intrauterine growth restriction

Intrauterine growth restriction (IUGR) or fetal growth restriction (FGR)  is defined as an estimated fetal weight (EFW) / abdominal circumference (AC) at one point in time during pregnancy being below 3 percentile or EFW/AC below the 10 percentile for gestational age with deranged Doppler parameters .

An IUGR can be broadly divided into two main types:

Some authors also enlist a third type termed: femur-sparing intrauterine growth restriction .

Pathology

Etiology

IUGR can result from a vast number of causes:

Radiographic features

Antenatal ultrasound

Sonographic parameters include:

  • non-Doppler features
    • reduced abdominal circumference (AC) and/or EFW
      • AC/EFW <3 percentile
      • AC/EFW <10 percentile with deranged Doppler parameters
    • presence of oligohydramnios without ruptured membranes
    • increased head circumference (HC) to abdominal circumference (AC) ratio (in asymmetrical type)
    • advanced placental grade
  • Doppler features: will require a chart to calculate absolute values

Treatment and prognosis

While there is no cure, management is reliant on a structured antenatal surveillance program with timely intervention in order to minimize fetal compromise.

Complications

There are many including:

  • antepartum 
    • stillbirth
    • iatrogenic prematurity
    • abruption
    • perinatal stroke 
  • intrapartum
    • abnormal fetal status (fetal heart rate tracing) 
    • asphyxia 
    • emergency Cesarean section 
    • need for active neonatal resuscitation 
    • perinatal stroke 
  • neonatal 
  • pediatric
    • increased risk of: 
      • short stature 
      • cerebral palsy 
      • developmental delay
      • behavioral and emotional problems 
      • lower IQ scores 
      • chronic lung disease 
      • future cardiovascular disease and hypertension

Differential diagnosis

General considerations include:

  • incorrect dates

See also