Intrauterine Growth Restriction (IUGR)

Intrauterine Growth Restriction (IUGR)

IUGR or intrauterine growth restriction is a condition that causes fetal growth to be stunted. IUGR is characterized by the size and weight of the fetus that does not match the gestational age.

IUGR or fetal growth restriction can be caused by various conditions. However, the most common cause is an abnormality of the placenta , which is the organ that supplies the oxygen and nutrients the fetus needs.

IUGR is a different condition from low birth weight babies. IUGR can cause babies to be born with low body weight, but not all babies with low birth weight suffer from IUGR.

In general, IUGR is divided into two types, namely:

1. IUGR is symmetrical

Fetuses with this condition experience growth retardation but the size of each body part is proportional. In other words, all parts of the fetus with symmetrical IUGR are small, including the internal organs.

2. Asymmetric IUGR

In asymmetric IUGR, fetal growth is stunted by disproportionate body size. One part of the body of the fetus with symmetrical IUGR, for example the size of the head, can be normal and according to the gestational age. However, other parts of the body are smaller.

Causes of IUGR

IUGR is most often caused by disorders or abnormalities in the placenta. This condition causes the supply of oxygen and nutrients to the fetus to be disrupted so that fetal growth becomes stunted.

The risk of IUGR can increase if pregnant women experience the following conditions:

  • Uncontrolled diabetes mellitus
  • High blood pressure ( hypertension )
  • Preeclampsia
  • Heart disease
  • Kidney illness
  • Lung disease
  • Anemia
  • Infections, such as rubella, cytomegalovirus, toxoplasmosis, and syphilis
  • Malnutrition
  • Addicted to alcohol , smoking, or using drugs

Congenital abnormalities in the fetus, such as Down syndrome, Fanconi syndrome, and anencephaly , as well as twin pregnancies, can also increase the risk of IUGR.

IUGR symptoms

The main symptom of IUGR is the smaller size of the fetus compared to the mother's gestational age (gestational age). These measurements include estimates of body length and weight, as well as head circumference measurements.

Fetuses with IUGR generally have an estimated weight below the 10th percentile for their gestational age.

Meanwhile, pregnant women who carry a fetus with IUGR do not necessarily feel specific complaints. However, the size of the stomach may be smaller when compared to a pregnancy where the fetus grows normally.

When to see a doctor

As previously explained, IUGR is generally asymptomatic. Therefore, pregnant women need to regularly check their pregnancy with a doctor to find out the condition of their pregnancy, and monitor the growth and development of the fetus.

Following are the details of the routine control schedule to the doctor that pregnant women need to do:

  • Week 4 to 28: Once a month
  • Week 28 to 36: every 2 weeks
  • Week 36 to 40: Once a week

Pregnant women are also advised to routinely check themselves if they suffer from conditions that can increase the risk of IUGR, such as diabetes, hypertension, and preeclampsia .

Diagnosis of IUGR

IUGR can be detected when pregnant women undergo routine pregnancy checks. During the examination, the doctor will ask questions about the complaints experienced, the medical history of the pregnant woman, and how often the fetus moves.

Furthermore, to make a diagnosis, the doctor will carry out supporting examinations, which include:

  • Weight measurement
    Pregnant women's weight will be weighed at each pregnancy check-up. It aims to detect malnutrition in pregnant women. If the pregnant woman's weight does not increase, this condition can be a sign of a pregnancy disorder, including IUGR.
  • Measurement of uterine height (uterine fundal height)
    This examination aims to assess the approximate weight of the fetus by calculating the distance from the pubic bone to the top of the uterus. Uterine fundus height that does not match gestational age can indicate an abnormality.

  • Ultrasound ultrasound examination of the uterus is carried out to determine the size of the circumference of the head and abdomen of the fetus, as well as the level of amniotic fluid. That way, doctors can determine whether the fetus grows normally according to gestational age or not.
  • Doppler
    examination Doppler examination aims to measure blood flow to the placenta and blood vessels in the fetal brain. This examination can detect any disturbance of fetal blood flow which can indicate the possibility of IUGR.
  • Examination of amniocentesis
    Amniocentesis aims to detect abnormalities in the fetus that can cause IUGR. This procedure is carried out by taking a sample of amniotic fluid for further examination in the laboratory.

Treatment of IUGR

IUGR treatment will be adjusted to the medical history of the pregnant woman, the condition of the fetus, and the gestational age. Treatment methods include:

Setting diet and nutritional intake

If the pregnant woman does not gain weight or is malnourished, the doctor will determine a diet that meets nutritional intake during pregnancy . Improved diet is expected to help pregnant women get the ideal body weight during pregnancy .

Enough rest

Doctors will advise pregnant women to rest on bed . Bed rest can be done in a hospital or at home with monitoring from a doctor. This effort can be done to help improve blood circulation to the fetus so that the fetus can grow properly.

Labor induction

If IUGR occurs when the gestational age enters 34 weeks, the doctor may suggest expediting labor with induction. However, if the gestational age is less than 34 weeks, the doctor will inject corticosteroids to maximize fetal lung function.

Caesarean section

A caesarean section may be performed if the pressure from the birth canal during normal delivery is deemed too risky for the fetus.

IUGR complications

Babies born with IUGR are at risk of experiencing health complications in the form of:

  • Low oxygen levels at birth
  • Low body temperature ( hypothermia )
  • Low blood sugar ( hypoglycemia )
  • Easy to get infection
  • Delayed motor development
  • Abnormal blood cell count
  • Hard to gain weight
  • Disorders of the respiratory, nervous, or digestive systems
  • Cerebral palsy
  • Blindness
  • Deaf
  • Sudden infant death syndrome (SIDS)

Prevention of IUGR

To reduce the risk of IUGR, there are various efforts that can be made by mothers or expectant mothers, including:

  • Eat balanced nutritious foods, such as fish, milk and processed products, vegetables and fruits
  • Take folic acid since planning a pregnancy and during pregnancy
  • Regular exercise , for example by swimming or walking leisurely, to help improve circulation and increase the flow of oxygen to the fetus
  • Undergo routine checks to the doctor, especially if you experience health problems during pregnancy
  • Undergo TORCH examination and genetic screening before planning a pregnancy
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