1. IUGR
M ARSHAD HUSSAIN
FRCOG

2. IUGR
 Failure of the fetus to achieve its genetic growth
potential
 Usually results in a fetus that is small for
gestational age (SGA)
 Babies born below a particular centile weight
for gestation (3rd or 5th) are classified as IUGR
 3% if 3rd or 5% if the 5th centile is chosen

3. IUGR
 SGA & IUGR are not synonymous
 SGA – fetus or neonate is below a certain
defined centile of wt or size for a particular
gestational age
 Some SGA fetuses are constitutionally
small due to normal genetic influences

4. IUGR
 IUGR – a particular pathological process is
operating to modify the intrinsic growth
potential of the fetus by reducing its growth
rate
 Some IUGR fetuses may not fall into any
definition of SGA, but will have failed to
achieve their full growth potential

5. IUGR
 Major cause of neonatal morbidity
and mortality
 Significant cost involve in the care of
these fetuses
 Certain adult diseases (Hypertension
& DM) are related to IUGR

6. Aetiology
 Factors that directly affect the intrinsic growth
potential of the fetus:

Chromosome defects (Trisomy 18, Triploidy)

Single gene defects (Seckel’s syndrome)

Structural abnormalities (Anencephaly, Renal
agencies)

Infections (CMV, Toxoplasmosis)

7. Aetiology
 External factors that reduce the
support for fetal growth:
Maternal factors

Under nutrition (Poverty, Eating disorders)

Maternal hypoxia (Altitude, Cyanotic heart
disease)

Drugs (Alcohol, Cocaine, Cigarette smoke)

8. Aetiology
 External factors that reduce the
support for fetal growth:
Placental factors

Reduced utero-placental perfusion
(Inadequate trophoblast invasion, APS, DM,
Sickle-cell disease, Multiple gestation)

Reduced fetoplacental perfusion (Single
umbilical artery, Twin-twin transfusion
syndrome)

9. Pathophysiology
 Symmetrical IUGR
 Asymmetrical IUGR
 Mechanisms

10. Diagnostic Tools
 History
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Previous Obstetric History
Medical history
Drug History
APH/Abruption
Family History
Personal & Family History
Fetal Movements

11. Diagnostic Tools
 Abdominal Palpation
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24 weeks onward
Symphysis Fundal Height
Measurement in cm equates gestation
in weeks
Difference of more than 2 cm requires
further fetal assessment
Gross oligo - or polyhydramnios are
evident on palpation

12. Diagnostic Tools
 Ultrasound scanning

Biometry

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Anatomy

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BPD, AC, HC, FL, Cerebellum
Valuable in diagnosis, DD and surveillance of
IUGR fetuses
Structural abnormalities (Chromosomal
abnormalities causing IUGR)
Amniotic Fluid Volume

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AFI – sum of the deepest pool in each quadrant
Reproducible measure of AFV for the DD and
surveillance of IUGR

13. Diagnostic Tools
 Doppler Waveform Analysis
 Invasive Fetal Testing

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Amniocentesis (FISH - Fluorescent in situ
hybridization)
Placental Biopsy
 Retrospective Tests
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Maternal blood (CMV, Rubella, Toxoplasmosis,
metabolic disorders)
Placenta (H/P)
Fetus/Neonate (PM examination)

14. Management
 No widely accepted treatments for
placental dysfunction
 Avoidance of smoking, alcohol & drug
abuse
 Control of DM, Thyroid disease, etc
 Bed rest
 Aspirin, nitric oxide donors or
antioxidents
 Delivery

15. Prognosis
 IUD
 Morbidity or death due to immaturity
 Long term survivals – good prognosis
 Height and wt below 50th centile
 Majority show “catch up” growth
when feeding optimised
 Congenital infection or chromosomal
abnormality – development is
determined by the abnormality