohol, and substance abuse
Severe malnutrition and underweight
Infections such as Toxoplasmosis or Cytomegalovirus
Genetic disorders, i.e Down Syndrome
Exposure to teratogens
What are the consequences of IUGR ?
Abnormal heart rate pattern during labor
Greater incidence of low Apgar scores at birth
Metabolic abnormalities in the newborn: Including polycythemia (high blood count) , hyperbilirubinemia ( high bilirubin levels) , hypoglycemia (low blood sugar)
Hypothermia ( low body temperature) , apnea (failure to breathe), seizures, and neonatal infection
How do we follow and manage IUGR ?
According to the American College of Obstetricians and Gynecologists, (ACOG) once IUGR is suspected by lagging fundal height it should be confirmed and followed using
Serial Ultrasounds using multiple ultrasonographic parameters and ratios
Amniotic fluid volume checks
Doppler flow measurements of the umbilical cord
Non stress tests
Management centers on addressing any of the reversible or treatable problems that may have contributed to the IUGR. Delivery is indicated when the risks indicated by these tests outweigh the benefits of the baby staying in the uterus.