Intrauterine growth restriction (IUGR), also known as small for gestational age (SGA), refers to a fetus whose weight is below the 10th percentile for gestational age. It can be caused by placental insufficiency, genetic factors, maternal medical conditions, infections, or other uteroplacental problems. Diagnosis involves serial ultrasounds to measure fetal growth curves, biophysical profile, and Doppler studies of umbilical and uterine blood flow. Management may include bed rest, corticosteroids to promote lung maturity, c-section delivery, and neonatal intensive care. Complications can include fetal distress, low birth weight, and long term issues with growth, development and learning.

2. SGA
Intra Uterine Growth Restriction (IUGR)
or
Small for Gestational Age (SGA)
 Weight of the Fetus
is <10th percentile for
the gestational age.
 Some consider 5th or
3rd percentile as cut
off.
28 August 2017 2May All Be Happy & Healthy.
GA
(weeks)
Weight
(Kg)
10th
percen
1.2 0.828
2.2 1.532
3 2.336
3.3 2.738
IUGR

3. Constitutional SGA
(Healthy small fetus)
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Genetic cause:
• Race, Sex
• Maternal weight
• Paternal height

4. Incidence:
IUGR: 5 to 8 %
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5. Complications
 Short term:
1. Chronic Fetal hypoxia (distress).
2. Oligohydramnios with its complications.
3. Meconium Aspiration & RDS.
4. Problems of prematurity.
5. Neonatal Hypoglycemia, hypocalcaemia,
polycythemia, hypothermia.
6. LBW: Causes 60% of neonatal death.
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6. Complications
 Long term:
 Malnutrition in childhood & adulthood
 Low IQ, neurological handicaps
 Learning deficits
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7. 28 August 2017 7May All Be Happy & Healthy.

8. 28 August 2017 8May All Be Happy & Healthy.
Abdominal circumference AC
Head circumference AC

9. Types:
 Symmetrical:
 Less common 25%
Fetus is proportionately small.
Usually fetal genetic cause
Bad prognosis with slow growth after
birth
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HC ÷ AC: WNL

10. Symmetrical IUGR
HC & AC both lagging behind:
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11. Types:
 Asymmetrical
 More common 70%
Occurs late in pregnancy
Fetus has lagging abdominal growth.
Maternal & Uteroplacental cause.
Good prognosis with rapid growth
after delivery.
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HC ÷ AC: ↑

12. Asymmetrical IUGR
HC WNL while AC Falling to 10th %
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13. 28 August 2017 13May All Be Happy & Healthy.
Etiology:

14. Fetal Causes of IUGR:
1. Genetic
 Chromosomal, genetic, CFMF
 Vertically transmitted infection
(TORCHS infection)
2. Multiple pregnancy: TTT
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15. Uteroplacental Causes:
 Uteroplacental insufficiency:
1. Preeclampsia
2. Anti Phospholipid antibody
Syndrome
3. Chronic abruptio placenta.
4. Placenta previa.
5. Uterine malformation
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16. Maternal Causes
 Smoking & drug abuse.
 Anemia & malnutrition.
 Medical disorders:
 Hypertension, renal disease, DM.
 Heart diseases, COPD.
 Celiac disease
 Infections: Malaria & Viral infections.
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17. Risk factors for IUGR
 Hypertension, Anemia, diabetes, infections.
 Past H/O IUGR.
 Smoking & drug abuse
 Poor weight gain during pregnancy
 Multiple pregnancy
 Fundal Height less than expected as per GA.
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18. 28 August 2017 19May All Be Happy & Healthy.
Diagnosis &
management:

19. Diagnosis:
 History
 High risk factor should alert clinician.
 Poor weight gain.
 Reduced fetal kick
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20. Diagnosis:
 General examination
 Look for sign of maternal
cause
 Abdominal examination
 Fundal height < expected.
 Oligohydroamnios
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21. Diagnosis:
1. Investigation to confirm the Dx
 Serial USS
 AC, FL, HC/AC ratio
 Other finding: oligohydramnios, CFMF
 Doppler USS-
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22. Diagnosis:
2. Investigation to detect a cause
 Maternal: OGTT, ECHO for heart
 Fetal: prenatal diagnosis of CFMF
3. Tests to evaluate fetal wellbeing
4. Tests to evaluate fetal maturity
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23. Uterine Artery Doppler velocimetry:
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24. Umbilical artery
Doppler velocimetry:
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Absent Diastolic
Flow in
Umbilical Artery
Normal Diastolic
Flow in
Umbilical Artery
Reversed
Diastolic Flow in
Umbilical Artery

25. Management
 Prophylactic:
 Proper ANC for early diagnosis of any
RF with proper management.
 Active management
 During pregnancy
 During labor
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26. Management
 During pregnancy
 If the baby is mature (> 34 weeks)
TOP (Best CS)
 If the baby is not mature (<34 weeks)
conservative management
 Bed rest, left lateral position
 Proper maternal nutrition
 Low dose Aspirin + LMWH
 Induction of lung maturity- corticosteroid
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27. Management
 During labor
 Best by CS
 Vaginal delivery is possible under close fetal
monitoring, shortening of the 2nd stage by
forceps
 Management of neonate
 In NICU
 Early feeding, warming, care of RDS
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