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Intrauterine growth restriction
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Intrauterine growth restriction



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  • 1. Intrauterine Growth Restriction
    • By Donna Adelsperger RN, M.Ed.
  • 2. Intrauterine Growth Restriction
    • IUGR is important cause of AP fetal death
    • Leading contribution to PMR (perinatal mortality rate)
    • PMR = 6 X > than for AGA babies
    • 30% of all stillborns are growth restricted
    • Incidence of intrapartum asphyxia in cases of complicated IUGR = 50%
    • With good management PMR = lower
  • 3. Intrauterine Growth Restriction
    • IUGR also known as SGA (small for gestational age) based on on estimated fetal size alone (failure to reach growth potential)
  • 4. Intrauterine Growth Restriction Etiology - Fetoplacental
    • Chromosomal abnormalities
    • Genetic syndromes
    • Congenital malformations
    • Infectious diseases
      • CMV (cytomegalic virus)
      • Toxoplasmosis
      • Rubella
  • 5. Intrauterine Growth Restriction Etiology - Fetoplacental
    • Placental pathology
      • Previa
      • Abruption
      • Circumvallate
      • Mosaicism
      • Infarction
      • Twins
  • 6. Intrauterine Growth Restriction Maternal Origins
      •  uteroplacental blood flow responsible for majority of IUGR
      • Maternal vascular disease I.e. chronic hypertension, preeclampsia, diabetes
      • In preeclampsia IUGR is asymmetric (normal head growth)
      • Maternal pre-pregnancy weight and weight gain = 2 of most important variables
  • 7. Intrauterine Growth Restriction Maternal Origins (cont’d)
      • Maternal drug use, alcohol use & smoking
      • Prior birth of IUGR baby
      • History of poor pregnancy outcome
      •  Maternal serum AFP
      • Multiple gestation
      • Anemia, hemoglobinopathies, bleeding
      • Preterm labor, vaginal bleeding
      • Abnormal placentation
  • 8. IUGR - Diagnosis
    • Assessment of risk factors
    • Key physical finding is determination of uterine size i.e. fundal height (should be used for screening only)
    • IUGR incorrectly diagnosed 50% of time
    • All pregnancies screened for serial fundal height measurements
    • One measurement at 32-34 weeks is approx70-85% sensitive and 96% specific
    • 3 rd trimester US with 1 measurement of AC detects about 80% IUGR
  • 9. IUGR - Diagnosis
    • Amniotic fluid volume = diagnostic & prognostic parameter in IUGR babies
    • Oligohydramnios is highly suggestive of restricted growth
    • IUGR indicative of increased risk of fetal death (also diagnosed by US)
    • IUGR babies may have normal AF volumes
    • Doppler velocimetry useful if IUGR confirmed
  • 10. Intrauterine Growth Restriction Diagnosis
    • US is used to identify:
      • 2/3 of case BPD (biparietal diameter)  normally till late pregnancy
      • Abdominal circumference has > sensitivity in identification of IUGR
      • AC (abdominal circumference) used in combination with HC (head circumference)
      • In US most common assessment is fetal weight**
      • Birth weight below 10 th % most used criteria**
  • 11. IUGR - Diagnosis
    • Four standard fetal measurements part of OB US
      • Fetal abdominal circumference
      • Head circumference
      • Biparietal diameter
      • Femur length