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Delayed intrauterine development
Intrauterine growth retardation (IUGR) occurs in approximately 3-5% of all pregnancies. This is a situation where the child’s growth is impaired and limited, so they are smaller than they need to be. Traditionally, children with IUGG weigh 10 percent below their gestational age.
One of the goals of regular prenatal care is to assess whether this baby is growing at the desired level. The size of the mother’s abdomen is comparable to the weeks of her pregnancy. Although individual mothers differ in terms of abdomen, there are still standard abdominal signs that indicate that the baby is growing. For example, by the end of the first trimester, at 12 weeks, the uterus should rise to the level of the mother's pubic bone, and by 20 weeks of gestation, the upper or lower part of the uterus should be at the level of the umbilicus.
Risk factors for growth retardation
- Mothers with poor antenatal care and insufficient dietary intake
- Mothers who have previously given birth to an IUGR
- Smoking, illicit drug use and alcohol consumption are risk factors for IUGR
- IUGR is more common in infants with chromosomal abnormalities such as Down syndrome, Turner syndrome, or an abnormality in one of their major organs.
- Children infected with an infection such as measles, toxoplasmosis, or cytomegalovirus while in the womb
- Mothers who feel unwell or experience other pregnancy-related complications
- Mothers with high blood pressure or preeclampsia
- When there is placental insufficiency due to abnormal placenta or placental praevia
- IUGR is more common in twin pregnancies, especially in identical twins
- Genetics plays an important role: mothers who are smaller than they were born and whose partner is also smaller give birth to smaller children themselves.
What are the different types of IUGR?
Symmetrical restriction of growth is associated with early pregnancy, and if the baby’s head and body are small, it basically means that there is a complete cessation of the baby’s growth. This can happen when a baby becomes infected or is exposed to various toxic substances such as nicotine, illicit drugs or alcohol.
Restriction of asymmetric growth refers to the period after 20 weeks when the placenta is not functioning as effectively as it should. This is during preeclampsia, during multiple pregnancies, and if the baby is abnormal. This happens more or less as a protective mechanism to protect the child’s brain and heart and ensure their growth. These organs are a priority because they are so important for a baby’s survival.
However, there is a cost to the rest of the body as the fat stores are depleted. Children with asymmetrical growth retardation appear stigmatized after birth. They are thin and look like ‘little old men’. They have a very anxious, hungry face and always seem hungry.
How is intrauterine growth restriction determined?
When mothers go for prenatal treatment, their uterine growth is checked by palpation of the abdomen (feeling with fingers and hands during a physical examination).
This gives a reasonable indication that the baby is not growing when needed. The height of the base, i.e. the upper part of the uterus, is measured from the mother’s symphysis pubis (her squash bone) and this is compared to the weeks of her pregnancy.
The most accurate method of IUGR diagnosis is performed by ultrasound. Even if the mother is confident in her palms, an ultrasound scan can closely monitor the baby’s development and size. As the pregnancy progresses, the baby’s growth can be compared to previous scans, which is to compare its growth.
Controllable growth parameters include:
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The child's head circumference
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The length of the femur is a long bone that extends from the hip to the knee
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Measuring the abdominal cavity
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Blood flow from the placenta through the umbilical cord
Treatment / management of IUGR
Treatment is usually done by carefully monitoring the baby to avoid risk, regular scanning, fetal monitoring, prenatal examination of the mother, and regular weighing.
If the medical-obstetric team estimates that the baby will be better off in the womb than in the womb, the pregnancy may begin or be delivered by caesarean section. Obviously, the comparison of costs and benefits must be done carefully; premature babies come with a unique set of unique complications.
Resting in bed, consulting a specialist dietitian, minimizing stress, and striving for a calm, pleasant pregnancy will help. Unfortunately, there is no guarantee that these strategies will rectify the situation. Sometimes, the only solution is to feed the mother and her child until they are in a safe enough stage of pregnancy; if the child is viable, a cesarean delivery is arranged. Children with IUGR are more likely to experience stress, so a normal birth is not always possible.
It poses a risk to a child with IUGR
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You are more likely to experience discomfort during childbirth and not be able to breathe independently
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Due to immaturity and low fat reserves, it may have a problem maintaining its temperature
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You can also be very hungry in the first few days after delivery
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There may be problems with low blood sugar and monitoring is required in a special care unit
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Children with IUGR are more prone to infections and feel worse because they are not as strong as babies of normal size.