IUGR
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:
- type I: symmetrical intrauterine growth restriction
- type II: asymmetrical intrauterine growth restriction
Some authors also enlist a third type termed: femur-sparing intrauterine growth restriction .
Pathology
Etiology
IUGR can result from a vast number of causes:
- maternal conditions
- maternal narcotics/smoking
- maternal alcohol use: fetal alcohol syndrome
- maternal diabetes: when severe maternal diabetes, there can be a paradoxical IUGR as opposed to fetal macrosomia
- maternal malnutrition/starvation
- maternal vascular conditions
- certain medications
- placental insufficiency: commonest cause overall
- abnormal uteroplacental circulation
- abnormal fetoplacental circulation
- other placental causes
- increased incidence with a single umbilical artery
- fetal conditions
- multifetal pregnancy
- intrauterine infections
- chromosomal anomalies
- trisomy 13
- trisomy 18
- triploidy: IUGR is of early-onset
- Down syndrome: not a dominant feature
- chromosome 4p deletion syndrome (Wolf-Hirschhorn syndrome)
- chromosome 12p tetrasomy (Pallister-Killian syndrome)
- confined placental mosaicism (CPM)
- other syndromic anomalies
- in utero substance exposure
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
- reduced abdominal circumference (AC) and/or EFW
- Doppler features: will require a chart to calculate absolute values
- umbilical artery Doppler assessment
- increased PI above 95 percentile
- absent/reversed diastolic flow
- umbilical venous Doppler assessment
- presence of pulsatility
- uterine arterial Doppler assessment
- increased mean uterine artery PI above 95 percentile
- presence of notching in mid to late pregnancy
- CP ratio: reduced below 5 percentile
- umbilical artery Doppler assessment
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
- hypothermia
- hypoglycemia
- hypocalcemia
- polycythemia
- sepsis
- coagulopathy
- hepatocellular dysfunction
- respiratory distress syndrome
- necrotizing enterocolitis
- intraventricular hemorrhage, especially in premature IUGR neonates <750 g
- hypoxic-ischemic encephalopathy
- 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
- increased risk of:
Differential diagnosis
General considerations include:
- incorrect dates
See also
Siehe auch:
- Skelettdysplasie
- aneuploidy
- chagas disease
- trisomies
- Triploidie
- Fetales Warfarinsyndrom
- asymmetrische intrauterine Wachstumsretardierung
- hydantoin embryopathy
- small for dates fetus
- symmetrische intrauterine Wachstumsretardierung
und weiter:
- Pätau-Syndrom
- obstetric curriculum
- fetal conditions associated with maternal diabetes
- Turner-Syndrom
- Oligohydramnion
- Roberts-Syndrom
- Fetales Valproat-Syndrom
- Dopplersonographie der Nabelarterie
- Embryopathia rubeolosa
- Thalidomid-Embryopathie
- Trisomie 22
- Placenta membranacea
- Fetales Alkoholsyndrom
- velamentous cord insertion
- Smith-Lemli-Opitz-Syndrom
- Jacobsen syndrome
- singuläre Nabelschnurarterie (sNSA)
- fetal middle cerebral arterial Doppler assessment
- uterine arterial Doppler ultrasound assessment
- dilantin embryopathy
- fetal hypoxia
- small for date fetus
- verzögerte Skelettreifung
- Potter-Sequenz
- absent umbilical arterial end diastolic flow
- placental cyst
- uterine artery flow notching
- shortened fetal femoral length
- two vessel cord
- Plazentainsuffizienz
- hypertensive states in pregnancy
- 7-dehydrocholesterol reductase deficiency
- SHORT syndrome
- shortened fetal humerus
- oligohydramnios (mnemonic)
- Neu-Laxova-Syndrom
- connatale Zytomegalie
- microcephalic primordial dwarfism
- fetal ductus venosus flow assessment
- Wolf-Hirschhorn-Syndrom
- Dubowitz-Syndrom
- Klassifikation Osteogenesis imperfecta
- femur sparing intrauterine growth restriction
- IMAGE-Syndrom
- placental surface cyst
- transverse cerebellar diameter
- Miller-Dieker Syndrom