Small in the womb!

Intrauterine growth restriction (IUGR)

Is an unborn baby with impaired or restricted intrauterine growth (not growing at a normal rate).

Is suspected when fundal height has been normal for the gestational age then begins to fall behind.

Small for gestational age (SGA)

This is a born baby whose weight is < 10th percentile

The majority of SGA babies are IUGR but some are healthy babies who are just born smaller than average because their parents are small in stature (asians).

Causes

  • Malnutrition during pregnancy
  • Severe anemia in the mother
  • < 100 Lbs maternal weight
  • Chronic hypertension
  • Substance abuse: smoking, drugs, alcohol
  • Birth defects or chromosomal abnormalities
  • Placenta or umbilical cord abnormalities
  • Multiple pregnancy
  • Gestational diabetes in the mother
  • Low levels of amniotic fluid or oligohydramnios
  • Prolonged or post-term pregnancy
  • Chronic stress in the mother

Newborn babies with IUGR

– These babies are small for gestational age (SGA) either had a symmetric or asymmetric growth in the womb

– Present with subcutaneous tissue wasting (large skin folds, particularly around the shoulders and upper back)

– Are pale and have loose, dry skin

– Frequently present meconium

– Overalert or prominent eyes

– Umbilical cord is often thin and dull-looking rather than shiny and thick or fat

Two categories:
Symmetric growth restriction Asymmetric growth restriction
Affected
– Early around 18 – 20 weeks

– Weight < 10th percentile
– Body length < 10th percentile

– Reduced head circumference
– Reduced abdomen

Causes:
– Chromosomal abnormalities
– Perinatal infections
– Exposure to drugs
– Environmental teratogens
Affected
– Late around 3rd trimester

– Weight < 10th percentile
– Body length < 10th percentile

– The head and brain are normal in size (Head circumference > 10th percentile )
– Abdomen is smaller

Causes:
– A reduction in cell size, not number of cells resulting in “head-sparing”
– Uteroplacental insufficiency
Any condition that causes decreased placental blood flow or decreased oxygenation of the fetus

Ultrasound examination:

– Measure of bi-parietal diameter and head circumference, may be normal or small

– Measure abdominal circumference, may by normal or small

– Estimation of fetal weight, which is less than 10th percentil

– Oligohydramnios (low amniotic fluid)

– Placenta, which is likely to be small and may present calcification depositions (before 36 weeks)

Confirm diagnosis

Two ultrasounds at least four weeks apart

Compiled using information from the following sources:

  1. Williams Obstetrics Twenty-four Ed. Cunningham, F. Gary, et al
  2. Hearts and hands, A Midwife’s Guide to Pregnancy and Birth, Fifth Ed. Elizabeth Davis
  3. Varney midwifery fourth Ed. Helen Varney, et al

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