Intrauterine growth restriction

Last revised by Yuranga Weerakkody on 23 May 2022

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.

The symphysis fundal height (SFH) can be a commonly used crude measurement.

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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