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Intrauterine growth restriction

Intrauterine growth retardation; IUGR; Pregnancy - IUGR

 

Intrauterine growth restriction (IUGR) refers to the poor growth of a baby while in the mother's womb during pregnancy.

Causes

 

Many different things can lead to IUGR. An unborn baby may not get enough oxygen and nutrition from the placenta during pregnancy because of:

  • High altitudes
  • Multiple pregnancy, such as twins or triplets
  • Placenta problems
  • Preeclampsia or eclampsia

Problems at birth (congenital abnormalities) or chromosome problems are often associated with below-normal weight. Infections during pregnancy can also affect the weight of the developing baby. These include:

  • Cytomegalovirus
  • Rubella
  • Syphilis
  • Toxoplasmosis

Risk factors in the mother that may contribute to IUGR include:

  • Alcohol abuse
  • Smoking
  • Drug addiction
  • Clotting disorders
  • High blood pressure or heart disease
  • Kidney disease
  • Poor nutrition

If the mother is small, it may be normal for her baby to be small, but this is not due to IUGR.

Depending on the cause of IUGR, the developing baby may be small all over. Or, the baby's head may be normal size while the rest of the body is small.

 

Symptoms

 

A pregnant woman may feel that her baby is not as big as it should be. The measurement from the mother's pubic bone to the top of the uterus will be smaller than expected for the baby's gestational age. This measurement is called the uterine fundal height.

 

Exams and Tests

 

IUGR may be suspected if the size of the pregnant woman's uterus is small. The condition is most often confirmed by ultrasound.

More tests may be needed to screen for infection or genetic problems if IUGR is suspected.

 

Treatment

 

IUGR increases the risk that the baby will die inside the womb before birth. If your health care provider thinks you might have IUGR, you will be monitored closely. This will include regular pregnancy ultrasounds to measure the baby's growth, movements, blood flow, and fluid around the baby.

Nonstress testing will also be done. This involves listening to the baby's heart rate for a period of 20 to 30 minutes.

Depending on the results of these tests, your baby may need to be delivered early.

 

Outlook (Prognosis)

 

After delivery, the newborn's growth and development depends on the severity and cause of IUGR. Discuss the baby's outlook with your providers.

 

Possible Complications

 

IUGR increases the risk of pregnancy and newborn complications, depending on the cause. Babies whose growth is restricted often become more stressed during labor and need C-section delivery.

 

When to Contact a Medical Professional

 

Contact your provider right away if you are pregnant and notice that the baby is moving less than usual.

After giving birth, call your provider if your infant or child does not seem to be growing or developing normally.

 

Prevention

 

Following these guidelines will help prevent IUGR:

  • Do not drink alcohol, smoke, or use recreational drugs.
  • Eat healthy foods.
  • Get regular prenatal care.
  • If you have a chronic medical condition or you take prescribed medicines regularly, see your provider before you get pregnant. This can help reduce risks to your pregnancy and the baby.

 

 

References

Baschat AA, Galan HL. Intrauterine growth restriction. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, PA: Elsevier Saunders; 2017:chap 33.

Carlo WA. The high-risk infant. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 97.

 
  • Ultrasound, normal fetus - abdomen measurements

    Ultrasound, normal fetus - abdomen measurements - illustration

    This is a normal fetal ultrasound performed at 19 weeks gestation. Many health care providers like to have fetal measurements to verify the size of the fetus and to look for any abnormalities. This ultrasound is of an abdominal measurement. It shows a cross-section of the abdomen, and the measurements are indicated by the cross hairs and dotted lines.

    Ultrasound, normal fetus - abdomen measurements

    illustration

  • Ultrasound, normal fetus - arm and legs

    Ultrasound, normal fetus - arm and legs - illustration

    This is a normal fetal ultrasound performed at 17 weeks gestation. This is the type of image pregnant mothers may see on the ultrasound screen, or that the technician may print. It shows the head on the right, and the cross hair pointing to the left ankle. The left leg and arm are visible in the center of the screen.

    Ultrasound, normal fetus - arm and legs

    illustration

  • Ultrasound, normal fetus - face

    Ultrasound, normal fetus - face - illustration

    This is a normal ultrasound of the fetus performed at 17 weeks gestation. The fetal face can be seen in the middle of the screen. The head is tilted left toward the placenta, which can be seen as a mound in the left of the ultrasound image. Both eyes are visible, and the area of white within the eye is the lens. Other facial features, such as the nose and mouth, are also visible.

    Ultrasound, normal fetus - face

    illustration

  • Ultrasound, normal fetus - femur measurement

    Ultrasound, normal fetus - femur measurement - illustration

    This is a normal ultrasound of the fetus performed at 19 weeks gestation. A clear view of the left femur (the large bone of the leg) can be seen in the middle, towards the top of the ultrasound screen.

    Ultrasound, normal fetus - femur measurement

    illustration

  • Ultrasound, normal fetus - foot

    Ultrasound, normal fetus - foot - illustration

    This is a normal ultrasound of a fetus at 19 weeks gestation. The right foot, including the developing bones, are clearly visible in the middle of the screen.

    Ultrasound, normal fetus - foot

    illustration

  • Ultrasound, normal fetus - head measurements

    Ultrasound, normal fetus - head measurements - illustration

    This is a normal fetal ultrasound performed at 19 weeks gestation. Many health care providers like to have fetal measurements to verify the size of the fetus and to look for any abnormalities. This ultrasound is of a head measurement, indicated by the cross hairs and dotted lines.

    Ultrasound, normal fetus - head measurements

    illustration

  • Ultrasound, normal fetus - arms and legs

    Ultrasound, normal fetus - arms and legs - illustration

    This is a normal fetal ultrasound performed at 19 weeks gestation. This is the type of spilt-screen display you might see during an ultrasound, or if the technician prints a copy of the ultrasound for you. This ultrasound shows both the left arm (seen in the left side of the display), and the lower extremities (seen in the right side of the display). The white areas of the arm or legs is developing bone.

    Ultrasound, normal fetus - arms and legs

    illustration

  • Ultrasound, normal fetus - profile view

    Ultrasound, normal fetus - profile view - illustration

    This is a normal fetal ultrasound performed at 17 weeks gestation. In the middle of the screen, the profile of the fetus is visible. The outline of the head can be seen in the left middle of the screen with the face down and the body in the fetal position extending to the lower right of the head. The outline of the spine can be seen on the right middle side of the screen.

    Ultrasound, normal fetus - profile view

    illustration

  • Ultrasound, normal fetus - spine and ribs

    Ultrasound, normal fetus - spine and ribs - illustration

    This is a normal fetal ultrasound performed at 30 weeks gestation. In the middle of the screen, a clear outline of the spine and ribs is visible. The cross hair is between two ribs just above the spine.

    Ultrasound, normal fetus - spine and ribs

    illustration

  • Ultrasound, normal fetus - ventricles of brain

    Ultrasound, normal fetus - ventricles of brain - illustration

    This is a normal fetal ultrasound performed at 17 weeks gestation. The development of the brain and nervous system begins early in fetal development. During an ultrasound, the technician usually looks for the presence of brain ventricles. Ventricles are spaces in the brain that are filled with fluid. In this early ultrasound, the ventricles can be seen as light lines extending through the skull, seen in the upper right side of the image. The cross hair is pointing to the front of the skull, and directly to the right, the lines of the ventricles are visible.

    Ultrasound, normal fetus - ventricles of brain

    illustration

    • Ultrasound, normal fetus - abdomen measurements

      Ultrasound, normal fetus - abdomen measurements - illustration

      This is a normal fetal ultrasound performed at 19 weeks gestation. Many health care providers like to have fetal measurements to verify the size of the fetus and to look for any abnormalities. This ultrasound is of an abdominal measurement. It shows a cross-section of the abdomen, and the measurements are indicated by the cross hairs and dotted lines.

      Ultrasound, normal fetus - abdomen measurements

      illustration

    • Ultrasound, normal fetus - arm and legs

      Ultrasound, normal fetus - arm and legs - illustration

      This is a normal fetal ultrasound performed at 17 weeks gestation. This is the type of image pregnant mothers may see on the ultrasound screen, or that the technician may print. It shows the head on the right, and the cross hair pointing to the left ankle. The left leg and arm are visible in the center of the screen.

      Ultrasound, normal fetus - arm and legs

      illustration

    • Ultrasound, normal fetus - face

      Ultrasound, normal fetus - face - illustration

      This is a normal ultrasound of the fetus performed at 17 weeks gestation. The fetal face can be seen in the middle of the screen. The head is tilted left toward the placenta, which can be seen as a mound in the left of the ultrasound image. Both eyes are visible, and the area of white within the eye is the lens. Other facial features, such as the nose and mouth, are also visible.

      Ultrasound, normal fetus - face

      illustration

    • Ultrasound, normal fetus - femur measurement

      Ultrasound, normal fetus - femur measurement - illustration

      This is a normal ultrasound of the fetus performed at 19 weeks gestation. A clear view of the left femur (the large bone of the leg) can be seen in the middle, towards the top of the ultrasound screen.

      Ultrasound, normal fetus - femur measurement

      illustration

    • Ultrasound, normal fetus - foot

      Ultrasound, normal fetus - foot - illustration

      This is a normal ultrasound of a fetus at 19 weeks gestation. The right foot, including the developing bones, are clearly visible in the middle of the screen.

      Ultrasound, normal fetus - foot

      illustration

    • Ultrasound, normal fetus - head measurements

      Ultrasound, normal fetus - head measurements - illustration

      This is a normal fetal ultrasound performed at 19 weeks gestation. Many health care providers like to have fetal measurements to verify the size of the fetus and to look for any abnormalities. This ultrasound is of a head measurement, indicated by the cross hairs and dotted lines.

      Ultrasound, normal fetus - head measurements

      illustration

    • Ultrasound, normal fetus - arms and legs

      Ultrasound, normal fetus - arms and legs - illustration

      This is a normal fetal ultrasound performed at 19 weeks gestation. This is the type of spilt-screen display you might see during an ultrasound, or if the technician prints a copy of the ultrasound for you. This ultrasound shows both the left arm (seen in the left side of the display), and the lower extremities (seen in the right side of the display). The white areas of the arm or legs is developing bone.

      Ultrasound, normal fetus - arms and legs

      illustration

    • Ultrasound, normal fetus - profile view

      Ultrasound, normal fetus - profile view - illustration

      This is a normal fetal ultrasound performed at 17 weeks gestation. In the middle of the screen, the profile of the fetus is visible. The outline of the head can be seen in the left middle of the screen with the face down and the body in the fetal position extending to the lower right of the head. The outline of the spine can be seen on the right middle side of the screen.

      Ultrasound, normal fetus - profile view

      illustration

    • Ultrasound, normal fetus - spine and ribs

      Ultrasound, normal fetus - spine and ribs - illustration

      This is a normal fetal ultrasound performed at 30 weeks gestation. In the middle of the screen, a clear outline of the spine and ribs is visible. The cross hair is between two ribs just above the spine.

      Ultrasound, normal fetus - spine and ribs

      illustration

    • Ultrasound, normal fetus - ventricles of brain

      Ultrasound, normal fetus - ventricles of brain - illustration

      This is a normal fetal ultrasound performed at 17 weeks gestation. The development of the brain and nervous system begins early in fetal development. During an ultrasound, the technician usually looks for the presence of brain ventricles. Ventricles are spaces in the brain that are filled with fluid. In this early ultrasound, the ventricles can be seen as light lines extending through the skull, seen in the upper right side of the image. The cross hair is pointing to the front of the skull, and directly to the right, the lines of the ventricles are visible.

      Ultrasound, normal fetus - ventricles of brain

      illustration

    A Closer Look

     

      Self Care

       

        Tests for Intrauterine growth restriction

         

           

          Review Date: 10/4/2016

          Reviewed By: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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