Dysmaturity Intrauterine Growth Retardation

Overview, Causes, & Risk Factors

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
  • Symptoms & Signs

    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
  • Diagnosis & Tests

    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.

    Prevention & Expectations

    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.

    Treatment & Monitoring

    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.

    Article type: xmedgeneral