Intrauterine Growth Restriction

Intrauterine Growth Restriction - Tiny Tot Troubles

• Definition: Estimated Fetal Weight (EFW) or Abdominal Circumference (AC) $< ext{10th centile}$ for gestational age.
• SGA vs. IUGR:
  • SGA (Small for Gestational Age): Constitutionally small, normal growth pattern.
  • IUGR (Intrauterine Growth Restriction): Pathological failure to achieve growth potential. | Feature | Symmetric IUGR | Asymmetric IUGR | |------------------|-------------------------------------------------|----------------------------------------------------------| | Onset | Early (<20 wks) | Late (>20 wks) | | Cause | Intrinsic: Chromosomal abnormalities, TORCH infections | Extrinsic: Uteroplacental insufficiency, maternal disease (e.g., HTN) | | HC/AC Ratio | Normal | ↑ (Brain sparing) | | All measurements | ↓ Proportionately | AC ↓↓↓, HC/FL relatively spared |📌 Symmetric: Small all over, early. Asymmetric: Abdomen small, late.

⭐ Asymmetric IUGR, often due to late-onset uteroplacental insufficiency, spares the brain initially (brain-sparing effect).

Intrauterine Growth Restriction - Growth Gone Wrong

• Maternal Factors:
  • Chronic diseases: Hypertension (HTN), Diabetes Mellitus (DM).
  • Lifestyle: Smoking, substance abuse, severe malnutrition.
  • Infections: 📌 TORCH (Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes).
• Placental Factors:
  • Uteroplacental insufficiency (commonest).
  • Abnormalities: Placental abruption, previa.
  • Structural: Single umbilical artery, infarcts.
• Fetal Factors:
  • Chromosomal: Trisomy 13, 18, 21.
  • Genetic syndromes (e.g., Russell-Silver).
  • Congenital infections.
  • Multiple gestation.

⭐ Maternal smoking is a significant and modifiable risk factor for symmetric IUGR.

Intrauterine Growth Restriction - Detecting Deficits

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Intrauterine Growth Restriction - Growth Guidance

Antenatal Surveillance:

• Fetal Movement Count (FMC)
• Non-Stress Test (NST)
• Biophysical Profile (BPP)
• Amniotic Fluid Index (AFI)

Doppler (UA, MCA, DV): Guides management. Frequency based on severity.

Interventions:

• Corticosteroids: If delivery <34 weeks (up to 36+6 wks).
• $MgSO_4$: Neuroprotection if preterm <32 weeks.

Delivery Timing Guidelines (Umbilical Artery Doppler):

Intrauterine Growth Restriction - Lasting Little Legacies

• Short-term: Perinatal asphyxia, meconium aspiration, hypoglycemia, hypothermia, polycythemia, thrombocytopenia, sepsis, NEC.
• Long-term: Neurodevelopmental delay, cerebral palsy, poor cognition; ↑ adult disease risk (metabolic syndrome, HTN, T2DM, CVD).

⭐ Barker's hypothesis (Developmental Origins of Health and Disease - DOHaD) links IUGR to an increased predisposition to chronic diseases such as hypertension, type 2 diabetes, and ischemic heart disease in adulthood.

High‑Yield Points - ⚡ Biggest Takeaways

• IUGR: Estimated fetal weight <10th percentile for gestational age.
• Symmetric IUGR (early; chromosomal/infection) vs. Asymmetric IUGR (late; placental insufficiency, brain-sparing).
• Umbilical Artery Doppler is crucial: ↑S/D ratio, Absent/Reversed End-Diastolic Flow (AEDF/REDF) indicate fetal compromise.
• Management: Serial growth scans, Doppler, antenatal corticosteroids, and timely delivery based on severity.
• Neonatal risks: Hypoglycemia, hypothermia, polycythemia, NEC, ↑perinatal mortality, neurodevelopmental issues.