Dysmaturity Intrauterine Growth Retardation

Intrauterine growth retardation, or IUGR, is a condition in which a fetus grows ata slower rate than expected.

What is going on in the body?

There are expected ranges of growth for a fetus at a given gestational age. Thegrowth of a fetus depends on the health and nutrition of the mother and thehealth of the fetus. IUGR may occur if the health of the placenta or its bloodsupply is impaired. IUGR may also occur if the mother’s nutrition, health, orlifestyle prevents a healthy pregnancy.

What are the causes and risks of the disease?

Women with certain conditions may be more likely to have a child with IUGR.These conditions include the following:

placental insufficiency, whichleads to poor nutrition of the fetus

multiple pregnancies, such as twins

IUGR in a previous pregnancy

high blood pressure

diabetes

severe kidney disease

heavy smoking

poor weight gain in pregnancy

preeclampsia or eclampsia, whichare complications of pregnancy causing highblood pressure in the mother

exposure to high altitudes

drug abuse

HIV infection

severe inflammatory bowel diseaseor ulcerative colitis

alcohol dependence or abuse

toxoplasma infection, also called toxoplasmosis \ \other infections, such as hepatitis B, syphilis, and herpes zoster, the virus that causes chickenpox \ \ rubella, the virus that causes German measles\ \ cytomegalovirus, or CMV\ \ herpes simplex virus, the cause of genital herpes \ TORCH infections, a set ofinfectious diseases that can harm the fetus if the mother is infected during her pregnancy

poor nutrition in the mother

congenital or chromosome abnormalities in the fetus

recurrent bleeding, such as placentaprevia, a condition in which the placenta implants over or near the opening ofthe cervix

blood disorders, such as sickle cellanemia or thalassemia

small stature in the mother

placenta abruptio, which is apremature separation of the placenta from the uterine wall

What are the signs and symptoms of the disease?

There are often no symptoms of IUGR. Symptoms that do occur may include the following:

a uterus that is smaller than in previous pregnancies

fewer fetal movements than expected

How is the disease diagnosed?

The diagnosis can be made with 2 tests: pregnancy ultrasound and the nonstresstest. Ultrasound uses many measurements to evaluate expected fetalgrowth. The nonstress test measures the heart rate and themovement of the fetus. Other tests can be used to check for other conditionsaffecting the fetus.

What can be done to prevent the disease?

Most cases of IUGR cannot be prevented, especially if they are due to geneticcauses. Some cases can be prevented by taking the following precautions:

avoiding risk factors for the toxoplasma infection, also called toxoplasmosis \ \other infections, such as hepatitis B, syphilis, and herpes zoster, the virus that causes chickenpox \ \ rubella, the virus that causes German measles\ \ cytomegalovirus, or CMV\ \ herpes simplex virus, the cause of genital herpes \ TORCHinfections

eliminating use of alcohol, tobacco, and illicit drugs

careful monitoring and early treatment for high blood pressure and diabetes

eating a diet high in folatebefore and during pregnancy to protect against certain birth defects

What are the long-term effects of the disease?

Long-term effects in the fetus before or during delivery include the following:

premature delivery

poor tolerance of labor

increased chances of a C-section,or delivery of the baby through an incision in the mother’s abdomen

increased risk of birth defects

asphyxia, or too little oxygen, at birth, which may lead to cerebral palsy

Long-term effects in the infant after delivery include the following:

temperature instability

hypoglycemia, or low bloodsugar

difficulty fighting infection

death

Complications later in childhood may include:

learning disabilities

communication\ \education, including reading, writing, and basic math\ \motor function\ \personal care, such as bathing, dressing, eating, and toileting\ \social skills\ \thinking skills, such as decision making, problem solving, and self-direction\ \working\mental retardation

What are the risks to others?

IUGR is not contagious, but it does pose a risk for the fetus. IUGR may alsooccur in future pregnancies.

What are the treatments for the disease?

Treatment of IUGR depends on the suspected cause and may include the following:

stopping smoking

stopping all drugs, such as cocaine and alcohol

eating a good diet with proper amounts of folic acid and other vitamins

increasing bed rest, lying on the left side as much as possible

if prescribed, taking low-dose aspirin to prevent tiny clots fromforming in the placenta

monitoring fetal movements, contractions, or spontaneous rupture ofmembranes

close monitoring by the healthcare provider

using continuous internal fetal heartmonitoring during labor to detect fetal distress

using minimal anesthesia, althoughepidurals are safe

having a C-section or forcepsdelivery if fetal distress is detected

What are the side effects of the treatments?

Treatments are intended to prevent serious complications in infants with IUGR.Side effects of surgery include bleeding, infection, and allergic reaction to anesthesia.

What happens after treatment for the disease?

Recovery from surgery may take a few days to several weeks, depending on theprocedure used. The baby may be given oxygen, antibiotics, and intravenous fluids after delivery. An infant with cerebral palsy or seizures may need physicaltherapy. Other disabilities may require other treatments.

How is the disease monitored?

The following may be used to monitor the pregnancy:

nonstress testing every week ortwo

biophysical profile every weekor two. This test uses ultrasound and a series of measurements to determinethe health status of the developing fetus.

pregnancy ultrasounds every 10 to14 days

Any new or worsening symptoms should be reported to the healthcare provider.