1. INTRA UTERINE
GROWTH
RETARDATION

2. Definition
• It is said to be present in babies
with birth wt less than 10th
percentile of the average for the
gestational age in weeks .
• SGA -metabolic and nutritional
problems
• PRETERM CHILD -Organ immaturity

3. • LBW < 2.5 KG,
• VLBW < 1.5 KG,
• ELBW < 1.0 KG
• Growth-restricted pregnancies are often complicated by a
high rate of antepartum and intrapartum fetal distress and
the need for cesarean delivery.
• Infants who are small for their gestational dates are
predisposed to low APGAR scores, low cord pH,
intraventricular hemorrhage, necrotizing enterocolitis,
hypoglycemia, hypocalcemia, and polycythemia.

4. TYPES OF IUGR
• small and healthy with normal ponderal
index
• true IUGR
A. SYMMETRICAL IUGR
•
damage in phase of cellular
hyperplasia
Early pregnancy damage
B. ASYMMETRICAL IUGR damage in phase of cellular
hypertrophy
»
Late pregnancy damage

5. MECHANISM OF IUGR
• endothelial damage—decreased
blood supply.—IUGR
• morphological damage –decreased
utilization of nutrients and O2—IUGR

6. ETIOLOGY OF IUGR
• Fetal cause :
1. genetic disorders
2. immunological disorders
3. infection
•
4. metabolic
•
• Feto maternal unit cause : ANAEMIA, CVD, HT, DM, CRF
Substance abuse (smoking,
•
alcohol, drugs), thrombophilia
• Environmental cause : multiple gestation,teenage
pregnancy,ut anomalies,LSES

7. DIAGNOSIS OF IUGR
• HISTORY : 1. previous history of IUGR
•
2. medical history
3. drugs and drug abuse
•
4. malnutrition
•
5. PRESENT FACTORS DURING PREGNANCY;
•
(APH,early pregnancy bleeding,maternal preeclampsia)
•
• EXAMINATION : clinical palpation and
Serial measurements of SFH,
•
•
Maternal weight gain,AC

8. INVESTIGATION
A. ULTRASONOGRAPHY
•
•
•
•
1.
2
3.
4.
5.
1st trimester USG for dating
HC/AC Ratio
TCD
PLACENTAL ASSESSMENT
BPP
• 6. DOPPLER ULTRASOUND VELOCIMETRY.
B. CTG TRACING
NST----Reactive/Non Reactive
•

9. INVESTIGATION
C. BIOCHEMICAL MARKERS
• Elevated levels of MSAFP and hcg level in 2nd trimester
s/o abnormal placentation
• Increased urokinase type antigen and sTNF-R2 s/o severe
pih in later pregnancy.

10. MANAGEMENT
Identification and treatment of underlying cause
Bed rest in left lateral position
Adequate balance diet
Avoidance of smoking ,tobacco and alcohol
Low dose Aspirin 75mg/day to be started in early
pregnancy
• infusion of i.v aminoacids
• Mode of delivery according to age of viability and
fetal surveillance during antenatal period
•
•
•
•
•

11. DFMC : three counts each of one hour(3
sessions) X4
Interpretation: < 10 movement in 12
hrs/<3 movement in 3 hrs
NST : Test is valuable to identify fetal
wellness rather than fetal illness
• Interpretation : 2 or more accelerations
of more than 15 beats per minute
above
baseline and longer than 15 seconds in
duration in 20 min observation.
• NST still holds its importance in fetal
monitoring because of its ease of
performance and cost effectiveness.

12. Role of Amino Acids in
IUGR
Protein usually deficient in vegetarian,fastfood
junky and milk and milk product avoiders
Maternal proteins actively transported thru
placenta to fetus
Parenteral AA-highest bioavailability1st class proteins
Parenteral AA improves amniotic fluid index and
improve perinatal morbidity and mortality in IUGR
fetus

13. BPP: NST, fetal breathing movement,fetal
muscle tone,gross body movement,AF
• Interpretation: 8-10 no hypoxia,<8
fetal hypoxia
Modified BPP : Along with AFI

14. Fetal hypoxia
Brain Sparing Reflex
Increased blood flow to
brain,heart and adrenals
Increased end diastolic
Velocity in MCA
Decreased S/D ratio,
PI and RI
Decreased blood flow to
Peripheral & placental
circulation
Decreased end diastolic
Velocity in umbilical
Vessels
Increased S/D ratio,
PI and RI

15. DOPPLER VELOCIMETRY
• Doppler identifies fetal compromise
earlier than NST. The lead time
helps to plan delivery in preterm
compromised pregnancies, resulting
in better perinatal survival

16. Abnormal Doppler values
• Pulsatility index (PI) of umbilical artery
(UA) > 2 SD for the gestational age
• Absence or reversal of end diastolic flow
in UA.
• PI of MCA < 5th percentile for the
gestational age
• Abnormal cerebroplacental ratios – PI
MCA/UA<1.08

17. Fetal surveillance of IUGR fetus
DFMC
daily
NST
biweekly
MBPP
weekly
DOPPLER
every 2 weeks

18. DFMC/NST
Normal
Abnormal
Continue Fetal surveillance
till maturity
DOPPLER STUDY
Termination of pregnancy
Normal
Fetal survey and
termination
Abnormal

19. Abnormal doppler
study
Less than 34 weeks
More than 34 weeks
Steroid followed by
termination
AFI
Less than 5
Caesarian delivery
More than 5
Vaginal delivery attempted with
Induction of labour
Failed induction