Asymmetrical intrauterine growth restriction is a type of intrauterine growth restriction (IUGR) where some fetal biometric parameters are disproportionately lower than others, as well as falling under the 10th percentile. The parameter classically affected is the abdominal circumference (AC).
Please, refer to the article on symmetrical intrauterine growth restriction for a particular discussion of this other type of IUGR.
It tends to present more in the 3rd trimester (later than the symmetrical IUGR pattern) and is the commoner of the two primary types of IUGR.
In this type, there is classically relative preservation of the fetal brain (fetal head sparing theory), which pathologically characterised by an increased brain to liver ratio (BLR) 2. This can also result in decreased fetal subcutaneous fat 4,6. A rare paradoxical situation is with maternal cocaine use where the head circumference is reduced out of proportion to others 5.
The incidence of concurrent karyotypic abnormalities are low (or minimal 3) especially if asymmetrical IUGR is detected late in pregnancy.
Syndromes that can give an asymmetrical IUGR picture include:
Features in the classical situation include:
- changes in fetal biometric parameters
- fetal abdominal circumference (AC) classically reduced out of proportion to other fetal biometric parameters and is below the 10th percentile
- certain fetal biometric parameters such as biparietal diameter (BPD) and head circumference (HC) may be normal
- increased HC:AC ratio
- fetal tachycardia (may be present in up to 50% of cases 4)
Oligohydramnios may be present as an additional sonographic feature.
- 1. Sanders RC, Winter TC. Clinical sonography, a practical guide. Lippincott Williams & Wilkins. (2006) ISBN:0781748690. Read it at Google Books - Find it at Amazon
- 2. Rodeck CH, Whittle MJ. Fetal medicine, basic science and clinical practice. Elsevier Health Sciences. (2008) ISBN:0443104085. Read it at Google Books - Find it at Amazon
- 3. Anandakumar C, Chew S, Wong YC et-al. Early asymmetric IUGR and aneuploidy. J. Obstet. Gynaecol. Res. 1996;22 (4): 365-70. - Pubmed citation
- 4. Thureen PJ, Hay WW. Neonatal nutrition and metabolism. Cambridge Univ Pr. (2006) ISBN:0521824559. Read it at Google Books - Find it at Amazon
- 5. Little BB, Snell LM. Brain growth among fetuses exposed to cocaine in utero: asymmetrical growth retardation. Obstet Gynecol. 1991;77 (3): 361-4. - Pubmed citation
- 6. Schmidt W, Kurjak A. Color Doppler Sonography in Gynecology and Obstetrics. Thieme Medical Publishers. (2004) ISBN:1588902560. Read it at Google Books - Find it at Amazon
- 7. Al-ghazali W, Chita SK, Chapman MG et-al. Evidence of redistribution of cardiac output in asymmetrical growth retardation. Br J Obstet Gynaecol. 1989;96 (6): 697-704. - Pubmed citation
- 8. Merz E, Bahlmann F. Ultrasound in obstetrics and gynecology. Thieme Medical Publishers. (2005) ISBN:1588901475. Read it at Google Books - Find it at Amazon
- 9. Entezami M, Albig M, Knoll U et-al. Ultrasound Diagnosis of Fetal Anomalies. Thieme. (2003) ISBN:1588902129. Read it at Google Books - Find it at Amazon