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 : 

Hypertension

Kidney disease

Disease

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

Stillbirth

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.