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Intrauterine Growth Restriction

Written by Lisa Alexander

Intrauterine Growth Restriction


Intrauterine growth restriction or (IUGR) is a complication of pregnancy and its characterised by a deficiency of foetal growth compared to normal growth rates for gestational age.  Approximately 7% of all pregnancies are complicated by IUGR. IUGR is also referred to as small for gestational age (SGA). Around 3% of foetuses are true intra-uterine growth retardation (IUGR) and another 7% are constitutionally small. 50% are undetected at birth and many suspected of IUGR turn out to be normal.


Risk Factors

  • History of restricted foetal growth, hypertension, diabetes, raised alpha fetoprotein or hCG, chronic illness, low weight before pregnancy, poor maternal weight gain (<10kg by 40 weeks), twins, use of alcohol, tobacco or illicit drugs, maternal anaemia, vaginal bleeding, living above 3000 metres, severe lung disease.
  • Infections – syphilis, CMV, toxoplasmosis, rubella, HBV, HSV, HIV
  • Congenital disorders e.g. trisomy 21, 18, 13, Turner’s syndrome
  • Placental pathology e.g. previa abruption
  • Drugs – warfarin, phenytoin, steroids
  • Maternal smoking causes 30-40% of cases of IUGR (11 cigarettes/day equates to babies weighing 330g less and being 1.2cm shorter on average than non smokers). IUGR occurs in 15-20% of cases of twins.

Management

Clinical determination of baby’s growth is inaccurate. If there is a suspicion that a baby is small-for-dates then an ultrasound growth scan should be performed.
If growth is restricted then repeated scans should be performed at fortnightly intervals. The biparietal diameter and abdominal circumference (between the liver and the kidneys) should be measured and plotted.
Abdominal circumference is correlated with baby’s weight; this information is important in deciding when to deliver the baby.
If you have had lots of ultrasound scans that have shown a normal growth rate, even if the baby is small for dates this will most likely mean that your baby will simply be small and not growth restricted.  Growth restricted babies will show a slowing down of growing over a matter of weeks.
Poor biophysical profile scores in a growth retarded foetus are an indication for early delivery.
The time of delivery depends on how well your baby is doing. Sometimes, babies with IUGR keep on growing in the uterus. If your baby keeps gaining some weight, an early delivery (before the due date) may not be needed. But if your baby is not growing at all or has other problems, your doctor may decide that an early delivery could help. In this case, your doctor may want to induce labour. Your baby's heart rate and movements will be closely watched to help you and your doctor make this decision.
If there are no signs of problems with your baby during labour, a vaginal delivery is OK.
The length of your stay in hospital after the birth will depend on how early your baby was at birth, many babies born early will spend some time in hospital before they are allowed home. Generally, babies stay in the hospital until they weigh about 5 pounds and can breathe and feed normally.
Most babies born with IUGR will gain weight and catch up with their peers at around age 2.
Subsequent children
IUGR usually doesn't occur in another pregnancy. But in some women, it does happen again. Women who have another pregnancy affected by IUGR usually have an illness, such as hypertension, that causes IUGR. Good control of illnesses before and during pregnancy lowers the risk of having another baby with IUGR.

My experience

The information above was gathered from various sources after I discovered that my son was a IUGR baby.  I was admitted to hospital with pains at 34 weeks pregnant and a scan showed that they baby wasn’t growing as fast as expected (the pains were unrelated), I was scanned again at 36 and 37 weeks and this showed a further slowing down of the growth, It was explained to me that my baby had asymmetric IUGR his body had slowed down its growing to allow his head and in turn his brain to develop leaving him looking very scrawny at birth.  My son was born at exactly 38wks gestation and weighing 5lbs exactly, his head circumference was the same as my daughters at birth and she weighed a little less than 9lb.  He is now a healthy 3year old who has shown no sign since birth that he has been in anyway affected by the IUGR that he had before he was born. 
I would like to add that what you have read in this article what I have put together from information I have sourced on the internet and from my own personal experience.
 
If you have any concerns about IUGR or SGA please speak to your GP, Midwife or hospital consultant.




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