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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