Objective : ( IUGR)
the student should be able to:
1. describe definition of IUGR
2. describes how many types of IUGR there are
Guiding Question
1. What definition of IUGR ?
Substandard growth rates , intrauerine growth restriction ( IUGR) can result from a
multitude of pathologic and non pathologic processes. The original tem : intrauterine
growth retardation” is no longer used , because the use of the word “ retardation”
often alrmed parents who took it to mean that herir baby would be “retarded” or
mentally deficient.
At the times, the existence of two terms that describe less than desired
growth (IUGR) and small for gestational age ( SGA) can cause confussion.
Perhaps the easiest way to think about these terms is that IUGR is a term used to
describe a pattern of fetal growth over a periode, whereas SGA is the term used
pediatricians to describe a baby’s weight compared with its contemporaries born at
the same gestational age.
The significance of the label “small for gestational age” depends on the cut off
percentile used to define small. It is common to use the 10th persentile in population
studies because this gives a substatial number of babies to study while including
probably 70% of babies that are genuinely growth restricted.
(Klaus & fanaroff’s, Care of the High risk neonate, 6 th ed. Elsevier.2013 page :
109)
2. clasification IUGR
a. Asymmetric IUGR is assessed when U/S findings show fetal size less than
expected with the measurements of the fetal biparietal diameter and head
circumference relatively normal but the fetal abdominal circumference is
relatively small.
This is due to decreased placental perfusion due to maternal vascular disease (e.g.,
chronic hypertension, lupus, type 1 diabetes). The fetus has normal growth potential
but is prevented from actualizing it by a lack of nutritional substrates from insufficient
placental function (most commonly from maternal hypertension as is probable in this
case). The fetus prefer- entially shunts blood to the brain, thereby preserving the
head growth.
decreased amniotic fluid may be seen in these cases and testing for fetal well- being
is imperative.
b. Symmetric IUGR is assessed when the U/S findings show a failure of all the
fetal measurement parameters (BPD, HC and AC) to follow normal growth curves.
This is consistent with an intrinsic fetal problem of long duration which is associated
with decreased growth potential.
Examples include:
•Cytogenetic abnormalities [e.g., trisomy 18, trisomy 13, Turner syndrome]
•First trimester intrauterine infections [e.g., toxoplasmosis, cytomegalovirus]
•Gross structural anomalies [e.g., gastroschisis, congenital heart disease]
•While most small-for-gestational-age fetuses are constitutionally small, this is
a diagnosis of exclusion.
Thus, it is important to monitor fetal growth and well-being to determine when to
continue observing and when to intervene and deliver.
