Download Intrauterine Growth Restriction (IUGR)

Intrauterine Growth
Restriction (IUGR)
Dr. Hazem Al-Mandeel
Intrauterine Growth Restriction
• Definition: if estimated fetal weight or newborn
birth weight below 10th percentile (< 5th or < 3rd)
• IUGR vs. Small for Gestation Age (SGA)
• Growth-restricted fetuses are prone to:
asphyxia, meconium aspiration, hypoglycemia,
polycythemia, and mental retardation
Etiology
• Maternal: poor nutritional intake, smoking, drug
abuse, alcohol intake, heart & pulmonary disease,
APA syndrome, and thromobophilias
• Fetal: intrauterine infection (TORCH &
Listeriosis) and congenital anomalies
• Placental: essential hypertension, preeclampsia,
and chronic renal disease
Clinical Manifestation
• Two types of IUGR:
1. Symmetric: head to abdomen is normal
early, e.g. infections or congenital anomalies
2. Asymmetric: head > abdomen; late occurrence
• Methods of gestational age calculation:
determination of GA is essential for the
diagnosis.
Diagnosis of IUGR
• History: to identify risk factors
• Physical exam: fundal height measurement in
each antenatal visit
• Investigation: ultrasound assessment
(sometimes serial) can identify 50-90% of cases
esp. if there is an indication
– Sonographic parameters: fetal biometry, calculated
fetal weight, amniotic fluid volume, umbilical artery
doppler
– Plot of measurements on a standard growth curve
Management
• Prepregnancy: to prevent it by identifying risk
factors and treat as necessary (e.g. improve
nutrition intake, stop smoking or alcohol, ASA in
APA syndrome, and Heparin in thrombophilias)
• Antepartum: identify risk factors that can be
changed. Fetal surveillance by ultrasound (BPP)
and fetal heart monitoring (Non-Stress Test). To
decide on timing and mode of delivery.
Management
• Labour & Delivery: IUGR is not a
contraindication for induction of labour or
vaginal delivery. Continuous electronic fetal
monitoring (use of cardiotocography) during
labour is necessary. Low-threshold for caesarean
section
• Prognosis: depends on the etiology. If treatable
then prognosis is generally good