Intrauterine growth restriction

Intrauterine growth restriction (IUGR) is commonly defined as an estimated fetal weight (EFW) at one point in time during pregnancy being at or below the 10th percentile for gestational age 2.

Some authors define the term IUGR when fetal biometric parameters fall under the 5th percentile or fall below two standard deviations 12.

Some authors consider this definition synonymous with the term small for gestational age (SGA).

An IUGR can be broadly divided into two main types:

Some authors also enlist a 3rd type termed: femur sparing intrauterine growth restriction 10.

By its standard definition itself, it carries a prevalence of 10% of all births (if the 5th centile is used it will affect 5% of all births instead).

Causes

IUGR can result from a vast number of causes:

Antenatal ultrasound

Sonographic parameters include:

They are many which include:

  • antepartum 
    • stillbirth 
    • iatrogenic prematurity 
    • abruption 
    • perinatal stroke 
  • intrapartum
    • abnormal fetal status (fetal heart rate tracing) 
    • asphyxia 
    • emergency Caesarean section 
    • need for active neonatal resuscitation 
    • perinatal stroke 
  • neonatal 
    • hypothermia 
    • hypoglycemia 
    • hypocalcemia 
    • polycythemia 
    • sepsis 
    • coagulopathy 
    • hepatocellular dysfunction 
    • respiratory distress syndrome
    • necrotizing enterocolitis
    • intraventricular hemorrhage, especially in premature IUGR neonates < 750 g 
    • hypoxic-ischemic encephalopathy
  • paediatric
    • increased risk of: 
      • short stature 
      • cerebral palsy 
      • developmental delay 
      • behavioural and emotional problems 
      • lower IQ scores 
      • chronic lung disease 
      • future cardiovascular disease and hypertension

While there is no cure, management is reliant on a structured antenatal surveillance program with timely intervention in order to minimize fetal compromise.

General considerations include:

  • incorrect dates
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Article Information

rID: 10744
System: Obstetrics
Section: Pathology
Tag: cases
Synonyms or Alternate Spellings:
  • IUGR
  • Intrauterine growth restriction (IUGR)
  • Intrauterine growth retardation
  • Small for gestational age
  • Small for gestational age (SGA)
  • Intra uterine growth restriction
  • Intra-uterine growth restriction (IUGR)
  • Fetal growth restriction
  • Fetal growth restriction (FGR)
  • Intrauterine growth retardation (IUGR)

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    Case 1: UA Doppler trace in IUGR
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    Case 2: symmetrical
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