Intrauterine Growth Restriction

Evidence  

https://ranzcog.edu.au/wp-content/uploads/Fetal-Growth-Restriction.pdf 

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists 

Babies come in all sizes. Some are just naturally larger or smaller than others. But in some cases, babies in the womb don’t grow as well as we expect them to. This is a condition known as fetal growth restriction (FGR). Babies with FGR are at an increased risk of complications before, during, and after birth. An unborn baby is considered small if their size or estimated weight on an ultrasound scan is less than the 10th percentile. This means that out of every 100 babies, 10 would be this size or smaller. However, many babies who are smaller than expected are healthy. Babies are resilient and with the appropriate specialist medical care and monitoring, even a small baby can have good health outcomes. 

Education 

Intrauterine growth restriction, or IUGR, is when a baby in the womb does not grow as expected. The baby is not as big as would be expected for the stage of the mother's pregnancy.  

The two types of IUGR are: 

• Symmetrical IUGR: all parts of the baby's body are similarly small in size. 

• Asymmetrical IUGR: the baby's head and brain are the expected size, but the rest of the baby's body is small.

What Causes IUGR? 

Often, IUGR happens because the baby isn’t getting enough nutrients and nourishment. This can happen if there is a problem with: 

• The placenta, the tissue that brings nutrients and oxygen to the developing baby. 

• The blood flow in the umbilical cord, which connects the baby to the placenta.

Intrauterine growth restriction also can happen if a pregnant woman: 

• smokes, drinks alcohol, or uses drugs. 

• has an infection, such as cytomegalovirus, German measles (rubella), toxoplasmosis, or syphilis. 

• takes some types of medicines  

• has a medical condition such as lupus, anaemia, or clotting problems. 

• has high blood pressure (hypertension) 

• is carrying a baby that has a genetic disorder or birth defect. 

• is pregnant with multiples (such as twins or triplets)

How Is IUGR diagnosed? 

Before babies are born, doctors check their growth by measuring the mother's belly from the top of the pubic bone to the top of the uterus. This is called the uterine fundal height. 

Antenatal ultrasound is another way to assess your baby’s size. These estimates aren't exact, but they do help health care providers track the baby's growth. Ultrasounds also can help find other issues, such as problems with the placenta or a low level of amniotic fluid (the fluid surrounding the baby).  

Doctors will also use ultrasounds to check the blood flow to the placenta and through the umbilical cord. 

If they think a baby has IUGR, doctors also might do such tests as: 

• monitoring to track the baby's heart rate and movements. 

• screening the mother for infections that could affect the baby.

How Is IUGR Treated? 

Treatment for intrauterine growth restriction depends on how far along the pregnancy is and the wellbeing of the baby. Doctors will watch a baby with IUGR closely during prenatal visits.  

If the baby's mother has a condition, doctors will help her manage it. This might include making sure she eats a healthy and nutritious diet and gains the right amount of weight during her pregnancy. Some women might go on bed rest to try to improve blood flow to the baby. 

Sometimes, doctors will recommend early delivery. They might do this if the baby seems to have stopped growing, or if there's a problem with the placenta or the blood flow in the umbilical cord. 

A woman might have a caesarean section (C-section) if the stress of a vaginal delivery is considered too risky for the baby. 

What Problems Can Happen? 

Babies with IUGR are at higher risk for health problems. Those born early or who are very small at birth are more likely to need to stay in the hospital for a longer time. They also might need special care in the neonatal intensive care unit (the NICU). 

Other problems that can be related to intrauterine growth restriction include: 

• problems with breathing and feeding 

• trouble keeping a steady body temperature 

• abnormal blood cell counts 

• low blood sugar level (hypoglycaemia) 

• problems fighting off infections 

• The long-term effects of IUGR on a baby may depend on the condition that caused the problem

Empowerment  

It is important to understand that Intrauterine Growth Restriction (IUGR) is not your fault.   You should; 

1. Attend all your prenatal visits and testing appointments. These appointments are crucial for your doctor to monitor the development and growth of your baby.
2. If you had planned to deliver at home, birth unit, or a small community hospital, you may need to consider transferring to a larger hospital equipped with a Neonatal Intensive Care Unit (NICU). This ensures better management of any potential complications that may arise.
3. If you smoke, drink alcohol or use illicit drugs, stop, for you and your baby. Don't hesitate to ask your healthcare team for guidance or assistance in finding a support program.
4. Maintain a healthy diet, ensuring you consume enough calories each day to support both your well-being and your baby's development.
5. Prioritise getting sufficient rest and aim for eight hours of sleep per night to support your overall health during this crucial time.

Useful Links  

The Royal Australian College of General Practitioners 

https://www.racgp.org.au/getattachment/ae99da93-a815-4c61-940b-51eeaae12760/attachment.aspx 

Red Nose, Australia 

https://rednose.org.au/article/fetal-growth-restriction-fgr-and-stillbirth 

Perinatal Society of Australia and New Zealand and Centre of Research Excellence Stillbirth 

https://sanda.psanz.com.au/assets/Uploads/Position-Statement-FGR.pdf