Intra uterine Growth restriction

Intrauterine Growth Restriction Treatment in Jaipur

Intra uterine growth restriction (IUGR) also known as Fetal Growth Restriction (FGR) is a condition in which the unborn baby’s birth weight is less than the 10th percentile of the average for the pregnancy duration. Growth restriction can occur in pre tern, term or post term babies. 5% of the term babies have this while it is seen in 15% of post term babies.

What causes FGR/IUGR?

The causes can be maternal, fetal or placental.

1. Maternal :

• Small slim women with low body mass index may be associated with small babies.
• Undernutrition of mother before and during pregnancy.
• Diseases such as Anemia, hypertension, heart disease, chronic renal disease, diabetes etc.
• Alcohol, smoking, cocaine, heroin, drugs.

2. Fetal :

• Heart or Kidney or any other structural abnormality.
• chromosomal anomalies like trisomy and turner syndrome.
• Toxoplasmosis, rubella, cytomegalovirus and herpes simplex and malaria
• multiple pregnancies (twins, triplets)

3. Placental :

• Placenta previa, Abruption, Circumvallate, Infarction.
• Yet the cause remain unknown in about 40% of the cases.

Why does IUGR occurs?

the above mentioned causes might lead to reduced availability of nutrients in the mother or its reduced transfer by the placenta to the fetus. It may also cause to reduced ultilization by the fetus and hence IUGR.

How is IUGR diagnosed in Jaipur?

• Clinical palpation of the uterus for the fundal height, liquor volume and fetal mass may be used for screening. But it is less sensitive.
• Symphysis Fundal Height (SFH) measurement in centimeters (top of the uterus to pubic bone height)
• Maternal weight gain remains stationary or at times falling during the second half of the pregnancy.
• USG to check for Amniotic fluid volume < 1 cm suggests IUGR in 96% of fetuses, Head circumference (HC) and abdominal circumference (AC) ratios .
• Doppler flow is a technique that uses sound waves to measure the amount and speed of blood flow through the blood vessels. Doctors may use this test to check the flow of blood in the umbilical cord and vessels in the baby’s brain.
• A low level of PAPP – A in maternal serum in the first trimester of pregnancy is considered a marker of major risk factor for FGR.
• Physical features of the fetus at birth show dry and wrinkled skin because of less subcutaneous fat, and thin umbilical cord. All these give the baby an “old-man look”.

What can be the complications of IUGR?

• Before birth- Chronic fetal distress, fetal death, Hypoxia and acidosis.
• After birth- asphyxia, hypothermia, hemorrhage in lungs, multi organ failure
• Other longterm complications are- Increased risk of obesity, hypertension, diabetes and coronary heart disease.

Prevention and management of IUGR

The following may be tried with some success:

1. Adequate bedrest, especially in left lateral position;
2. To correct malnutrition by balanced diet: 300 extra calories per day are to be taken;
3. To institute appropriate therapy for the associated complicating factors likely to produce growth restriction;
4. Avoidance of smoking, tobacco and alcohol;
5. Low dose aspirin (50 mg daily) may be helpful in very selected cases with history of thrombotic disease, hypertension, preeclampsia, or recurrent IUGR;
6. Maternal hyperalimentation by amino acids can improve fetal growth if it was due to maternal malnutrition.
7. Serial evaluations of fetal growth and assessment of well-being should be done once the diagnosis is made.
8. Fetal well-being is assessed by Kick count, NST, biophysical profile, amniotic fluid volume and cordocentesis for blood gases.

Outcome is poor for women with early onset of IUGR (<34 weeks) compared to late onset (>34 weeks). Decision for early delivery has to balance the risk of neonatal deaths due to complications, on the other hand delay in delivery that may increase the risk of IUFD. Majority of fetal deaths occur after the 36th week of gestation. So, correct diagnosis and timed intervention are essential.