Intrauterine growth restriction

Last revised by Karen Machang'a on 26 Sep 2023

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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  • Case4: fetal IUGR - severe hemodynamic adaptation
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