Intrauterine growth restriction
Updates to Article Attributes
Body
was changed:
Intrauterine growth restriction (IUGR) or fetal growth restriction (FGR) is defined as an estimated fetal weight (EFW)/abdominal circumference (AC) at one point in time during pregnancy being below 3rd percentile or EFW/ACbelow the 10th percentile for gestational age with deranged DopplerDoppler parameters14.
An IUGR can be broadly divided into two main types:
- type I: symmetrical intrauterine growth restriction
- type II: asymmetrical intrauterine growth restriction
Some authors also enlist a 3rd type termed: femur-sparing intrauterine growth restriction 10.
Pathology
Aetiology
IUGR can result from a vast number of causes:
- maternal conditions
- maternal narcotics/smoking
- maternal alcohol use: fetal alcohol syndrome
- maternal diabetes: when severe maternal diabetes, there can be a paradoxical IUGR as opposed to fetal macrosomia
- maternal malnutrition/starvation
- maternal vascular conditions
- certain medications
- placental insufficiency: commonest cause overall
- other placental causes
- increased incidence with a single umbilical artery
- fetal conditions
- multifetal pregnancy
- intrauterine infections
-
chromosomal anomalies
- trisomy 13
- trisomy 18
-
triploidy: IUGR is of early
onset-onset - Down syndrome: not a dominant feature
- chromosome 4p deletion syndrome (Wolf-Hirschhorn syndrome)
- chromosome 12p tetrasomy (Pallister-Killian syndrome)
- confined placental mosaicism (CPM) 13
- other syndromic anomalies
- in utero substance exposure
Radiographic features
Antenatal ultrasound
Sonographic parameters include:
-
non-Doppler features
- reduced abdominal circumference (AC) and/or EFW
- AC/EFW <3rd percentile
- AC/EFW <10th percentile with deranged Doppler parameters
- presence of oligohydramnios without ruptured membranes
- increased head circumference (HC) to abdominal circumference (AC) ratio (in asymmetrical type)
- advanced placental grade
- reduced abdominal circumference (AC) and/or EFW
-
Doppler features: will require a chart to calculate absolute values
-
umbilical artery Doppler assessment
- increased PI above 95th percentile
- absent/reversed diastolic flow
-
umbilical venous Doppler assessment
- presence of pulsatility
-
uterine arterial Doppler assessment
- increased mean uterine artery PI above 95th percentile
- presence of notching in mid to late pregnancy
- CP ratio: reduced below 5th percentile
-
umbilical artery Doppler assessment
Treatment and prognosis
While there is no cure, management is reliant on a structured antenatal surveillance program with timely intervention in order to minimise fetal compromise.
Complications
There are many including:
- 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
- hypoglycaemia
- hypocalcaemia
- polycythaemia
- sepsis
- coagulopathy
- hepatocellular dysfunction
- respiratory distress syndrome
- necrotising enterocolitis
- intraventricular haemorrhage, especially in premature IUGR neonates <750 g
- hypoxic-ischaemic 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
- increased risk of:
Differential diagnosis
General considerations include:
- incorrect dates
See also
-<p><strong>Intra</strong><strong>uterine growth restriction (IUGR) or fetal growth restriction (FGR) </strong>is defined as an <a href="/articles/estimated-fetal-weight-efw">estimated fetal weight (EFW)</a>/abdominal circumference (AC) at one point in time during pregnancy being <span style="line-height:20.8px">below 3</span><sup>rd</sup><span style="line-height:20.8px"> percentile or </span><span style="line-height:20.8px">EFW/AC</span><span style="line-height:20.8px"> </span><span style="line-height:1.6">below the 10</span><sup>th</sup><span style="line-height:1.6"> percentile for gestational age with deranged D</span><span style="line-height:1.6">oppler parameters</span><span style="line-height:1.6"> </span><sup>14</sup><span style="line-height:1.6">.</span></p><p>An IUGR can be broadly divided into two main types:</p><ul>- +<p><strong>Intra</strong><strong>uterine growth restriction (IUGR) or fetal growth restriction (FGR) </strong>is defined as an <a href="/articles/estimated-fetal-weight-efw">estimated fetal weight (EFW)</a>/abdominal circumference (AC) at one point in time during pregnancy being below 3<sup>rd</sup> percentile or EFW/AC below the 10<sup>th</sup> percentile for gestational age with deranged Doppler parameters <sup>14</sup>.</p><p>An IUGR can be broadly divided into two main types:</p><ul>
-<a href="/articles/triploidy">triploidy</a>: IUGR is of early onset</li>- +<a href="/articles/triploidy">triploidy</a>: IUGR is of early-onset</li>