Intrauterine Growth Restriction

Published on 31/05/2015 by admin

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Last modified 31/05/2015

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Chapter 213 Intrauterine Growth Restriction

INTRODUCTION

Description: Intrauterine growth restriction is symmetric or asymmetric reduction in the size and weight of the growing fetus in utero, compared with that expected for a fetus of comparable gestational age. This may occur for many reasons, but most occurrences represent signs of significant risk of fetal death or jeopardy to the fetus. Some authors advocate identifying fetuses with growth between the 10th and 20th percentiles as suffering “diminished” growth and at intermediate risk for complications.
Prevalence: Problems of consistent definition make estimates difficult; by most definitions 5% to 10% of pregnancies.
Predominant Age: Reproductive; higher at the extremes of childbearing. (For women younger than age 15 the rate of low birthweight is 13.6% compared with 7.3% for women between 25 and 29 years of age. When multiple gestations are excluded, the rate for women older than age 45 is greater than 20%.)
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Idiopathic (50%). Maternal disease—hypertension; drug or alcohol use; smoking; Dilantin (phenytoin), coumarin, propranolol, or steroid use; poor nutrition, inflammatory bowel disease, low maternal weight (<50 kg), high altitude, hemoglobinopathy, cyanotic heart disease, multiple pregnancy, irradiation. Placental disease or abnormalities—placenta previa, fibrosis, chronic infection, partial abruption or infarction. Fetal factors—congenital anomalies, chromosomal factors, chronic fetal infections.
Risk Factors: Chronic maternal disease (hypertension, renal disease, cardiovascular disease), impaired placental function, congenital anomalies, history of recurrent abortion, fetal death, or preterm labor.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Uterine size less than dates
• Oligohydramnios
• Fetal growth that falls below the 10th percentile for gestational age or demonstrates reduced growth velocity on serial examinations

DIAGNOSTIC APPROACH

Differential Diagnosis

• Inaccurate gestational age
• Congenital anomalies
• Multiple gestation
• Constitutionally small infants (small for gestational age [SGA])
• Extrauterine gestation

Associated Conditions: Prematurity, intrauterine fetal death, congenital anomalies, and oligohydramnios.

Workup and Evaluation

Laboratory: No evaluation indicated unless suggested by maternal disease.
Imaging: Ultrasonography with fetal biometry compared with curves specific to the location and population served. The diagnosis must also be based on serial examinations that provide information about the growth of the individual fetus.
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