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• What Is Intrauterine Growth Restriction?
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|Other Names: Intrauterine growth restriction (IUGR) is also known as Intrauterine growth retardation (image), fetus growth restriction and small-for gestational age (SGA).
It is a medical term used to describe a baby during pregnancy that is smaller than normal. A diagnosis is given where the baby's weight is below the 10th percentile for its gestational age. In other words it weighs less than 90 percent of other babies the same age growing in their mother's womb. It is a relatively common condition which occurs in about 3 percent of all pregnancies. It is the second leading cause of perinatal death (meaning death after 24 weeks of gestation or those that die within days of childbirth). Intrauterine growth restriction (IUGR) can occur when the placenta or its blood supply is not acting as it should, so the fetus receives less nutrients and oxygen than it needs. This can, outside of being fatal, cause several other problems for the baby including:
• Difficulties handling the stress of a vaginal delivery.
Given the risks involved, early diagnosis, evaluation and management is critical because it can improve the outcome for the baby.
There are rarely any outward signs that a baby has IUGR. A mother may instinctively feel that her baby bump is not as large as it should be, but this is not always an indication.
Accurate Due Date
One of the best predictors of a baby's health is its birth weight. The more normal and healthy the birth weight, the fewer the complications they are likely to experience. That is why it is important to diagnose IUGR as soon as possible because doctors can then try to boost the growth rate in the womb before birth. As no effective treatments for IUGR are known, the goal is to deliver the most mature fetus as possible, in the best physiological condition while at the same time minimizing the risk to the mother. If you have been diagnosed with IUGR a variety of approaches may be taken, depending in the cause. These include:
Medications to correct blood flow to the placenta or to correct a medical issue which is preventing good blood flow (for example, if the umbilical cord is wrapped around the fetus causing compression).
Bed rest until the baby is born with weekly nonstress tests (NST) to monitor the fetus size. Levels of amniotic fluid may also be measured.
Intravenous feedings of the baby if necessary. If labor needs to be induced, and the baby is less than 36 weeks old (premature labor), steroids are usually administered to boost the fetus' lungs growth in order to significantly reduce the risks of respiratory distress syndrome.
If the environment in the uterine is poor, and the fetus' lungs have matured enough, labor induction by Cesarean section delivery may be the best option. In such instances the mother and child can still have a normal hospital stay and C-section recovery advice still applies. Extended stays are only necessary where the baby is born very prematurely or if there are complications after birth.
Why the fetus should not receive enough nutrients or oxygen through the placenta can have many causes. These include:
Risk Factors Which May Contribute
If the mother:
• Does not eat a good nutritious diet.
• Hypoxia - lack of oxygen
Increasingly, data supports the idea that the complications of IUGR can last well into adulthood. Several studies have noted that people who suffered IUGR in the womb have a greater risk of developing metabolic syndrome later in life. This can manifest as obesity, hypercholesterolemia, hypertension, coronary heart disease and type 2 diabetes. Additionally mental health problems appear to be more common in children with growth restriction.
By reducing some of the risk factors such as smoking and drinking, and ensuring she eats a healthy diet, a woman can reduce her chances of IUGR. Good prenatal care and gaining pregnancy weight at the recommended rate can also help. When preparing for pregnancy, ensure any chronic conditions such as diabetes or hypertension are under control before conception. There are some conflicting studies to the benefits of taking aspirin during pregnancy by women at high risk of IUGR. One study reported a decline in the rate of IUGR from 61 percent to 13 percent in those treated with aspirin and dipyridamole.
No, IUGR in one pregnancy does not increase the risk in subsequent pregnancies. It is more frequent in first pregnancies, 5th pregnancies and all subsequent ones after that. It is also slightly more common in women under 17 and those experiencing a pregnancy after 35.
No, sometimes babies are simply born smaller than average (small-for gestational age). This can be genetic, where either or both parents have small body frames - and not caused because their growth was restricted in the uterus. In fact, only about one third of all low weight babies have IUGR.
What Is The Difference Between SGA and IUGR?
After delivery and childbirth the doctor will carry out a physical examination, checking skin thickness and texture, looking at the soles of the feet, the firmness of ears and the appearance of genitals. Neurological responses will also be checked, such as flexion of feet and hands. This will determine the presence or not of IUGR.
Doctors need to determine if a small newborn is premature or IUGR because the medical difficulties they face can be different. Some premature babies have no problems at all, while others may be vulnerable to respiratory distress syndrome, jaundice and sleep apnea. On the other hand, newborns with IUGR are prone to hypoglycemia (low blood sugar), hypocalcemia (low blood calcium), polycythemia (blood disorder) and meconium aspiration (causes lung problems which may require a ventilator).
A pediatric endocrinologist specializes in growth disorders. They are normally only consulted if an IUGR infant does not catch up to the normal height range for its height within the first 12 months of birth. When the child is older, the specialist may recommend specific medical treatments to enhance the child's growth.
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