IUGR -What Is It and What Does It Mean To My Baby?

IUGR, or Intra-Uterine Growth Restriction is a condition in which the fetal weight (as determined by ultrasound) is below the 10th percentile for gestational age. Some may also call this fetal growth restriction.

HOW IS IUGR DIAGNOSED?

One of the most important things when attempting to diagnose IUGR is to ensure accurate dating of the pregnancy. Because the appropriate fetal weight is based on the length of the pregnancy, the duration of the pregnancy in question must be known. Once the estimated gestational age (or EGA) of the pregnancy has been established, the current fetal weight can be estimated by ultrasound.

Perhaps the first indication of possible IUGR would be a fundal height that does not correlate with gestational age. At each prenatal visit, your health care provider measures from the pubic bone to the top of your uterus (called the fundus). If this measurement measures substantially lower than expected, (a lag in fundal height of 4 cm or more is suggestive of IUGR), your health care provider may decide further testing is in order.

Ultrasound biometry is the standard for assessing fetal growth. The diameter of the baby's head, the circumference of the head, the baby's abdominal circumference and the length of the baby's femur (the large bone in the upper leg) will all be measured. Percentiles have been established for each of these parameters and an approximate fetal weight can be calculated from these measurements.

Another important measurement taken during the ultrasound will be estimating the amount of amniotic fluid present. Decreased amniotic fluid volume can be associated with IUGR. Health care providers prefer to see an amniotic fluid index of greater than 5 centimeters.


WHAT IS THE TREATMENT?

If the baby is considered to have IUGR, serial ultrasounds are important in monitoring the growth restriction. Each case must be individualized according to the degree of growth restriction, any complicating or underlying maternal factors and the fetal gestational age.

If the baby is 35 weeks or greater, many health care providers may recommend induction for an early delivery, although some may prefer to wait as long as 36 weeks if there are no other precipitating factors.

If the baby is less than 35 weeks, many health care providers will continue monitoring unless other precipitating factors present themselves. Monitoring during this time might include serial ultrasounds, level of amniotic fluid and external fetal monitoring of the fetal heart rate. If at any time any of these parameters becomes a concern, immediate delivery may be indicated.

You will likely be seeing your health care provider at least every 2-3 weeks until you deliver. If it is suggested to deliver prior to 34 weeks, your health care provider may request to perform an amniocentesis to remove a small amount of amniotic fluid to evaluate fetal lung maturity.


WHY DOES IUGR HAPPEN?

In some cases, no underlying reason is ever found. Pregnancies with any of the following conditions, however, may be at a greater risk for developing IUGR:

• Maternal weight of less than 100 pounds
• Poor nutrition during pregnancy
• Chromosomal abnormalities
• Alcohol, tobacco and drug use
• Pregnancy-induced hypertension
• Placental abnormalities
• Multiple pregnancies
• Gestational diabetes
• Oligohydramnios, or low levels of amniotic fluid

WHY IS IT IMPORTANT TO DIAGNOSE IUGR?

Identification of IUGR is crucial, because for those babies, proper evaluation and management can result in a favorable outcome. Fetal growth restriction is the second leading cause of perinatal morbidity and mortality, followed only by prematurity. Occuring in about 5% of the general population, the risks to a baby born with IUGR can include:

• Increased risk of Cesarean delivery
• Increased risk of hypoxia (lack of oxygen)
• Increased risk of hypoglycemia (low blood sugar)
• Increased risk for motor and neurological disabilities possibly related to the increased risk of preterm delivery

CONCLUSION

During pregnancy, try to provide your baby with the best environment in which to grow.

Provide the best nutrition for you and your baby that you possibly can. Avoid any harmful substances, such as alcohol, tobacco and drugs. Make sure to keep all your visits with your health care provider so that those important measurements can be taken at each visit.

Keeping yourself healthy during pregnancy can go a long way toward helping your baby have a healthy start as well.

Unexpected Outcomes

We all approach Labor & Delivery with expectations of a happy and healthy delivery and the eventual outcome of a beautiful baby and thriving new family. This is true not only for the new parents, but for those who care for them as well.

Unfortunately, sometimes things don't go according "to plans". Sometimes complications arise which could not have been anticipated, or prevented, which preclude that "happy" or sometimes even, "healthy", outcome.

Sometimes the things that don't go according to plans may be simple and small, like the new father who forgets to bring the camera to the hospital. While this may seem small, but for the new father who envisioned his primary role in labor as the photographer, or videographer, not having that piece of equipment can bring a great sense of disappointment and let-down to his experience. I actually had a delivery where this occurred and the laboring mother scolded the dad for being disappointed. I could see however, that for months this man had looked forward to this very thing and in their haste to make it to the hospital, the video camera had been forgotten.

Sometimes the things are not quite as simple as that. Perhaps an epidural that never quite seems to make the mother completely comfortable. For the couple who had been promised a labor of relative ease, this can significant change their attitude and perception of the day and the events. Telling them to think about their baby won't help erase the disappointment they are experiencing.

For the patient who desires to go totally without interventions or medications and then finds it necessary, in spite of their plans, to have a Cesarean Section, the disappointment and grief afterward can be quite severe. Some patients have even been diagnosed with Post Traumatic Stress Disorder afterward.

Then there are those cases where the unexpected outcomes are very big. Perhaps the baby is very ill, is born with unexpected anomalies, or perhaps there is even the loss of the baby. Although "fetal demise" as health care providers term it (perhaps to help them stave off grief until a later time) doesn't happen often, it does still happen.

It is important when handling disappointment and grief related to labor to approach it the same way you approached the expectations of delivery, together. Each partner needs to allow the other to express their emotions in the manner which is most consistent with their character. Some people are very vocal and open with their emotions. They cry easily, perhaps even loudly. Others are very quiet and stoic. It does not mean that the person who is more vocal feels more strongly than the person who is more quiet. These are just personality difference.

Most people at some point of grieving will experience times of anger. The anger may not be directly related to the event or those around the event. It may be directed to their partner or other family members. Anger is a normal part of the grieving process and must be dealt with for closure to occur.

Some people will begin to question themselves regarding the situation. "If I had only done this", or "If I hadn't done that", are normal thoughts and expressions of the grief process. These too must come and go for the person to find healing of their grief.

If you have experienced perinatal loss, which includes the loss of a pregnancy or a newborn, please seek a perinatal support group in your area. You and your spouse will find the help, comfort and encouragement of those who have walked the path before you invaluable. If you don't have a support group in your area, here is a website that is a great place to start: http://www.griefwatch.com/.

Remember, you do not need to go through this alone. There is help available for you. Speak to your health care provider, call your local Labor & Delivery unit or contact your clergy, but talk to someone. Grief should never be shouldered alone.