Obstetrics Simplified - Diaa
Intrauterine Growth Retardation (IUGR)
(Dysmaturity or Small-for-Date)
Infant’s weight less than the tenth percentile of its gestational age.
- Chromosomal and genetic disorders: e.g.
- Down’s syndrome.
- Turner’s syndrome.
- Renal agenesis.
- Intrauterine infections: e.g.
- Maternal factors:
- Maternal malnutrition: due to,
- Chronic infections.
- Worm infestations.
- Malabsorption syndrome.
- Wasting diseases.
- Narcotic drug addiction.
- Cigarette smoking.
- Exposure to ionising radiation .
- Maternal anaemia.
- Uteroplacental vascular insufficiency: due to
- Maternal hypertension.
- Maternal diabetes.
- Chronic renal disorders.
- Partial abruptio placentae.
- Multiple pregnancy.
- Post-term pregnancy.
- Symmetric IUGR:
- Early stage of IUGR.
- The growth impairment involves all body structures including
the internal organs.
- It is usually due to chromosomal, genetic or infective causes.
- Asymmetric IUGR:
- Late stage of IUGR.
- The growth impairment involves the body but not the brain tissues
"sparing effect", so the head is big in comparison to the body.
- It is usually due to chronic malnutrition and uteroplacental
History: of any of the aetiological factors.
Examination may reveal:
- Poor maternal weight gain or even weight loss during pregnancy.
- Fundal level is lower than that corresponds to the period of amenorrhoea.
- Underlying cause may be detected.
- The neonate shows signs of dysmaturity as:
- dry wrinkled skin,
- meconium stains the foetus, placenta umbilical cord as well
as the amniotic fluid.
- Ultrasonography: may show;
- Smaller biparietal diameter in serial measurements.
- Smaller abdominal circumference (measured at the level of bifurcation
of the portal vein in the liver).
- Large head/abdominal circumference ratio in case of asymmetric
- Congenital anomalies.
- Doppler ultrasound: shows increased systolic / diastolic velocity
ratio in the umbilical artery due to high resistance in the distal
vascular bed in the placenta.
- Daily foetal movement count:
- Less than 10 movements / 12 hours.
- Antenatal cardiotocography:
- Non -stress test: non -reactive.
- Stress test: late deceleration.
- Biophysical profile: see before.
- Hormonal study: see before.
- Amnioscopy: meconium stained liquor.
- Rest in bed in lateral position (better the left) to prevent IVC
compression . This increases the placental blood flow by 25%.
- Smoking should be discouraged.
- Treatment of the underlying cause.
- Monitoring of foetal wellbeing.
- Termination of pregnancy according to the balance between risk of
intrauterine asphyxia against those of prematurity.
- Mode of delivery is influenced by:
- gestational age,
- result of the stress test,
- associated factors as malpresentations, antepartum haemorrhage,
previous caesarean section ...etc.
- Caesarean section is more liberally indicated especially if
there are associated adverse factors as the foetus does not tolerate
the reduced oxygen supply and birth trauma encountered during vaginal
- Continuous intranatal monitoring.
Identification and management of problems of dysmaturity as:
- Hypothermia: due to relatively large surface area and lack of insulating
- Asphyxia neonatorum: as an extension to the intrauterine asphyxia
or due to meconium aspiration.
- Hypoglycaemia: due to increased metabolic demands, especially in
presence of chilling and poor glycogen reserves.
- Hypocalcaemia: manifested by clonus, tremors or convulsions.
- Haemorrhagic tendency: may cause pulmonary haemorrhage and death.
- Stunted growth and mental retardation: more liable to occur in the
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Edited by Aldo Campana,