Iugr

Intrauterine Growth Restriction (IUGR)
HALE TEKA, M.D,
OBSTETRICIAN AND GYNECOLOGIST,
MEKELLE UNIVERSITY, DEP’T OF OBGYN
Saturday, April 20, 2019 HALE TEKA, M.D., ASSISTANT PROF OF OBSTETICS AND GYNECOLOGY 1

Contents
•Definition
•Types of IUGR
•Etiology
•Diagnosis
•Management

Definition

• IUGR
 Failure of the fetus to reach growth potential associated with
increased morbidity and mortality

• Phases of fetal growth
 < 16 weeks
o Primary hyperplasia
 16 – 32 weeks
o Both hyperplasia + hypertrophy
 > 32 weeks
o Primary hypertrophy

Types of Fetal Growth Patterns
• AGA
 Normal
• SGA
 Constitutional
 Pathologic (Pathologic)
• LAG
 Constitutional
 Pathologic

• SGA
 Babies whose weight is less than
10th centile
 All SGAs are not IUGR
o Some might be genetically small
who have achieved their growth
potential

Classification of Birthweight
Class Birthweight (in grams)
Macrosomia > 4000 grams
Normal Between 2500 – 4000
Low birthweight Between 1500 – 2500
Very low birthweight Between 1000 – 1500
Extremly low birthweight Below 1000

Types of IUGR

•Symmetrical
Weight, head and length are all below the 10th percentile
Accounts for 20 to 30% of IUGR
•Asymmetrical
Weight is below the 10th percentile and head and femoral length are
preserved
Accounts for 70 to 80% of IUGR

Symmetric Asymmetric
Intrinsic cause Metabolic (extrinsic cause)
Occurs early Occurs late
All body parts affected equally
(Early insult affecting cell number )
In the early phase, brain spared
(glycogen utilization by liver, liver
shrinkage, decreased AC; preferential
shunting to brain thus maintained HC)
Example of causes
1. Genetic syndromes
2. Intrauterine infections (congenital
infections)
3. Congenital anomalies
4. Abnormal karyotype
Example of causes
1. Hypertensive disorders
2. Overt DM
3. Placental insufficiency due to other
several causes

Etiology and Risk Factors of IUGR

Conditions Associated with Symetric IUGR
1. Genetic
a) Chromosomal and single gene defects, and
b) Deletion disorders and inborn errors of metabolism.
2. Congenital anomalies,
3. Intrauterine infections
4. Others: substance abuse, cigarette smoking and therapeutic
irradiation

Conditions Associated with Asymmetric IUGR
• Chronic hypertension
• Preeclampsia
• Placental infarcts
• Abruptio placenta
• Velamentous insertion of the umbilical cord and
• Circumvallate placenta

Asymmetric IUGR cont’d
• Maternal illness
 Chronic renal disease
 Cyanotic heart disease
 Hemoglobinopathies

Asymmetric IUGR cont’d
• Other factors
 Multiple pregnancies
 Altitude
 Substance abuse and cigarete smoking
 Alcol abuse
 Illicit drug use

Diagnosis of IUGR

• History
 E.g. – pregnancy induced hypertension
• Physical examination
 SFH
o Negative discrepancy of 2 – 4 weeks
o Sesitivity 95%

• Ultrasound
 Biometric measurements
o Symmetric IUGR
 All biometric measurements are uniformlly small
 HC:AC, FL:AC  Normal
o Asymmetric IUGR
 Fetal abdomen is proportionately small compared to fetal head (Brain
sparing effect)
 HC:AC, FL:AC  Elevated

Management of IUGR

Prenatal
• Symmetric IUGR
 Amniocentesis
o TORCH analysis
o Karyotype
 Asymmetric IUGR
o Look for maternal disorders

• Ongoing close observation with ultrasound
 Look for oligohydramnios
 Rate of growth
 Biophysical profile

• Delivery
 Early delivery or expectant management can be considered
based on the fetal status
o Doppler indices
o Biophysical profile
o Severity of IUGR (weight < 3% - severe IUGR)
o Gestational age

Complications of IUGR

Complications
1. Greater risk of stillbirth (4x)
2. Greater risk of asphyxia (2x)
3. Likely to have lower APGAR scores
4. Higher incidence of meconium at delivery
5. Risk of hypoglycaemia
6. Risk of hypocalcaemia and hypomagnesaemia
7. Risk of hypothermia
8. NEC and IVH

• Postpartum neonatal exam findings that support the diagnosis of IUGR
Obviously, < 10th centile for gestation
 Look at baby carefully – especially if symmetrically growth retarded
Need to be wary of genetic/infective causes – look for dysmorphic
features, for skin rashes (blueberry muffin and patechiae) and for
hepatosplenomegaly
Old man appearance
Lack of subcutaneous fat
Skin is dry cracked and peeling (especially palms & soles)

• Appearance cont’d
 Often thin cord due to lack of Wharton’s jelly
 May be meconium stained
 Ruddy appearance due to polycythaemia
May be jittery due to low sugar or calcium
 May also be irritable and show signs of asphyxia, including fitting.

References
1. Gabbe, et al., Obstetrics: Normal and Problem Pregnancies
7ed2017: Elsevier, Inc.
2. Robert K. Creasy, et al., CREASY & RESNIK'S MATERNAL-FETAL
MEDICINE Principles and Practice 7ed2014: Saunders, an imprint
of Elsevier Inc.
HALE TEKA, M.D., ASSISTANT PROF OF OBSTETICS AND GYNECOLOGY 36
Saturday, April 20, 2019

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you for
listening!

Iugr

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