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Intrauterine growth restriction

Last revised by Dr Michael Carey on 12 Apr 2021

Intrauterine growth restriction (IUGR) or fetal growth restriction (FGR)  is defined as an estimated fetal weight (EFW) and/or abdominal circumference (AC) at one point in time during pregnancy being below 3rd percentile or EFW and/or AC below the 10th percentile for gestational age with deranged Doppler parameters 14.

An IUGR can be broadly divided into two main types:

Some authors also enlist a third type termed: femur-sparing intrauterine growth restriction 10.

IUGR can result from a vast number of causes:

Sonographic parameters include:

  • non-Doppler features
    • reduced abdominal circumference (AC) and/or EFW
      • AC and/or EFW <3rd percentile
      • AC and/or 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
  • Doppler features: will require a chart to calculate absolute values

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

There are many including:

  • antepartum 
    • stillbirth
    • iatrogenic prematurity
    • abruption
    • perinatal stroke 
  • intrapartum
    • abnormal fetal status (fetal heart rate tracing) 
    • asphyxia 
    • emergency Cesarean section 
    • need for active neonatal resuscitation 
    • perinatal stroke 
  • neonatal 
  • pediatric
    • increased risk of: 
      • short stature 
      • cerebral palsy 
      • developmental delay
      • behavioral and emotional problems 
      • lower IQ scores 
      • chronic lung disease 
      • future cardiovascular disease and hypertension

General considerations include:

  • incorrect dates

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Cases and figures

  • Case 1: IUGR (symmetrical)
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  • Case 2: symmetrical
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  • Case 3: asymmetrical intrauterine growth restriction with fetal distress
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