2. Presented by: Mr. Jay V. Sanap
III yr Basic B.sc Nsg (TNC)

4.  Intrauterine growth restriction (IUGR)
refers to poor growth of a baby while in the
mother's womb during pregnancy.
 The causes can be many, but most often
involve poor maternal nutrition or lack of
adequate oxygen supply to the fetus

5.  At least 60% of the 4 million neonatal deaths
that occur worldwide every year are
associated with low birth weight (LBW),
caused by:
 intrauterine growth restriction (IUGR)
 preterm delivery
 Genetic/chromosomal abnormalities,
demonstrating that under-nutrition is already
a leading health problem at birth.

6.  Intra Uterine Growth Restriction is said to be
present in those babies whose birth weight is
below the tenth percentile of the average for
the gestational age.
 Growth Restriction can occur in preterm,
term or post-term babies.

7.  Fetuses those are small and healthy. The
birth weight is less than 10th percentile for
their gestational age. They have normal
ponderal index, normal subcutaneous fat
and usually have uneventful neonatal course.
 Fetuses where growth is restricted by
pathological (true IUGR). Depending upon
the relative size of their head, abdomen and
femur, the fetuses are subdivided into:
 Symmetrical or Type I
 Asymmetrical or Type II

8.  Symmetrical IUGR (20 per cent)
 In this state there is noxious effect on the
fetus, which in turn leads to cellular
hyperplasia.
 The total number cells are less. This form of
growth retardation is often caused by
structural or chromosomal abnormalties or
congenital infection (TORCH).
 The pathological process is intrinsic to the
fetus and involves all the organ including
the head

9.  Asymmetrical IUGR (80 per cent) is most
commonly caused by extrinsic factors that
affect the fetus at later gestational ages.
 It shows cellular hypertrophy. The total
number remains same but size is smaller
than normal.
 These diseases alter the fetal size by
reducing uteroplacental blood flow or by
restricting the oxygen and nutrient transfer
or by reducing the placental size.

10.  Maternal
 pre-pregnancy weight and nutritional status
 poor weight gain during pregnancy
 poor nutrition
 anemia
 alcohol and/or drug use
 Maternal smoking
 recent pregnancy
 Pre-gestational diabetes
 Gestational diabetes
 pulmonary disease
 cardiovascular disease
 renal disease
 Hypertension

11.  Uteroplacental
 preeclampsia
 Multiple gestation
 Uterine malformation
 Placental praevia
 Infarction
 Abruption
 Mosaicism

12.  Fetal
 Chromosomal abnormalities
 intrauterine infection
 Structural Anomalies.
 Multiple pregnancy.

13.  If the cause of IUGR is extrinsic to the fetus
(maternal or uteroplacental), transfer
of oxygen and nutrients to the fetus is
decreased. This causes a reduction in the fetus’
stores of glycogen and lipids. This often leads
to hypoglycemia at birth.
 Polycythemia can occur secondary to
increased erythropoietin production caused by
the chronic hypoxemia.
 Hypothermia, thrombocytopenia, leucopenia,
hypocalcaemia and pulmonary hemorrhage are
often results of IUGR.
 If the cause of IUGR is intrinsic to the fetus,
growth is restricted due to genetic factors or as
a sequela of infection.

14.  Doctors have many ways to estimate the size
of babies during pregnancy. One of the
simplest and most common is measuring the
distance from the mother's fundus (the top of
the uterus) to the pubic bone. After the 20th
week of pregnancy, the measure in
centimeters usually corresponds with the
number of weeks of pregnancy. A lower than
expected measurement may indicate the
baby is not growing as it should.

15.  Ultrasound.
 Doppler flow.
 Weight checks.
 Fetal monitoring.
 Amniocentesis.

16.  Weight deficit at birth is about 600g below the minimum in
percentile standard.
 Every hospital should have their own birth weight-
gestational age chart.
 Length is unaffected.
 Head Circumference is relatively larger than the body in
asymmetric variety.
 Physical features shows dry and wrinkled skin because of less
subcutaneous fat, scaphoid abdomen, thin meconium stained
vernix caseosa and thin umbilical cord.
 All these gives the baby an ‘’old man look’’.
 Pinna of ear is cartilaginous ridges. Plantar creases are
well defined.
 The baby is alert, active and having normal cry. Eyes are open.
 Reflexes are normal including Moro-reflex.

17.  Fetal:
 (a) Antenatal –
Chronic Fetal Distress, fetal death.
 Intranatal –
Hypoxia & Acidosis.

18.  Immediate:
 Asphyxia, Broncho-pulmonary dysplasia and RDS.
 Hypoglycemia due to shortage of glycogen reserve in liver.
 Meconium aspiration syndrome.
 Microcoagulation leading to DIC.
 Hypothermia.
 Pulmonary Hemorrhage.
 Polycythemia, Anemia, Thrmobocytopneia.
 Hyperviscocity – thrombosis.
 Necrotising enterocolitis due to reduced intestinal blood flow.
 Intraventricular Hemorrhage.
 Electrolyte abnormalties, Hyper phosphatemia, Hypokalemia due
to impaired renal function.
 Multi organ failure.
 Increased Perinatal morbidity and mortality.

19.  Retarded neurological and intellectual
development in infancy.
(Cong.infection, abnormalities & defects)
 Increased risk of metabolic syndrome in adult
life: obesity, HTN, DM & CHD.
 LBW infants- increased appetite bt low
satiety.
 Reduced Nephrons – causes renal vascular
hypertension.

20.  No harm to mother.
 But underlying disease such as pre-
eclampsia,heart disease & malnutrition may
be life threatening.
 Risk of having another child retarded too.

21.  The best way to manage IUGR depends on
the severity of growth restriction and how
early the problem began in the pregnancy.
 Improving nutrition.
 Bed Rest.
 Delivery.

22.  Thermoregulation
 Hypoglycemia
 Feeding
 Environment promotion
 Handling & touch
 Noise & light hazard
 Sleeping Position
 Prevention of Infection

23.  Impaired Gas Exchange.
 Ineffective Breathing Pattern.
 Ineffective Thermoregulation.
 Risk for deficient fluid volume.
 Risk for imbalanced nutrition less than body
requirement.
 Risk for Infection.
 Risk for Constipation/Diarrhea.

24.  Although IUGR can occur even when a
mother is perfectly healthy, there are things
mothers can do to reduce the risk of IUGR
and increase the odds of a healthy pregnancy
and baby.
 Keep all of your prenatal appointments.
Detecting potential problems early allows
you treat them early.
 Be aware of your baby's movements. A baby
who doesn't move often or who stops moving
may have a problem. If you notice changes in
your baby's movement, call your doctor.

25.  Check your medications. Sometimes a
medication a mother is taking for another health
problem can lead to problems with her unborn
baby.
 Eat healthfully. Healthy foods and ample
calories help keep your baby well nourished.
 Get plenty of rest. Rest will help you feel better
and it may even help your baby grow. Try to get
eight hours of sleep (or more) each night. An
hour or two of rest in the afternoon is also good
for you.
 Practice healthy lifestyle habits. If you drink
alcohol, take drugs, or smoke, stop for the
health of your baby.