Intrauterine Growth Restriction (IUGR)

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Premature Baby in Incubator

Intrauterine growth restriction (IUGR) is a condition where the growth of the foetus is restricted and the foetus is smaller than 90% of foetuses of the same age. Babies in this condition are also known as ‘small for gestational age’ and occur in up to 5% of all pregnancies.

What is Intrauterine Growth Restriction?

IUGR is a condition where the growth of the baby is slow while in the mother’s womb. It is also known as Intrauterine Growth Retardation or Foetal Growth Restriction.

Types

There are two types of Intrauterine growth restriction – Symmetrical IUGR and Asymmetrical IUGR.

Symmetrical IUGR

Symmetrical IUGR, also known as Primary IUGR, comprises of 20-25% cases of IUGR. In this condition, the baby displays overall restriction in growth and all internal organs are reduced in size.

Asymmetrical IUGR

Asymmetrical IUGR, also known as Secondary IUGR, is when the baby’s abdomen is smaller than the head and brain which are of normal size. This condition is more difficult to diagnose and can go unnoticed up until the third trimester.

Causes of IUGR

IUGR may be caused by various factors, ranging from the medical history of parents to pregnancy complications. The following are some of the causes of IUGR:

  • Some medical conditions are known to cause IUGR. The chief causes among these are chronic hypertension, problems with kidney function, heart disease, lung disorders, Antiphospholipid Antibody Syndrome, sickle cell disease, and advanced diabetes.
  • If there are abnormalities in the placenta or it is too small, it will be ineffective in providing the required nutrients to the baby and in removing waste from the baby’s blood, resulting in IUGR.
  • Abnormalities such as anencephaly (brain complication), Down Syndrome, kidney defects, chromosomal abnormalities, etc. are also known to cause this condition.
  • Mothers carrying twins or triplets may also suffer from IUGR.
  • If the mother has a history of alcohol and drug abuse or is a smoker, the risk of IUGR increases.
  • Diseases such as rubella, syphilis and toxoplasmosis carried by the mother.
  • If the mother has been malnourished during pregnancy, the growth of the baby will be inhibited.
  • High altitudes may also cause IUGR.
  • Anticonvulsant drugs administered to mothers during pregnancy.
  • If the mother is underweight it can have a direct impact on the growth of the unborn child.
  • A malfunction in the umbilical cord may also cause IUGR.

What Are the Symptoms of Intrauterine Growth Restriction?

While the small size of the baby may be indicative of the condition, it is also important to note that not all babies that are born small have IUGR.

The primary symptom of IUGR is the ‘Small for gestational age’ trait. A baby is considered as an SGA baby when the estimated age of the baby is below the 10th percentile. i.e. if the estimated weight of the baby is less than 90% of the babies with the same gestational age. The baby may also appear thin, pale, have loose dry skin, or just be small in overall size. Also, the umbilical cord is thin and dull instead of thick and shiny.

Diagnosis and Tests for IUGR

There are various methods that doctors have at their disposal to check the estimated size of babies in the womb. One of the commonest test procedure employed is to measure the distance from the top of the mother’s uterus to her pubic bone. 20 weeks into the pregnancy, this measurement in centimetres should roughly correspond with the number of weeks of pregnancy. If the measurement is lower compared to expectations, this is a strong indicator that the baby is not growing as expected.

There are also various other tests that can be conducted to check for IUGR which include:

  1. Ultrasound: Ultrasound is another IUGR radiology method of creating an image of the baby in the womb by the use of sound waves. An ultrasound allows the doctor to see the baby in the womb and take the measurement of the baby’s head and abdomen. These measurements are then compared to growth charts for an estimate of the baby’s weight. This method may also be used to detect the amount of amniotic fluid in the uterus.  Less than the necessary amount of amniotic fluid in the womb may be indicative of IUGR.
  2. Doppler Flow: This is a method of measuring the flow of blood, its amount, and the speed with which blood is flowing through blood vessels. Doppler in IUGR can measure the flow of blood in the umbilical cord and the blood vessels in the baby’s developing brain.
  3. Weight Checks: Another method is to closely monitor the weight of the mother upon every prenatal checkup, as growth problems with the baby can be detected if the mother does not display adequate weight gain.
  4. Foetal Monitoring: The heartbeat of the baby is measured and monitored by the use of electrodes which are placed on the mother’s abdomen.
  5. Amniocentesis: In this method, a small amount of amniotic fluid is withdrawn from the mother’s uterus to test for any infection or abnormalities.

Risk Factors Associated with IUGR

There are several risk factors that may cause IUGR. It has mostly been observed that mothers carrying twins and triplets run a risk as do mothers that have had an earlier IUGR pregnancy. It has also been observed that underweight women or those with poor appetites also face the risk. Women with lung disease, heart ailments, and blood and kidney disorders are vulnerable too.

Complications

Some complications which can arise because of IUGR include:

  • The small size of the baby means that it cannot receive sufficient oxygen and nutrients.
  • A caesarean may have to be performed since the baby may not withstand the rigour of a natural birth.
  • Low blood sugar levels of the baby make it prone to infections and jaundice.
  • The baby may find it difficult to feed and breathe.
  • The baby may not be able to maintain its body temperature.
  • Preterm delivery.
  • A weak immune system making baby vulnerable to infection.
  • Increased probability of stillbirth.
  • Babies born with neurological disorders.
  • Babies with hampered renal function.

Effects of IUGR

Certain effects of an IUGR pregnancy are listed below:

  • Foetuses with IUGR may display altered cardiac function.
  • It may have a direct impact on the ability of the foetus to acquire genetic growth potential on account of nutritional deprivation.
  • Insufficient nutrition can lead to the death of the uterus.
  • The deprivation of oxygen could also lead to the death of the foetus.
  • IUGR foetuses are prone to preterm delivery.
  • IUGR foetuses are in grave danger of perinatal asphyxia which affects various organs.
  • Infant mortality is high among IUGR babies.
  • IUGR foetuses may also suffer from retarded neurological development.

IUGR Treatment and Management

There are certain precautions that can be taken to manage IUGR, which include:

  1. Do not consume alcohol, tobacco or recreational drugs.
  2. Ensure a healthy diet, avoiding such foods mentioned by your doctor.
  3. Do not miss out on prenatal appointments.
  4. Check any prescribed medications for side effects.
  5. Appropriate rest could help IUGR babies through the pregnancy.

While there are no specific treatments or medication for women with IUGR pregnancy there are some treatments that can help:

  1. The mother may be administered with medication to improve blood flow.
  2. The mother can be given timely treatment for any other complications she may have, which could also be contributing to IUGR.
  3. Intravenous medications, steroids and nutrients to help the foetus mature faster.

Prevention

Certain preventive measures that can be taken are:

  • If problems with the foetus can be detected earlier, they can be treated earlier. It is essential to attend all prenatal appointments.
  • If the baby is not moving enough or kicking enough, visit your doctor as it could indicate a problem.
  • All medication consumed by the mother should be checked as some medication that the mother could be taking for another complication could pose a threat to the baby.
  • Eat healthily and keep away from alcohol, tobacco and drugs.

What to Expect After Delivery?

IUGR in pregnancy is not the end of the world, as most IUGR babies would catch up with other children after birth. In case of severe IUGR babies may face complications that preterm babies face but can also live a normal life once they are around the age of three. While IUGR is a risky condition, the advances in modern medicine and improved knowledge of the condition today allow us to address most of the problems associated with it.

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