Intrauterine growth restriction (IUGR), also known as small for gestational age (SGA), is an important cause of antepartum fetal death and perinatal mortality. IUGR occurs when a fetus fails to reach its growth potential and can be caused by placental pathology, fetal chromosomal or genetic abnormalities, infections, or maternal factors like hypertension, diabetes, drug use, smoking, or poor nutrition. IUGR is diagnosed through assessment of risk factors, fundal height measurements, ultrasound to measure fetal size and amniotic fluid volume, and Doppler velocimetry if growth restriction is confirmed. Close monitoring and management can help lower the risk of complications like intrapartum asphyxia that often accompany

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