Intrauterine Growth Retardation

IUGR; SMALL-FOR-GESTATIONAL-AGE [SGA] PREGNANCY

DESCRIPTION:

The fetus is much smaller than expected for the length of the pregnancy. IUGR occurs in 1 in 10 pregnancies.

FREQUENT SIGNS AND SYMPTOMS

Usually no signs or symptoms occur. Diagnosis is based on prenatal physical examinations and ultrasound studies.

CAUSES

Chromosome abnormalities and/or infections of the fetus are often the cause of IUGR. In other cases, the placenta fails to provide adequate nutrients to the fetus. most often, the placenta is normal, but is functioning abnormally. Abnormal placenta anatomy, such as placenta previa or placental abruption, can result in IUGR.

RISK INCREASES WITH

  • Multiple fetuses (twins or greater).
  • Poor maternal nutrition.
  • Maternal illness, such as cyanotic heart disease, hypertension, anemia, diabetes mellitus with vascular involvement, or sickle cell disease.
  • Smoking.
  • Fetal infections.
  • Maternal drug addiction or alcohol abuse.
  • Fetal congenital abnormalities; chromosomal abnormalities.
  • Maternal low pre-pregnancy weight and low weight gain with pregnancy.
  • Previous pregnancy with an intrauterine growth retardation baby.
  • Living at a high altitude.

PREVENTIVE MEASURES

  • Avoidance of any of the risk factors that are within the control of the mother, such as smoking or alcohol abuse.
  • Genetic counseling prior to pregnancy.
  • Good medical care and management of any maternal chronic disorder listed in risk factors.
  • Good prenatal care.
  • If pregnant, avoid people with infections.

EXPECTED OUTCOME

  • For the mother without an underlying condition, the outcome is equivalent to a mother who delivers an average-for-gestational-age (AGA) baby. A cesarean section delivery may be necessary in cases of fetal distress.
  • For the infant without abnormalities (a deviation from what is considered normal), abnormalities or infection, the outlook is generally good for subsequent normal physical development and neurological outcome.

POSSIBLE COMPLICATIONS

  • Increased risk for fetal problems prior to, and at birth, such as lack of oxygen, low birth weight, prematurity, low blood sugar and temperature instabilities.
  • Higher risk exists for congenital defects.
    · Risk of SIDS (sudden infant death syndrome).
  • Long-term, the child may develop physical or neurological handicaps.

TREATMENT
GENERAL MEASURES

  • Any substances being abused by the mother need to be discontinued (smoking, alcohol, drugs).
  • Any maternal illness should be stabilized if possible.
  • Ongoing testing will be done once or twice weekly to assess the condition of the fetus.
  • Hospitalization may be required if outpatients steps are unsuccessful.
  • Labor may need to be induced or a cesarean section performed if fetal compromise is diagnosed or it is determined that the optional time for delivery has been reached (the point at which the baby will do as well as inside the uterus).

MEDICATION

Low dose aspirin may be prescribed for some selected cases.

ACTIVITY

Following diagnosis, complete bed rest is often recommended, while others may be on a limited activity routine. If bed rest is prescribed, lying on the left side helps promote blood flow and nutrition for the fetus.

DIET

If poor nutrition is a problem, a special diet will be prescribed.